Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma
Abstract Background Treatment of open fractures remains a significant challenge in trauma care as these fractures are accompanied by extensive soft tissue damage, exposing the wound site to contaminants and increasing infection risk. Formation of biofilm, a capsule-like environment that acts as a ba...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-07-01
|
| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-022-03199-x |
| _version_ | 1811278394568998912 |
|---|---|
| author | Michael E. Whitely Sarah M. Helms Preeti J. Muire Alicia L. Lofgren Rebecca A. Lopez Joseph C. Wenke |
| author_facet | Michael E. Whitely Sarah M. Helms Preeti J. Muire Alicia L. Lofgren Rebecca A. Lopez Joseph C. Wenke |
| author_sort | Michael E. Whitely |
| collection | DOAJ |
| description | Abstract Background Treatment of open fractures remains a significant challenge in trauma care as these fractures are accompanied by extensive soft tissue damage, exposing the wound site to contaminants and increasing infection risk. Formation of biofilm, a capsule-like environment that acts as a barrier to treatment, is a primary mode by which infecting pathogens persist at the wound site. Therefore, a pressing need exists to identify irrigation methods that can disrupt biofilm and expose pathogens to treatment. This study aims to evaluate the antibiofilm wound lavage, Bactisure™, in comparison with saline for care of severe musculoskeletal wounds and elucidate potential effects on antibiotic treatment success. Methods UAMS-1 Staphylococcus aureus biofilms were formed in vitro and treated with Bactisure™ wound lavage or sterile normal saline, alone, or in combination with sub-biofilm inhibitory levels of vancomycin. Characterization methods included quantification of biofilm biomass, quantification of viable biofilm bacteria, and biofilm matrix imaging. For in vivo assessment, a delayed treatment model of contaminated open fracture was used wherein a critical-sized defect was created in a rat femur and wound site inoculated with UAMS-1. Following a 6 h delay, wounds were debrided, irrigated with lavage of interest, and antibiotic treatments administered. Bacterial enumeration was performed on bone and hardware samples after two weeks. Results An immediate reduction in biofilm biomass was observed in vitro following antibiofilm lavage treatment, with a subsequent 2- to 3- log reduction in viable bacteria achieved after 24 h. Furthermore, biofilms treated with antibiofilm lavage in combination with vancomycin exhibited a minor, but statistically significant, decrease in viable bacteria compared to irrigation alone. In vivo, a minor, not statistically significant, decrease in median bioburden was observed for the antibiofilm lavage compared to saline when used in combination with antibiotics. However, the percentage of bone and hardware samples with detectable bacteria was reduced from 50 to 38%. Conclusions These results suggest that the antibiofilm wound lavage, Bactisure™, may hold promise in mitigating infection in contaminated musculoskeletal wounds and warrants further investigation. Here, we proposed multiple mechanisms in vitro by which this antibiofilm lavage may help mitigate infection, and demonstrate this treatment slightly outperforms saline in controlling bioburden in vivo. |
| first_indexed | 2024-04-13T00:35:01Z |
| format | Article |
| id | doaj.art-e5815c1a60aa45c9972c5740292893d0 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-13T00:35:01Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-e5815c1a60aa45c9972c5740292893d02022-12-22T03:10:23ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2022-07-011711810.1186/s13018-022-03199-xPreclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal traumaMichael E. Whitely0Sarah M. Helms1Preeti J. Muire2Alicia L. Lofgren3Rebecca A. Lopez4Joseph C. Wenke5Combat Wound Care Department, US Army Institute of Surgical ResearchCombat Wound Care Department, US Army Institute of Surgical ResearchCombat Wound Care Department, US Army Institute of Surgical ResearchCombat Wound Care Department, US Army Institute of Surgical ResearchCombat Wound Care Department, US Army Institute of Surgical ResearchCombat Wound Care Department, US Army Institute of Surgical ResearchAbstract Background Treatment of open fractures remains a significant challenge in trauma care as these fractures are accompanied by extensive soft tissue damage, exposing the wound site to contaminants and increasing infection risk. Formation of biofilm, a capsule-like environment that acts as a barrier to treatment, is a primary mode by which infecting pathogens persist at the wound site. Therefore, a pressing need exists to identify irrigation methods that can disrupt biofilm and expose pathogens to treatment. This study aims to evaluate the antibiofilm wound lavage, Bactisure™, in comparison with saline for care of severe musculoskeletal wounds and elucidate potential effects on antibiotic treatment success. Methods UAMS-1 Staphylococcus aureus biofilms were formed in vitro and treated with Bactisure™ wound lavage or sterile normal saline, alone, or in combination with sub-biofilm inhibitory levels of vancomycin. Characterization methods included quantification of biofilm biomass, quantification of viable biofilm bacteria, and biofilm matrix imaging. For in vivo assessment, a delayed treatment model of contaminated open fracture was used wherein a critical-sized defect was created in a rat femur and wound site inoculated with UAMS-1. Following a 6 h delay, wounds were debrided, irrigated with lavage of interest, and antibiotic treatments administered. Bacterial enumeration was performed on bone and hardware samples after two weeks. Results An immediate reduction in biofilm biomass was observed in vitro following antibiofilm lavage treatment, with a subsequent 2- to 3- log reduction in viable bacteria achieved after 24 h. Furthermore, biofilms treated with antibiofilm lavage in combination with vancomycin exhibited a minor, but statistically significant, decrease in viable bacteria compared to irrigation alone. In vivo, a minor, not statistically significant, decrease in median bioburden was observed for the antibiofilm lavage compared to saline when used in combination with antibiotics. However, the percentage of bone and hardware samples with detectable bacteria was reduced from 50 to 38%. Conclusions These results suggest that the antibiofilm wound lavage, Bactisure™, may hold promise in mitigating infection in contaminated musculoskeletal wounds and warrants further investigation. Here, we proposed multiple mechanisms in vitro by which this antibiofilm lavage may help mitigate infection, and demonstrate this treatment slightly outperforms saline in controlling bioburden in vivo.https://doi.org/10.1186/s13018-022-03199-xWound irrigationAntibiofilmOpen fractureMusculoskeletal infection |
| spellingShingle | Michael E. Whitely Sarah M. Helms Preeti J. Muire Alicia L. Lofgren Rebecca A. Lopez Joseph C. Wenke Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma Journal of Orthopaedic Surgery and Research Wound irrigation Antibiofilm Open fracture Musculoskeletal infection |
| title | Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma |
| title_full | Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma |
| title_fullStr | Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma |
| title_full_unstemmed | Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma |
| title_short | Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma |
| title_sort | preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma |
| topic | Wound irrigation Antibiofilm Open fracture Musculoskeletal infection |
| url | https://doi.org/10.1186/s13018-022-03199-x |
| work_keys_str_mv | AT michaelewhitely preclinicalevaluationofacommerciallyavailablebiofilmdisruptingwoundlavageformusculoskeletaltrauma AT sarahmhelms preclinicalevaluationofacommerciallyavailablebiofilmdisruptingwoundlavageformusculoskeletaltrauma AT preetijmuire preclinicalevaluationofacommerciallyavailablebiofilmdisruptingwoundlavageformusculoskeletaltrauma AT aliciallofgren preclinicalevaluationofacommerciallyavailablebiofilmdisruptingwoundlavageformusculoskeletaltrauma AT rebeccaalopez preclinicalevaluationofacommerciallyavailablebiofilmdisruptingwoundlavageformusculoskeletaltrauma AT josephcwenke preclinicalevaluationofacommerciallyavailablebiofilmdisruptingwoundlavageformusculoskeletaltrauma |