Novel Antibiotic Thin Films Prevent Surgical Implant Infections
Jennifer Baker, MD1, Ahmed Beydoun, BS1, Ryan Boudrean, MD1, Aaron Seitz, MD1, Michael J. Edwards, MD1, Charles Caldwell, PhD1, Erich Gulbins, PhD2, Ryan Gobble, MD1.
1University of Cincinnati, Cincinnati, OH, USA, 2University Duisburg-Essen, Essen, Germany.
Purpose: Many common procedures in plastic surgery involve implantation of foreign bodies to achieve a cosmetic or functional goal. These materials can range from silicone breast implants, to expanded polytetrafluorethylene (ePTFE) facial implants, to titanium plates, screws, and wires for hand and craniofacial reconstruction. Surgical implant-associated infections are not common, but can be the cause of significant morbidity when they occur. We have developed a novel method of coating surgical implants that is cheap, easy, and effective at preventing implant infection in vivo.
Methods: Pieces of silicone breast implant were coated with doxycycline; pieces of ePTFE vascular grafts and titanium screws were coated with doxycycline, erythromycin, chloramphenicol, and levofloxacin using our novel dip-coating method which results in an evaporative-induced molecular crystal film on the surface.
Wildtype mice underwent sterile subcutaneous implantation of either antibiotic-coated or vehicle-coated silicone, ePTFE, or titanium after which methicillin resistant S. aureus (MRSA) or P. aeruginosa in saline were directly inoculated into the wound. After three days, mice were sacrificed, and the implants were harvested and subjected to bath sonication to release adherent bacteria. Bacterial counts then were quantified using a plate dilution method.
Results: Silicone coated with doxycycline reduced implant colonization by 1.7 log after MRSA inoculation and by 2.7 log after P. aeruginosa inoculation (p<0.05; n =8). ePTFE coated with erythromycin, doxycycline, chloramphenicol, and levofloxacin reduced MRSA and P. aeruginosa implant colonization by 3.2, 4.7, 2.3 and 3.7 log, and 3.3, 2.7, 2.8 and 3.7 log, respectively (p < 0.05; n=9). Titanium coated with erythromycin, doxycycline, chloramphenicol, and levofloxacin reduced MRSA and P. aeruginosa implant colonization by 2.5, 2.6, 2.3, and 2.9 log and 0.3, 2.8, 2.4 and 3.3, respectively (p<0.5; n=9) compared to vehicle-coated controls.
Conclusion: Wound infection is the dreaded complication of foreign body implantation due to the significant pain, suffering, and prolonged subsequent treatment. We present a novel, cheap, easy, and effective method for coating surgical implants that demonstrates marked reduction of implant infection against MRSA and P. aeruginosa in a murine model.
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