Implants improves the quality of life
Modern medicine has developed various implants to replace missing anatomical structure or biological function: joint prostheses, internal fixation devices, vascular prostheses, cardiac pacemakers and defibrillators, dental implants, neurosurgical shunts and breast implants. New devices are improved and optimized with regard to biocompatibility and functionality.
Biofilm infections – a challenge of modern medicine
With growing use of implants, modern medicine is facing an increasing risk of infections. Microorganisms on implant surface form biofilms, what makes them difficult to detect by conventional methods such as periprosthetic tissue cultures. For successful treatment of these infections accurate microbiological diagnosis is crucial. Such biofilms consist of an extracellular matrix of polymerized polysaccharide, in which bacteria are embedded (Fig. 1).
Figure 1 Formation of biofilm on implant surface
The microorganisms in biofilm are transformed in low metabolic, stationary growth state. Over weeks to months, depending on the type of microorganism, implant material and host, a complex three-dimensional structure develops, which consists of nutrition channels and rudimentary communication system resembling multicellular organism. Free-living (planktonic) bacteria are killed by antibiotics and the host defense system, while adherent (biofilm) bacteria can survive and persist in the extracellular matrix of the biofilm (Fig. 2).
Sonication – a new diagnostic method
After removal in the operating room, implants are placed in the air-tight container and transported to the microbiological laboratory. After addition of Ringer’s solution, the implant is processed by vortexing (30 seconds) and sonication (1 minute) to dislodge (planktonize) microorganism into the surrounding fluid (sonicate). The sonication fluid is cultured on aerobic and anaerobic agar plates (Fig. 3) and inoculated in broth media.
Figure 3 Sonication removes more than 99.9 % of the biofilm bacteria from the surface
Principle of sonication
High acoustic intensity of conventional ultrasound baths kills microorganisms (especially gram-negative and
Figure 4 Sonication removes the detection of bacteria up to 10,000 times compared to periprosthetic tissue cultures
The resulting cavitation energy is reduce to the level, that no significant cell destruction occurs, enabling culture of viable microorganisms.
Advantages of sonication
• High accuracy
• Rapid result
• Quantiative biofilm assessment
• Additional investigations
The sonication fluid contains high density of bacteria, making it suitable for further microbial (e.g. PCR, MALDI-TOF, microcalorimetry) and immunological analyses (e.g. determination of biomarkers, gene expression).
Scope of delivery – ready-to-use
The BactoSonic® includes an ultrasonic bath BS 14, different sizes of implant containers, corresponding holders, other accessories and standard operating procedure of the sonication.
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