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Biofilm formation and antimicrobial susceptibility of staphylococci and enterococci from osteomyelitis associated with percutaneous orthopaedic implants.

Journal article
Authors Magdalena Zaborowska
Jonatan Tillander
Rickard Brånemark
Lars Hagberg
Peter Thomsen
Margarita Trobos
Published in Journal of biomedical materials research. Part B, Applied biomaterials
Volume 105
Issue 8
Pages 2630–2640
ISSN 1552-4981
Publication year 2017
Published at Institute of Clinical Sciences, Department of Biomaterials
Institute of Biomedicine, Department of Infectious Medicine
Institute of Clinical Sciences, Department of Orthopaedics
Pages 2630–2640
Language en
Links dx.doi.org/10.1002/jbm.b.33803
www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Enterococcus; MBEC; MIC; Staphylococcus; biofilm; biomaterial-associated infections
Subject categories Biomaterials Science, Orthopedics

Abstract

Staphylococci and enterococci account for most deep infections associated with bone-anchored percutaneous implants for amputation treatment. Implant-associated infections are difficult to treat; therefore, it is important to investigate if these infections have a biofilm origin and to determine the biofilm antimicrobial susceptibility to improve treatment strategies. The aims were: (i) to test a novel combination of the Calgary biofilm device and a custom-made susceptibility MIC plate (Sensititre(®) ), (ii) to determine the biofilm formation and antimicrobial resistance in clinical isolates causing implant-associated osteomyelitis, and (iii) to describe the associated clinical outcome. Enterococci and staphylococci were characterized by microtitre plate assay, Congo Red Agar plate test, and PCR. Biofilm susceptibility to 10 antimicrobials and its relationship to treatment outcomes were determined. The majority of the strains produced biofilm in vitro showing inter- and intraspecies differences. Biofilms showed a significantly increased antimicrobial resistance compared with their planktonic counterparts. Slime-producing strains tolerated significantly higher antimicrobial concentrations compared with non-producers. All seven staphylococcal strains carried ica genes, but two did not produce slime. The degree of biofilm formation and up-regulated antibiotic resistance may translate into a variable risk of treatment failure. This new method set-up allows for the reproducible determination of minimum biofilm eradication concentration of antimicrobial agents, which may guide future antimicrobial treatment decisions in orthopaedic implant-associated infection. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2016.

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