Topical adjuvants incompletely remove adherent Staphylococcus aureus from implant materials

Adjuvant treatments including Betadine, Dakin's solution (sodium hypochlorite), or hydrogen peroxide (H₂O₂) have been attempted to eradicate prosthetic joint infection caused by biofilm or intracellular bacteria. The purpose of this study was to evaluate the in vitro abilities of chemical adjuvants to decrease Staphylococcus aureus (S. aureus) biofilm presence on orthopaedic implant grade materials, including titanium, stainless steel, and cobalt chrome. S. aureus biofilms were grown for 48 h and evaluated for baseline colony forming units/centimeter squared (CFU/cm²) and compared to treatments with Betadine, Dakin's solution, H₂O₂, or 1% chlorine dioxide (ClO₂). Control discs (n = 18) across all metals had an average of 4.2 × 10⁷ CFU/cm². All treatments had statistically significant reductions in CFU/cm² when compared to respective control discs (p < 0.05). For all metals combined, the most efficacious treatments were Betadine and H₂O₂, with an average 98% and 97% CFU/cm² reduction, respectively. There were no significant differences between reductions seen with Betadine and H₂O₂, but both groups had statistically greater reductions than Dakin's solution and ClO₂. There was no change in antibiotic resistance patterns after treatment. Analysis of S. aureus biofilms demonstrated a statistically significant reduction in biofilm after a five‐minute treatment with the modalities, with an average two log reduction in CFU/cm². Statement of clinical significance: While statistically significant reductions in CFU/cm² were accomplished with chemical adjuvant treatments, the overall concentration of bacteria never fell below 10⁵ CFU/cm², leading to questionable clinical significance. Further techniques to eradicate biofilm should be investigated. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1599–1604, 2018.