Breakpoints24 Tammi 2025

#110 – A Bone to Pick: Biofilm Busters for Prosthetic Joint Infections

Drs. Nico Cortes-Penfield (@Cortes-Penfield), Kerry LaPlante (@Kerry_LaPlante), Jessica Seidelman (@JessieLSeidel) join Dr. Julie Ann Justo (@julie_justo) to discuss the pesky slime that is biofilm in periprosthetic joint infections. They review biofilm composition & development, have an honest discussion about whether antibiotics can ever really eradicate it, and provide updates on the promising non-pharmacologic strategies on the horizon (bacteriophages, electromagnetism, & more).

Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About X: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp

References

Nixing the Nidus: Managing Retained Sources in Prosthetic Joint Infections. Breakpoints Podcast Episode #67. Society of Infectious Diseases Pharmacists.
Dosing Consult: Rifampin Part 1. Breakpoints Podcast Episode #104. Society of Infectious Diseases Pharmacists.
Review on Staphylococcal biofilm development: Schilcher K, Horswill AR. 2020 Aug 12;84(3):e00026-19. doi: 10.1128/MMBR.00026-19. PMID: 32792334.
Antibiotics can fail to kill biofilm cells even if they penetrate the biofilm: Singh R, et al. Pathog Dis. 2016 Aug;74(6):ftw056. doi: 10.1093/femspd/ftw056. Epub 2016 Jul 7. PMID: 27402781.
Subinhibitory antibiotic concentrations can promote biofilm formation: Schilcher K, et al. Antimicrob Agents Chemother. 2016 Sep 23;60(10):5957-67. doi: 10.1128/AAC.00463-16. PMID: 27458233.
Clinical and genetic risk factors for biofilm-forming Staphylococcus aureus: Luther MK, et al. Antimicrob Agents Chemother. 2018 Apr 26;62(5):e02252-17. doi: 10.1128/AAC.02252-17. PMID: 29530854.
Meta-analysis showing poor clinical outcomes with debridement, antibiotics, and implant retention (DAIR): Kunutsor SK, et al. J Infect. 2018 Dec;77(6):479-488. doi: 10.1016/j.jinf.2018.08.017. PMID: 30205122.
Thieme L, et al. MBEC versus MBIC: the lack of differentiation between biofilm reducing and inhibitory effects as a current problem in biofilm methodology. Biol Proced Online 21, 18 (2019). https://doi.org/10.1186/s12575-019-0106-0.
Ongoing trial investigating use of MBEC in the treatment of PJIs: Tillander JAN, et al. BMJ Open. 2022 Sep 15;12(9):e058168. doi: 10.1136/bmjopen-2021-058168. PMID: 36109038.
Maale, G. Complete eradication of biofilm using low frequency electromagnetic force (EMF) and antibiotics at MIC. 34th Annual Meeting Musculoskeletal Infection Society. 2024 Aug. Abstract 1232 (see full program).
Meta-analysis on bacteriophages for biofilm: Kovacs CJ, et al. Mil Med. 2024 May 18;189(5-6):e1294-e1302. doi: 10.1093/milmed/usad385. PMID: 37847552.
Berking BB, et al. Biofilm disruption from within: light-activated molecular drill-functionalized polymersomes bridge the gap between membrane damage and quorum sensing-mediated cell death. ACS Biomater Sci Eng. 2024 Sep 9;10(9):5881-5891. doi: 10.1021/acsbiomaterials.4c01177. PMID: 39176452.
Aboelnaga N, et al. Deciphering the dynamics of methicillin-resistant Staphylococcus aureus biofilm formation: from molecular signaling to nanotherapeutic advances. Cell Commun Signal. 2024 Mar 22;22(1):188. doi: 10.1186/s12964-024-01511-2. PMID: 38519959.
Conway J, et al. Phase 1 study of the pharmacokinetics and clinical proof-of-concept activity of a biofilm-disrupting human monoclonal antibody in patients with chronic prosthetic joint infection of the knee or hip. Antimicrob Agents Chemother. 2024 Aug 7;68(8):e0065524. doi: 10.1128/aac.00655-24. PMID: 39012102.
Mulpur P, et al. Efficacy of intrawound vancomycin in prevention of periprosthetic joint infection after primary total knee arthroplasty: a prospective double-blinded randomized control trial. J Arthroplasty. 2024 Jun;39(6):1569-1576. doi: 10.1016/j.arth.2024.01.003. PMID: 38749600.
Dong Y, et al. Synergy of ultrasound microbubbles and vancomycin against Staphylococcus epidermidis biofilm. J Antimicrob Chemother. 2013 Apr;68(4):816-26. doi: 10.1093/jac/dks490. PMID: 23248238.
Miltenberg B, et al. Intraosseous Regional Administration of Antibiotic Prophylaxis for Total Knee Arthroplasty: A Systematic Review. J Arthroplasty. 2023 Apr;38(4):769-774. doi: 10.1016/j.arth.2022.10.023. PMID: 36280158.
Viswanathan VK, et al. Intraosseous regional antibiotic prophylaxis in total joint arthroplasty (TJA): Systematic review and meta-analysis. J Clin Orthop Trauma. 2024 Oct 3;57:102553. doi: 10.1016/j.jcot.2024.102553. PMID: 39435324.
SOLARIO trial: Dudareva M, et al. The European Bone and Joint Infection Society Meeting, 2024 Sept.
SOLARIO trial press release from BoneSupportTM. 2024 Oct 3.
Fehring TK, et al. Does treatment at a specialized prosthetic joint infection center improve the rate of reimplantation. J Arthroplasty. 2023 Jun;38(6S):S314-7. PMID 37004968.
ROADMAP trial website. 2024.

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