Antimicrobial efficacy of on-label vs. hand-mixed irrigation solutions against S. aureus biofilms
Wound irrigation is routinely performed as part of the DAIR procedure and for hardware infections, yet the most effective irrigation solution for reducing bacterial bioburden is unknown. Clinicians can choose on-label, commercially available irrigation solutions or hand-mix preparations off-label on...
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Elsevier
2025-12-01
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| Series: | Biofilm |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590207525000528 |
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| author | Robert Falconer Tyler Smith David Rothberg Jeremy Gililland Nicholas Ashton Dustin Williams |
| author_facet | Robert Falconer Tyler Smith David Rothberg Jeremy Gililland Nicholas Ashton Dustin Williams |
| author_sort | Robert Falconer |
| collection | DOAJ |
| description | Wound irrigation is routinely performed as part of the DAIR procedure and for hardware infections, yet the most effective irrigation solution for reducing bacterial bioburden is unknown. Clinicians can choose on-label, commercially available irrigation solutions or hand-mix preparations off-label on the operating back table. Current methods for evaluating antiseptic efficacy often do not represent the clinical scenario. Here, we present a proof-of-concept ex vivo setup to evaluate whether on-label, commercially available irrigation solutions were superior at reducing bacterial biofilm burden compared to off-label, hand-mixed irrigation solutions. Staphylococcus aureus ATCC 49525 (Xen36) biofilms were grown on Grade 5 titanium simulated fracture fixation plates and secured to sections of autoclaved bovine femur with cortical bone screws. Fourteen irrigation solutions (three commercial, eleven hand-mixed) and one untreated control group were evaluated by irrigating the biofilm-ridden plates and quantifying the remaining bioburden using a 10-fold dilution series to determine the log10 reduction. None of the fourteen treatments reduced bioburden statistically significantly compared to the untreated control, where no irrigation was performed. Additionally, no treatment achieved the FDA benchmark of a 4 log10 reduction for antibacterial activity. An off-label, hand-mixed 0.472 % w/v chlorhexidine gluconate solution reduced the greatest bioburden overall, with a 1.43 ± 0.20 log10 reduction. On-label irrigation products did not reduce bioburden more than off-label, hand-mixed solutions clinicians often prepare in the operating room. Musculoskeletal infections remain a significant clinical challenge and contribute to increasing healthcare costs. The antimicrobial efficacy of irrigation products should be assessed using clinically relevant models. |
| format | Article |
| id | doaj-art-0648eeebea044c51b0a5515d7e01f421 |
| institution | DOAJ |
| issn | 2590-2075 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Elsevier |
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| series | Biofilm |
| spelling | doaj-art-0648eeebea044c51b0a5515d7e01f4212025-08-20T03:17:03ZengElsevierBiofilm2590-20752025-12-011010030410.1016/j.bioflm.2025.100304Antimicrobial efficacy of on-label vs. hand-mixed irrigation solutions against S. aureus biofilmsRobert Falconer0Tyler Smith1David Rothberg2Jeremy Gililland3Nicholas Ashton4Dustin Williams5Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84112, USA; Corresponding author. 20 S 2030 E, Salt Lake City, UT, 84112, USA.Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USADepartment of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USADepartment of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USADepartment of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84112, USADepartment of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84112, USA; Department of Pathology, University of Utah, Salt Lake City, UT, 84112, USA; Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USAWound irrigation is routinely performed as part of the DAIR procedure and for hardware infections, yet the most effective irrigation solution for reducing bacterial bioburden is unknown. Clinicians can choose on-label, commercially available irrigation solutions or hand-mix preparations off-label on the operating back table. Current methods for evaluating antiseptic efficacy often do not represent the clinical scenario. Here, we present a proof-of-concept ex vivo setup to evaluate whether on-label, commercially available irrigation solutions were superior at reducing bacterial biofilm burden compared to off-label, hand-mixed irrigation solutions. Staphylococcus aureus ATCC 49525 (Xen36) biofilms were grown on Grade 5 titanium simulated fracture fixation plates and secured to sections of autoclaved bovine femur with cortical bone screws. Fourteen irrigation solutions (three commercial, eleven hand-mixed) and one untreated control group were evaluated by irrigating the biofilm-ridden plates and quantifying the remaining bioburden using a 10-fold dilution series to determine the log10 reduction. None of the fourteen treatments reduced bioburden statistically significantly compared to the untreated control, where no irrigation was performed. Additionally, no treatment achieved the FDA benchmark of a 4 log10 reduction for antibacterial activity. An off-label, hand-mixed 0.472 % w/v chlorhexidine gluconate solution reduced the greatest bioburden overall, with a 1.43 ± 0.20 log10 reduction. On-label irrigation products did not reduce bioburden more than off-label, hand-mixed solutions clinicians often prepare in the operating room. Musculoskeletal infections remain a significant clinical challenge and contribute to increasing healthcare costs. The antimicrobial efficacy of irrigation products should be assessed using clinically relevant models.http://www.sciencedirect.com/science/article/pii/S2590207525000528InfectionTraumaChlorhexidinePovidone-iodineBiofilmStaphylococcus aureus |
| spellingShingle | Robert Falconer Tyler Smith David Rothberg Jeremy Gililland Nicholas Ashton Dustin Williams Antimicrobial efficacy of on-label vs. hand-mixed irrigation solutions against S. aureus biofilms Biofilm Infection Trauma Chlorhexidine Povidone-iodine Biofilm Staphylococcus aureus |
| title | Antimicrobial efficacy of on-label vs. hand-mixed irrigation solutions against S. aureus biofilms |
| title_full | Antimicrobial efficacy of on-label vs. hand-mixed irrigation solutions against S. aureus biofilms |
| title_fullStr | Antimicrobial efficacy of on-label vs. hand-mixed irrigation solutions against S. aureus biofilms |
| title_full_unstemmed | Antimicrobial efficacy of on-label vs. hand-mixed irrigation solutions against S. aureus biofilms |
| title_short | Antimicrobial efficacy of on-label vs. hand-mixed irrigation solutions against S. aureus biofilms |
| title_sort | antimicrobial efficacy of on label vs hand mixed irrigation solutions against s aureus biofilms |
| topic | Infection Trauma Chlorhexidine Povidone-iodine Biofilm Staphylococcus aureus |
| url | http://www.sciencedirect.com/science/article/pii/S2590207525000528 |
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