Commonly Encountered Skin Biome-Derived Pathogens after Orthopedic Surgery.

Background: Normal skin microbiota influence susceptibility to surgical infections. The distribution of skin bacteria differs by anatomic site, and given the right conditions, almost any of these bacteria can become an opportunistic pathogen. Methods: This paper provides a thorough review of the most commonly encountered bacteria in various regions of the body and their isolation from operative incisions at those locations. These data may be useful in optimizing targeted antibiotic therapy for surgical site infections and provide a better understanding of the skin biome distribution at specific surgical sites. Conclusion: Typical skin-borne flora, surgical site infections, orthopedic infections by body part, and drug-resistant pathogens are reviewed.

Silver doped titanium oxide-PDMS hybrid coating inhibits Staphylococcus aureus and Staphylococcus epidermidis growth on PEEK.

Bacterial infection remains one of the most serious issues affecting the successful installation and retention of orthopedic implants. Many bacteria develop resistance to current antibiotics, which complicates or prevents traditional antibiotic-dependent eradication therapy. In this study, a hybrid coating of titanium dioxide and polydimethylsiloxane (PDMS) was synthesized to regulate the release of silver. The coatings were benefited from the antimicrobial activity of silver ion, the biocompatibility of titanium dioxide, and the flexibility of the polymer. Three studied silver doped coatings with different titanium dioxide-PDMS ratios effectively inhibited the attachment and growth of Staphylococcus aureus and Staphylococcus epidermidis in a dose-dependent manner. The coatings were successfully applied on the discs of polyether ether ketone (PEEK), a common spinal implant material and antibacterial property of these coatings was assessed via Kirby Bauer assay. More importantly, these selected coatings completely inhibited biofilm formation. The release study demonstrated that the release rate of silver from the coating depended on doping levels and also the ratios of titanium dioxide and PDMS. This result is crucial for designing coatings with desired silver release rate on PEEK materials for antimicrobial applications.

Niobium oxide-polydimethylsiloxane hybrid composite coatings for tuning primary fibroblast functions.

This study evaluates the potential of niobium oxide-polydimethylsiloxane (PDMS) composites for tuning cellular response of fibroblasts, a key cell type of soft tissue/implant interfaces. In this study, various hybrid coatings of niobium oxide and PDMS with different niobium oxide concentrations were synthesized and characterized using scanning electron microscopy, X-ray photoelectron spectrometry (XPS), and contact angle goniometry. The coatings were then applied to 96-well plates, on which primary fibroblasts were seeded. Fibroblast viability, proliferation, and morphology were assessed after 1, 2, and 3 days of incubation using WST-1 and calcein AM assays along with fluorescent microscopy. The results showed that the prepared coatings had distinct surface features with submicron spherical composites covered in a polymeric layer. The water contact angle measurement demonstrated that the hybrid surfaces were much more hydrophobic than the original pure niobium oxide and PDMS. The combination of surface roughness and chemistry resulted in a biphasic cellular response with maximum fibroblast density on substrate with 40 wt % of niobium oxide. The results of the current study indicate that by adjusting the concentration of niobium oxide in the coating, a desirable cell response can be achieved to improve tissue/implant interfaces.

Characterization and bioactive properties of zirconia based polymeric hybrid for orthopedic applications.

Zirconia is a transition metal oxide with current applications to orthopedic implants. It has been shown to up-regulate specific genes involved in bio-integration and injury repair. This study examines the effects of zirconia and polydimethylsiloxane (PDMS) hybrids on the proliferation and viability of human primary osteoblast and fibroblast cells. In this study, zirconia-PDMS hybrid coatings were synthesized using a modified sol gel process. The hybrid material was characterized using optical microscopy, scanning electron microscopy, X-ray photoelectron spectroscopy, and contact angle analysis. This study demonstrates that Zr-PMDS surface materials display hydrophobic surface properties coupled with a preferential deposition of polymer near the surface. Primary osteoblast and fibroblast proliferation and viability on hybrid coated surfaces were evaluated via a rapid screening methodology using WST-1 and calcein AM assays. The cells were seed at 5,000 cells per well in 96-well plates coated with various composition of Zr-PDMS hybrids. The results showed increasing cell proliferation with increasing zirconia concentration, which peaked at 90 % v/v zirconia. Proliferation of osteoblasts and fibroblasts displayed similar trends on the hybrid material, although osteoblasts displayed a bi-phasic dose response by the calcein AM assay. The results of this current study show that Zr-PDMS may be used to influence tissue-implant integration, supporting the use of the hybrid as a promising coating for orthopedic trauma implants.

In vivo caprine model for osteomyelitis and evaluation of biofilm-resistant intramedullary nails.

