PDF(Pubmed)
Abstract：
Irrigation and debridement using an irrigation solution is a fundamental step during the surgical treatment of both acute and chronic periprosthetic joint infection (PJI). However, there is no consensus on the optimal solution, nor is there sufficient evidence on the optimal irrigation time and combination of solutions. Therefore, it is necessary to determine which solution or combination of solutions is most efficacious against biofilm, as well as the optimal irrigation time. We conducted an experimental in vitro model by inoculating stainless steel discs with ATCC strains of methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, and a clinical strain of Staphylococcus epidermidis. The discs were all irrigated with commonly used antiseptic solutions (10% and 3% povidone iodine, hydrogen peroxide, 3% acetic acid, and Bactisure™) for 1 min, 3 min, and 5 min and their combinations for 9 min (3 min each) vs. sterile saline as a positive control. We evaluated the reduction in biofilm based on colony-forming unit (cfu) counts and in combination assays, also based on cell viability and scanning electron microscopy. All antiseptics alone reduced more than 90% of cfu counts after 1 min of irrigation; the worst results were for hydrogen peroxide and 3% acetic acid. When solutions were sequentially combined, the best results were observed for all those starting with acetic acid, in terms of both reduction of log cfu/mL counts and viable cells. We consider that a combination of antiseptic solutions, particularly that comprising the sequence acetic acid + povidone iodine + hydrogen peroxide, would be the best option for chemical debridement during PJI surgery.
摘要：
使用冲洗溶液进行冲洗和清创是急性和慢性假体周围关节感染（PJI）手术治疗期间的基本步骤。然而,对最优解没有共识，也没有足够的证据表明最佳灌溉时间和解决方案的组合。因此,有必要确定哪种溶液或溶液组合对生物膜最有效，以及最佳灌溉时间。我们通过用ATCC菌株接种对甲氧西林敏感的金黄色葡萄球菌的不锈钢圆盘进行了体外实验模型，耐甲氧西林金黄色葡萄球菌，铜绿假单胞菌,和表皮葡萄球菌的临床菌株。圆盘都用常用的防腐剂溶液（10％和3％聚维酮碘，过氧化氢,3%乙酸，和Bactisure™)持续1分钟，3分钟,和5分钟及其组合9分钟（每个3分钟）与无菌盐水作为阳性对照。我们基于菌落形成单位（cfu）计数和组合测定来评估生物膜的减少，还基于细胞活力和扫描电子显微镜。灌溉1分钟后，所有防腐剂单独减少了90％以上的cfu计数；最差的结果是过氧化氢和3％乙酸。当溶液依次组合时，对于所有以乙酸开始的那些，观察到最好的结果，在减少logcfu/mL计数和活细胞方面。我们认为防腐溶液的组合，特别是包含乙酸+聚维酮碘+过氧化氢的序列，将是PJI手术期间化学清创术的最佳选择。
