Abstract | BACKGROUND: QUESTIONS/PURPOSES: Do commonly used antibacterials and antiseptics kill bacteria in established biofilm at clinically relevant concentrations and exposure times? METHODS: Staphylococcus epidermidis (ATCC#35984) biofilms were exposed to chlorhexidine (0.025%, 0.05%, and 0.1%), povidone-iodine (0.35%, 1.0%, 3.5%, and 10%), sodium hypochlorite (0.125%, 0.25%, and 0.5%,), and triple antibacterial solution ( bacitracin 50,000 U/L, gentamicin 80 mg/L, and polymyxin 500,000 U/L) for 1, 5, and 10 minutes in triplicate. Surviving bacteria were detected by 21-day subculture. Failure to eradicate all bacteria in any of the three replicates was considered to be "not effective" for that respective solution, concentration, and exposure time. RESULTS: CONCLUSIONS:
Chlorhexidine is capable of eradicating S epidermidis from biofilm in vitro in clinically relevant concentrations and exposure times. Povidone-iodine at commonly used concentrations and exposure times, sodium hypochlorite, and triple antibacterial solutions are not. CLINICAL RELEVANCE: This in vitro study suggests that chlorhexidine may be a more effective irrigation solution for S epidermidis in biofilm than other commonly used solutions, such as povidone-iodine, Dakin's solution, and triple antibiotic solution. Clinical outcomes should be studied to determine the most effective antiseptic agent, concentration, and exposure time when intraoperative irrigation is used in the presence of biofilm.
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Authors | Kenneth Schmidt, Chris Estes, Alex McLaren, Mark J Spangehl |
Journal | Clinical orthopaedics and related research
(Clin Orthop Relat Res)
Vol. 476
Issue 3
Pg. 648-653
(03 2018)
ISSN: 1528-1132 [Electronic] United States |
PMID | 29443852
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
- Anti-Bacterial Agents
- Anti-Infective Agents, Local
- Gentamicins
- Polymyxins
- Bacitracin
- Povidone-Iodine
- Sodium Hypochlorite
- Chlorhexidine
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Topics |
- Anti-Bacterial Agents
(pharmacology)
- Anti-Infective Agents, Local
(pharmacology)
- Bacitracin
(pharmacology)
- Biofilms
(drug effects, growth & development)
- Chlorhexidine
(pharmacology)
- Dose-Response Relationship, Drug
- Gentamicins
(pharmacology)
- Microbial Viability
(drug effects)
- Polymyxins
(pharmacology)
- Povidone-Iodine
(pharmacology)
- Sodium Hypochlorite
(pharmacology)
- Staphylococcus epidermidis
(drug effects, growth & development)
- Therapeutic Irrigation
(methods)
- Time Factors
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