Bone infection remains a formidable challenge to the medical field. The goal of the current study is to evaluate antibacterial coatings in vitro and to develop a large animal model to assess coated bone implants. A novel coating consisting of titanium oxide and siloxane polymer doped with silver was created by metal-organic methods. The coating was tested in vitro using rapid screening techniques to determine compositions which inhibited Staphylococcus aureus growth, while not affecting osteoblast viability. The coating was then applied to intramedullary nails and evaluated in vivo in a caprine model. In this pilot study, a fracture was created in the tibia of the goat, and Staphylococcus aureus was inoculated directly into the bone canal. The fractures were fixed by either coated (treated) or non-coated intramedullary nails (control) for 5 weeks. Clinical observations as well as microbiology, mechanical, radiology, and histology testing were used to compare the animals. The treated goat was able to walk using all four limbs after 5 weeks, while the control was unwilling to bear weight on the fixed leg. These results suggest the antimicrobial potential of the hybrid coating and the feasibility of the goat model for antimicrobial coated intramedullary implant evaluation.

BioIntraface®: the next quantum in medical devices.

BioIntraface®, Inc., located in Riverside, Rhode Island, was formed in February of 2009 to commercialize its biomaterials surface treatment technologies. The platform technologies involve the creation of economical, multifunctional metal oxide and polymer materials and coatings to control the bioactivity and antimicrobial properties of medical devices and implants. Biointraface® has continued optimizing and validating coatings for promising applications in orthopaedics, dentistry, catheters, wound dressings, topical antimicrobial products, and cosmetics applications. It has also obtained third-party verification of ISO biocompatibility testing for eight coatings with increasing levels of antimicrobial agents, where no cytotoxicity was indicated and similar tests showing long lasting antimicrobial efficacy against multiple strains of bacteria.

Rapid screening, in vitro study of metal oxide and polymer hybrids as delivery coatings for improved soft-tissue integration of implants.

Metal-organic chemistry allows for molecular mixing and creation of a range of submicron phase-separated structures from normally brittle metal oxides and flexible polymers with improved bioactivity and delivery properties. In this study, we used a high throughput platform to investigate the influence of organic metal oxide doping of polydimethylsiloxane (PDMS) coatings on cellular bioactivity and controlled release of vanadium compared with titanium oxide coatings without additional PDMS. Metal-organic-derived titanium and or vanadium was doped into PDMS and used to form a coating on the bottom of cell culture microplates in the absence of added water, acids, or bases. These hybrid coatings were rapidly screened to establish how titanium and vanadium concentration influences cell proliferation, adhesion, and morphology. We demonstrate that titanium doping of PDMS can be used to improve cell proliferation and adhesion, and that vanadium doping caused a biphasic dose response in proliferation. A 28-day vanadium and titanium elution study indicated that titanium was not released, but the presence of PDMS in coatings increased delivery rates of vanadium compared with titania coatings without polymer. Hybrid coatings of titanium-doped polymers have potential for improving wound healing dynamics, soft-tissue integration of medical implants, and use as controlled delivery vehicles.

Controlled release of vanadium from titanium oxide coatings for improved integration of soft tissue implants.

This study evaluates the potential of titanium oxide coatings for short-term delivery of vanadium for improved wound healing around implants. Titanium and vanadium oxides are bioactive agents that elicit different bioresponses in cells, ranging from implant integration and reduction of inflammation to modulation of cell proliferation and morphology. These oxides were combined in biomaterial coatings using metal-organic precursors and rapidly screened in cell-culture microplates to establish how vanadium-loading influences cell proliferation and morphology. Twenty-eight-day elution studies indicated that there was a controlled release of vanadium from stable titanium oxide matrices. Elution profiles were mathematically modeled for vanadium loading of 20-1.25% up to a period of 28 days. Scanning electron microscopy and energy dispersive spectroscopy of the coatings indicated that the vanadium was present as a nanoscale dispersion and not segregated micron-scale islands. The study confirmed that the observed bioresponse of cells was modulated by the soluble release of vanadium into the surrounding medium. Controlled release of vanadium from titania coatings may be used to influence soft-tissue integration of implants by modulating cell proliferation, attachment, inflammation, and wound healing dynamics.

Metal oxide coated cell culture arrays for rapid biological screening.

The biointerface of metallic alloy implants is a spontaneously formed metal oxide layer. This study presents a novel method for creating titanium oxide xerogel coated microplates for high-throughput biological screening that overcomes several limitations of using bulk metal samples to study oxides. Metal-organic precursors were used to evaluate the influence of Al, V, Ca, and P doped smooth and textured titanium oxide xerogel coatings on the bioresponse of human fibroblasts to increase understanding of the soft tissue sealing around transepithelial devices. Coatings made of titanium n-butoxide were characteristically smooth, while those of titanium isopropoxide were micro- and nanofeatured. Screening consisted of WST-1 proliferation assay, calcein AM cell number and viability assay, and a modified cell seeding efficiency and centrifugation adhesion assay. Small variations in initial attachment and centrifugation adhesion of human fibroblasts were observed among the coatings and comparable to tissue-culture treated polystyrene. Proliferation and viability at 24 and 48 h were reduced by the 10 and 20% vanadium additions. Metal oxide coated microplates are adaptable to the investigation of a wide range of metal-organic derived chemistries and the influence of oxide texture, and level of oxide crystallinity and oxide grain size on the biological responses of cells.