Disclosing Agents for the Intraoperative Identification of Biofilms on Orthopedic Implants

Joshua A. Parry, Melissa J. Karau, Sanjeev Kakar, Arlen D. Hanssen, Robin Patel, Matthew Abdel

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Disclosing agents are dyes used in dentistry to colorize plaque (biofilm) and may offer a means for intraoperative detection of biofilms on orthopedic implants. Methylene blue (MB) stains biofilm and is safely used in orthopedic applications. Injection of MB into acutely infected prosthetic knees before debridement may enable visualization of biofilm, which could influence treatment decisions. The aims of this study were to determine if MB could be used to visualize biofilm on total knee arthroplasty (TKA) implants and to determine if MB staining has an antimicrobial effect that might interfere with subsequent culture. Methods: Staphylococcus epidermidis biofilms were formed on TKA polyethylene liners and polymethylmethacrylate (PMMA) and Teflon discs. After staining biofilms on these implants, the bacterial densities were determined through sonication and quantitative culture. The antimicrobial activity of MB staining was determined by measuring the bacterial density of S. epidermidis biofilms on PMMA discs incubated in 0.05% MB for 24 hours vs 30 seconds and comparing it with controls unexposed to MB. Results: MB stained S. epidermidis biofilms grown on TKA implants and Teflon and PMMA discs in vitro. Sonication and quantitative culture of the stained implants showed that bacterial densities were at supraphysiological levels. Staining did not affect the ability to culture the organism. Conclusion: MB is a possible cost-effective and novel method to expeditiously identify intraoperative biofilm. To further evaluate MB staining and its potential clinical usefulness, future studies are needed to assess the ability of MB to stain physiological levels of biofilm.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Oct 26 2016

Fingerprint

Methylene Blue
Biofilms
Orthopedics
Knee Replacement Arthroplasties
Staphylococcus epidermidis
Staining and Labeling
Polymethyl Methacrylate
Sonication
Coloring Agents
Polytetrafluoroethylene
Polyethylene
Debridement
Dentistry
Knee
Costs and Cost Analysis

Keywords

  • Biofilm
  • Disclosing agent
  • Methylene blue
  • Periprosthetic infection
  • Polymethylmethacrylate
  • Staphylococcus epidermidis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Disclosing Agents for the Intraoperative Identification of Biofilms on Orthopedic Implants. / Parry, Joshua A.; Karau, Melissa J.; Kakar, Sanjeev; Hanssen, Arlen D.; Patel, Robin; Abdel, Matthew.

In: Journal of Arthroplasty, 26.10.2016.

Research output: Contribution to journalArticle

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abstract = "Background: Disclosing agents are dyes used in dentistry to colorize plaque (biofilm) and may offer a means for intraoperative detection of biofilms on orthopedic implants. Methylene blue (MB) stains biofilm and is safely used in orthopedic applications. Injection of MB into acutely infected prosthetic knees before debridement may enable visualization of biofilm, which could influence treatment decisions. The aims of this study were to determine if MB could be used to visualize biofilm on total knee arthroplasty (TKA) implants and to determine if MB staining has an antimicrobial effect that might interfere with subsequent culture. Methods: Staphylococcus epidermidis biofilms were formed on TKA polyethylene liners and polymethylmethacrylate (PMMA) and Teflon discs. After staining biofilms on these implants, the bacterial densities were determined through sonication and quantitative culture. The antimicrobial activity of MB staining was determined by measuring the bacterial density of S. epidermidis biofilms on PMMA discs incubated in 0.05{\%} MB for 24 hours vs 30 seconds and comparing it with controls unexposed to MB. Results: MB stained S. epidermidis biofilms grown on TKA implants and Teflon and PMMA discs in vitro. Sonication and quantitative culture of the stained implants showed that bacterial densities were at supraphysiological levels. Staining did not affect the ability to culture the organism. Conclusion: MB is a possible cost-effective and novel method to expeditiously identify intraoperative biofilm. To further evaluate MB staining and its potential clinical usefulness, future studies are needed to assess the ability of MB to stain physiological levels of biofilm.",
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AU - Karau, Melissa J.

AU - Kakar, Sanjeev

AU - Hanssen, Arlen D.

AU - Patel, Robin

AU - Abdel, Matthew

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N2 - Background: Disclosing agents are dyes used in dentistry to colorize plaque (biofilm) and may offer a means for intraoperative detection of biofilms on orthopedic implants. Methylene blue (MB) stains biofilm and is safely used in orthopedic applications. Injection of MB into acutely infected prosthetic knees before debridement may enable visualization of biofilm, which could influence treatment decisions. The aims of this study were to determine if MB could be used to visualize biofilm on total knee arthroplasty (TKA) implants and to determine if MB staining has an antimicrobial effect that might interfere with subsequent culture. Methods: Staphylococcus epidermidis biofilms were formed on TKA polyethylene liners and polymethylmethacrylate (PMMA) and Teflon discs. After staining biofilms on these implants, the bacterial densities were determined through sonication and quantitative culture. The antimicrobial activity of MB staining was determined by measuring the bacterial density of S. epidermidis biofilms on PMMA discs incubated in 0.05% MB for 24 hours vs 30 seconds and comparing it with controls unexposed to MB. Results: MB stained S. epidermidis biofilms grown on TKA implants and Teflon and PMMA discs in vitro. Sonication and quantitative culture of the stained implants showed that bacterial densities were at supraphysiological levels. Staining did not affect the ability to culture the organism. Conclusion: MB is a possible cost-effective and novel method to expeditiously identify intraoperative biofilm. To further evaluate MB staining and its potential clinical usefulness, future studies are needed to assess the ability of MB to stain physiological levels of biofilm.

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