Induction heating combined with antibiotics or SAAP-148 effectively reduces biofilm-embedded Staphylococcus aureus on a fracture-related implant mimic

Aims: Fracture-related infections and the associated treatment failure burden our society and healthcare system significantly. As an alternative approach, we investigated the effect of non-contact induction heating (NCIH) against Staphylococcus aureus within mature biofilms. In addition, we assesse...

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Main Authors: Marielle Verheul, Anne A. Wagenmakers, Rob G. H. H. Nelissen, Peter H. Nibbering, Bart G. Pijls
Format: Article
Language:English
Published: The British Editorial Society of Bone & Joint Surgery 2025-05-01
Series:Bone & Joint Research
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Online Access:https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.145.BJR-2024-0341.R1
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author Marielle Verheul
Anne A. Wagenmakers
Rob G. H. H. Nelissen
Peter H. Nibbering
Bart G. Pijls
author_facet Marielle Verheul
Anne A. Wagenmakers
Rob G. H. H. Nelissen
Peter H. Nibbering
Bart G. Pijls
author_sort Marielle Verheul
collection DOAJ
description Aims: Fracture-related infections and the associated treatment failure burden our society and healthcare system significantly. As an alternative approach, we investigated the effect of non-contact induction heating (NCIH) against Staphylococcus aureus within mature biofilms. In addition, we assessed the ability of antibiotics, the antimicrobial peptide SAAP-148, and bacteriophage (phage) ISP to enhance the efficacy of NCIH, thereby allowing the use of lower temperatures during NCIH. Methods: Clinical isolates of methicillin-resistant and methicillin-sensitive S. aureus (methicillin-resistant S. aureus (MRSA), methicillin-sensitive S. aureus (MSSA)) were cultured for seven days on Ti-6Al-7Nb (mimicking fracture plates) discs to obtain mature biofilms. Biofilms were exposed to 60°C to 80°C NCIH. In addition, biofilms were sequentially exposed to 60°C to 70°C NCIH and rifampicin/ciprofloxacin, SAAP-148, or phage ISP. Biofilm-embedded bacteria were harvested by sonication to determine the bacterial load and visualized by confocal microscopy (LIVE/DEAD). Results: NCIH to 60°C, 70°C, and 80°C reduced biofilm-embedded MRSA and MSSA by 2.3-log, 4.9-log, 5.5-log, and 1.1-log, 3.4-log, and 6.6-log CFU/ml, respectively. LIVE/DEAD staining revealed NCIH-induced bacterial cell death throughout the biofilm layers. The sequential combination of rifampicin/ciprofloxacin at 10 µg/ml and 1,280 µg/ml (MRSA) or 156 µg/l and 64 µg/ml (MSSA) and 70°C NCIH synergistically reduced biofilm-embedded bacteria by 2.7-log and 3.7-log CFU/ml, respectively, while the alternating exposure order reduced bacterial counts by -0.1 and 1.7-log CFU/ml. SAAP-148 at 51.2 µM followed by 70°C NCIH further diminished biofilm-embedded MRSA and MSSA by 2.3-log and 1.5-log CFU/ml, respectively. No significant reductions were observed for NCIH combined with phage ISP compared to these treatments alone. Conclusion: NCIH effectively reduced biofilm-embedded S. aureus on Ti-6Al-7Nb in a heat-dependent fashion. Rifampicin/ciprofloxacin and SAAP-148, but not phage ISP, enhanced the efficacy of NCIH. Antibiotic exposure at suboptimal concentrations followed by NCIH was more effective than vice versa, suggesting that the application of this approach might be most suitable in clinical situations where antibiotic treatment has already started. Cite this article: Bone Joint Res 2025;14(5):485–494.
