Publication: In vitro analysis of antibiotic-loaded bone cement effectiveness in preventing biofilm formation
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Date
2021
Authors
Anuwar, Nur Ashraf
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Abstract
Background: Implant-related infection is a feared complication in orthopaedic and trauma surgery as it may result in implant failure, poor functional outcome, chronic osteomyelitis, sepsis and death. Biofilm formation on the prosthesis surface makes it difficult to eliminate infections caused by microorganisms due to the presence of a protective environment created by the glycocalyx contributing to their resistance towards the host’s defence mechanism and antimicrobial therapy. The use of antibiotic-loaded bone cement as an implant coating has been the primary and only practical method of delivering local antibiotics in the clinical setting of total joint replacement. In this study, the efficacy of antibiotic-loaded bone cement at preventing bacterial adherence and biofilm formation was investigated using Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, cylindrical polymethylmethacrylate (PMMA) and two types of antibiotic-loaded bone cement as biomaterials to address the bacteria-biomaterial interactions. Methods: This study involves two types of antibiotic-loaded bone cement and a control group. Firstly, the cement was prepared by pouring it into a cylindrical mould (5mm x 2mm). Three microorganism species were used to investigate the efficacy of antibiotic-loaded bone cement at preventing bacterial adherence and biofilm formation, namely S. aureus, S. pyogenes and P. aeruginosa. The effect of antibiotic-loaded bone cement on each tested microorganism was determined in a series of time intervals. Meanwhile, the zone of inhibition model was utilized in comparing the antibacterial efficacy of antibiotics against selected bacterial strains over time. Finally, the data analysis for antibacterial efficacy and prevention of bacterial adherence was performed using Analysis of Variance (ANOVA) and post hoc Tukey test. In addition, the Screening Electron Microscopy (SEM) was used to examine biofilm formation on the specimens. No sample size calculation was required since this is a descriptive analysis study. Conclusions: Antibiotic-loaded bone cement should be considered to prevent direct contamination at the time of surgery or during the postoperative period as the wound seals.
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