Antiseptics’ Concentration, Combination, and Exposure Time on Bacterial and Fungal Biofilm Eradication

• Published in: Arthroplasty today 2024-08, Vol.28, p.101468, Article 101468
• Main Authors: Roscetto, Emanuela, Di Gennaro, Donato, Ascione, Tiziana, Galdiero, Umberto, Aversa, Martina, Festa, Enrico, Catania, Maria Rosaria, Balato, Giovanni
• Format: Article
• Language: English
• Subjects: Antiseptics; Biofilm; Hydrogen peroxide; Original Research; Periprosthetic joint infection; PJI
• ISSN: 2352-3441; 2352-3441
• DOI: 10.1016/j.artd.2024.101468

This study aims to assess the activity of solutions containing povidone-iodine (PI) and hydrogen peroxide (H2O2) alone or combined on the biofilm of microbial species in the contest of periprosthetic joint infection (PJI). Different antiseptic solutions were tested on 2-day-old biofilms of Gram-positive and Gram-negative bacteria and fungi at 1 and 3 minutes of exposure. The efficacy of these solutions was evaluated by measuring the biofilm metabolic activity by methoxynitrosulfophenyl-tetrazolium carboxanilide (XTT) reduction assay. The anti-biofilm effect of 5% PI and 0.3% PI + 0.5% H2O2 was tested on a 5-day-old biofilm using colony-forming unit counts and an XTT reduction assay. PI and H2O2 solutions showed concentration-dependent anti-biofilm activity except for E. faecalis. PI at 5% was the most active solution against the 2-day-old biofilm of all test microorganisms. The 0.3% PI + 0.5% H₂O₂ solution had a significant effect only at 3 minutes. The 5% PI and 0.3% PI + 0.5% H₂O₂ effect was evaluated on 5-day-old biofilms. PI at 5% produced a significant reduction in metabolic activity at both 1 and 3 minutes; 0.3% PI + 0.5% H₂O₂ caused a significant activity against all Gram-positive strains after 3 minutes, with a greater metabolic activity reduction than 5% PI. In the case of PJI caused by Gram-positive bacteria, 0.3% PI + 0.5% H₂O₂ could be used for wound irrigation for 3 minutes of exposure. In the case of PJI with a different etiological agent or PJI with an unknown etiology, it is advisable to use 5% PI for 1 minute of exposure.