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spelling doaj-art-dbc9a1bfa559485da480f252569fb24e2025-08-20T02:34:03ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Research2046-37582025-05-0114548549410.1302/2046-3758.145.BJR-2024-0341.R1Induction heating combined with antibiotics or SAAP-148 effectively reduces biofilm-embedded Staphylococcus aureus on a fracture-related implant mimicMarielle Verheul0Anne A. Wagenmakers1Rob G. H. H. Nelissen2Peter H. Nibbering3Bart G. Pijls4 Department of Orthopedics, Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, Netherlands Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, Netherlands Department of Orthopedics, Leiden University Medical Center, Leiden, Netherlands Leiden University Center for Infectious Diseases (LUCID), Leiden University Medical Center, Leiden, Netherlands Department of Orthopedics, Leiden University Medical Center, Leiden, Netherlands Aims: Fracture-related infections and the associated treatment failure burden our society and healthcare system significantly. As an alternative approach, we investigated the effect of non-contact induction heating (NCIH) against Staphylococcus aureus within mature biofilms. In addition, we assessed the ability of antibiotics, the antimicrobial peptide SAAP-148, and bacteriophage (phage) ISP to enhance the efficacy of NCIH, thereby allowing the use of lower temperatures during NCIH. Methods: Clinical isolates of methicillin-resistant and methicillin-sensitive S. aureus (methicillin-resistant S. aureus (MRSA), methicillin-sensitive S. aureus (MSSA)) were cultured for seven days on Ti-6Al-7Nb (mimicking fracture plates) discs to obtain mature biofilms. Biofilms were exposed to 60°C to 80°C NCIH. In addition, biofilms were sequentially exposed to 60°C to 70°C NCIH and rifampicin/ciprofloxacin, SAAP-148, or phage ISP. Biofilm-embedded bacteria were harvested by sonication to determine the bacterial load and visualized by confocal microscopy (LIVE/DEAD). Results: NCIH to 60°C, 70°C, and 80°C reduced biofilm-embedded MRSA and MSSA by 2.3-log, 4.9-log, 5.5-log, and 1.1-log, 3.4-log, and 6.6-log CFU/ml, respectively. LIVE/DEAD staining revealed NCIH-induced bacterial cell death throughout the biofilm layers. The sequential combination of rifampicin/ciprofloxacin at 10 µg/ml and 1,280 µg/ml (MRSA) or 156 µg/l and 64 µg/ml (MSSA) and 70°C NCIH synergistically reduced biofilm-embedded bacteria by 2.7-log and 3.7-log CFU/ml, respectively, while the alternating exposure order reduced bacterial counts by -0.1 and 1.7-log CFU/ml. SAAP-148 at 51.2 µM followed by 70°C NCIH further diminished biofilm-embedded MRSA and MSSA by 2.3-log and 1.5-log CFU/ml, respectively. No significant reductions were observed for NCIH combined with phage ISP compared to these treatments alone. Conclusion: NCIH effectively reduced biofilm-embedded S. aureus on Ti-6Al-7Nb in a heat-dependent fashion. Rifampicin/ciprofloxacin and SAAP-148, but not phage ISP, enhanced the efficacy of NCIH. Antibiotic exposure at suboptimal concentrations followed by NCIH was more effective than vice versa, suggesting that the application of this approach might be most suitable in clinical situations where antibiotic treatment has already started. Cite this article: Bone Joint Res 2025;14(5):485–494.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.145.BJR-2024-0341.R1ncihbacteriophage ispantimicrobial peptiderifampicin/ciprofloxacinfristaphylococcus aureusantibioticsbiofilmsrifampicinbacteriamrsapeptidestainingmethicillin-sensitive s. aureusinfections
spellingShingle Marielle Verheul
Anne A. Wagenmakers
Rob G. H. H. Nelissen
Peter H. Nibbering
Bart G. Pijls
Induction heating combined with antibiotics or SAAP-148 effectively reduces biofilm-embedded Staphylococcus aureus on a fracture-related implant mimic
Bone & Joint Research
ncih
bacteriophage isp
antimicrobial peptide
rifampicin/ciprofloxacin
fri
staphylococcus aureus
antibiotics
biofilms
rifampicin
bacteria
mrsa
peptide
staining
methicillin-sensitive s. aureus
infections
title Induction heating combined with antibiotics or SAAP-148 effectively reduces biofilm-embedded Staphylococcus aureus on a fracture-related implant mimic
title_full Induction heating combined with antibiotics or SAAP-148 effectively reduces biofilm-embedded Staphylococcus aureus on a fracture-related implant mimic
title_fullStr Induction heating combined with antibiotics or SAAP-148 effectively reduces biofilm-embedded Staphylococcus aureus on a fracture-related implant mimic
title_full_unstemmed Induction heating combined with antibiotics or SAAP-148 effectively reduces biofilm-embedded Staphylococcus aureus on a fracture-related implant mimic
title_short Induction heating combined with antibiotics or SAAP-148 effectively reduces biofilm-embedded Staphylococcus aureus on a fracture-related implant mimic
title_sort induction heating combined with antibiotics or saap 148 effectively reduces biofilm embedded staphylococcus aureus on a fracture related implant mimic
topic ncih
bacteriophage isp
antimicrobial peptide
rifampicin/ciprofloxacin
fri
staphylococcus aureus
antibiotics
biofilms
rifampicin
bacteria
mrsa
peptide
staining
methicillin-sensitive s. aureus
infections
url https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.145.BJR-2024-0341.R1
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AT anneawagenmakers inductionheatingcombinedwithantibioticsorsaap148effectivelyreducesbiofilmembeddedstaphylococcusaureusonafracturerelatedimplantmimic
AT robghhnelissen inductionheatingcombinedwithantibioticsorsaap148effectivelyreducesbiofilmembeddedstaphylococcusaureusonafracturerelatedimplantmimic
AT peterhnibbering inductionheatingcombinedwithantibioticsorsaap148effectivelyreducesbiofilmembeddedstaphylococcusaureusonafracturerelatedimplantmimic
AT bartgpijls inductionheatingcombinedwithantibioticsorsaap148effectivelyreducesbiofilmembeddedstaphylococcusaureusonafracturerelatedimplantmimic