CORRInsights®: Phosphatidylcholine Coatings Deliver Local Antimicrobials and Reduce Infection in a Murine Model: A Preliminary Study

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Prosthetic joint infection (PJI) therapy remains one of the most challenging and expensive diagnoses to treat in orthopaedic surgery because implant preservation is difficult to achieve, and often is unsuccessful [11]. Resistant biofilm on an implant's surface makes standard systemic antibiotic treatment ineffective. Because of this, we need more research on approaches to hinder or prevent bacterial biofilm growth. Recently, different approaches regarding biofilm inhibition with a phospholipid and unsaturated fatty acid have shown promising results [6, 7]. In vivo PJI models found that the phospholipid phosphatidylcholine reduced bacterial colony-forming units (CFUs), and the biofilm dispersal agent cis-2-decenoic acid (C2DA) inhibited Staphylococcus aureus biofilm in vitro [6, 7]. Pre-established catheter biofilms were eradicated using a combination of C2DA and antibiotics [12]. These substances may be useful during PJI treatment in combination with antibiotics.
In the current study, Harris and colleagues extended their previous work [4-7] by investigating (1) the in vitro elution profiles of amikacin and C2DA from phosphatidylcholine-coated coupons, (2) the effect of C2DA on the amount of amikacin needed for bacterial inhibition, and (3) the effect of adding amikacin and C2DA regarding CFUs in wires and bone compared with phosphatidylcholine coatings alone in a murine model of PJI. The authors found that all tested eluate samples inhibited Pseudomonas aeruginosa. The inhibition of S aureus was dependent on the ratio of amikacin combined with C2DA. All groups achieved bacterial clearance on wires, whereas the C2DA-alone and amikacin-alone coatings also cleared all CFUs from the bone. The results of this preliminary study bring us closer to the ultimate goal: The invention of biofilm-resistant implant coatings.
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