A Diagnostic-Driven Prospective Clinical Study Evaluating the Combination of an Antibiofilm Agent and Negative Pressure Wound Therapy.

BACKGROUND: Each year, millions of Americans develop truncal pressure ulcers (PUs) which can persist for months, years, or until the end of life. Despite the negative impact on quality of life and escalating costs associated with PUs, there is sparse evidence supporting validated and efficacious treatment options. As a result, treatment is based on opinion and extrapolation from other wound etiologies. The ideal reconstructive plan maximizes the patient's nutritional status, incorporates the basic tenets of wound bed preparation (debridement, offloading, proper moisture balance, reduction of bacterial burden), and employs diagnostics to guide therapeutic intervention. The use of combination therapies can potentially overcome several of the barriers to wound healing. Negative pressure wound therapy (NPWT), a commonly used modality in the management of PUs, facilitates healing by stimulating the formation of granulation tissue and promoting wound contraction; however, NPWT alone is not always effective. Clinical studies examining microbial bioburden in PUs determined that most ulcers contain bacteria at levels that impede wound healing (>104 CFU/g). OBJECTIVE: Thus, we hypothesized that adding an anti-microbial agent to decrease both planktonic and biofilm bacteria in the wound would increase the efficacy of NPWT. METHOD: In this prospective study, twenty patients with recalcitrant PUs that previously failed NPWT were treated with a biofilm-disrupting agent (Blast-X, Next Science, Jacksonville, FL, USA) in combination with NPWT. Fluorescence imaging was used to follow bacterial burden and guide therapy. RESULTS: In total, 45% of the PUs reduced in size over the course of the four-week study, with a resolution of bacterial fluorescence in the NPWT dressing and wound bed seen in an average of three weeks. CONCLUSION: The combination of an antibiofilm agent and NPWT reduced bacterial levels and improved wound healing in recalcitrant PUs.

An Overview of Research for the Application of a Novel Biofilm-Preventing Surgical Irrigation System for Total Joint Arthroplasty Procedures in Order to Reduce the Risk of Periprosthetic Infection.

Periprosthetic joint infection (PJI) is a serious postoperative complication in joint arthroplasty procedures that carries substantial morbidity and mortality associated with it. Several strategies have been developed both in the preoperative, perioperative, and postoperative periods to both combat and prevent the development of this devastating complication. Intraoperative irrigation is an important modality used during arthroplasty procedures prior to the implantation of final components that seeks to eradicate any biofilm formation. In this updated review, we discuss the XPERIENCE™ Advanced Surgical Irrigation solution (Next Science, Jacksonville, Florida) and the various completed, ongoing, and planned basic science and clinical investigations associated with it. Although there is already an impressive body of literature supporting its widespread utilization, future basic and clinical trials will continue to be performed to comprehensively characterize the effect this antimicrobial solution has on eliminating the risk of PJI following arthroplasty procedures.

A Novel Strategy to Substantially Reduce the Incidence of Periprosthetic Joint Infection Following Total Hip Arthroplasty with Antimicrobial Agents.

Periprosthetic joint infections (PJI) are devastating complications following total hip arthroplasty (THA) and are the most common reason for revision following primary arthroplasty. Although several devices, techniques, and procedures have been developed to combat this serious complication, there is little consensus as to how to prevent the development of PJI at the time of index arthroplasty. This article reviews the concept and implementation of a novel antimicrobial agent to substantially reduce the incidence of PJI. The regular implementation of this infection prophylaxis should be successful in drastically reducing the rate of PJI following primary THA.

Efficacy of biofilm disrupters against Candida auris and other Candida species in monomicrobial and polymicrobial biofilms.

Candida species are now considered global threats by the CDC and WHO. Candida auris specifically is on the critical pathogen threat list along with Candida albicans. In addition, it is not uncommon to find Candida spp. in a mixed culture with bacterial organisms, especially Staphylococcus aureus producing polymicrobial infections. To eradicate these organisms from the environment and from patient surfaces, surface agents such as chlorhexidine (CHD) and Puracyn are used. Biofilm disrupters (BDs) are novel agents with a broad spectrum of antimicrobial activity and have been used in the management of chronic wounds and to sterilise environmental surfaces for the past several years. The goal of this study was to evaluate BDs (BlastX, Torrent, NSSD) and CHD against Candida spp. and S. aureus using zone of inhibition assays, biofilm and time-kill assays. All BDs and CHD inhibited C. auris growth effectively in a concentration-dependent manner. Additionally, CHD and the BDs showed excellent antimicrobial activity within polymicrobial biofilms. A comparative analysis of the BDs and CHD against C. auris and C. albicans using biofilm kill-curves showed at least 99.999% killing. All three BDs and CHD have excellent activity against different Candida species, including C. auris. However, one isolate of C. auris in a polymicrobial biofilm assay showed resistance/tolerance to CHD, but not to the BDs. The fungicidal activity of these novel agents will be valuable in eradicating surface colonisation of Candida spp, especially C. auris from colonised environmental surfaces and from wounds in colonised patients.

A 6-month, Multi-center, Double-blind, Controlled Study to Evaluate the Effect of a Biofilm Disrupting Acne Cream on Mild-to-Moderate Facial Acne in Female Volunteer Subjects.

Objectives: The primary aim of this study was to assess the change in acne lesions and severity within all treatment groups over the course of a six-month study. Methods: This was a six-month, multisite, randomized, double-blind, controlled study in female subjects with mild-to-moderate acne to assess the clinical and psychological outcomes of treatment with biofilm disrupting acne cream 2x, biofilm disrupting acne cream 1x, biofilm disrupting acne cream without salicylic acid, 2.5% benzoyl peroxide (BPO) gel, and placebo. Subjects applied the assigned product to their face twice daily and were evaluated for clinical acne and quality of life outcomes at baseline and after six, 12, 18, and 24 weeks of treatment. Results: After 24 weeks of use, subjects treated with biofilm disrupting acne cream 2x had a significantly greater improvement in the Investigator Global Assessment (IGA), compared to those treated with 2.5% BPO gel. Based on dermatologic assessments, biofilm disrupting acne cream 2x, biofilm disrupting acne cream 1x, biofilm disrupting acne cream without salicylic acid, and placebo control were associated with less erythema and dryness, compared to 2.5% BPO gel. Limitations: Assessments within this study had the potential for subjective differences due to variability between evaluators. Conclucion: Biofilm disrupting acne cream 2x and biofilm disrupting acne cream 1x provided equivalent efficacy to 2.5% BPO gel with less of the adverse effects commonly associated with BPO, such as erythema and dryness. Both the biofilm disrupting acne cream without salicylic acid and the placebo control were associated with mild improvements to acne symptoms over the course of the 24-week study. Trial Registry Information: ClinicalTrials.gov, NCT03106766.

Anti-Biofilm Efficacy of Commonly Used Wound Care Products in In Vitro Settings.

Considering the prevalence and pathogenicity of biofilms in wounds, this study was designed to evaluate the anti-biofilm capabilities of eight commercially available wound care products using established in vitro assays for biofilms. The products evaluated included dressings with multiple delivery formats for ionic silver including nanocrystalline, gelling fibers, polyurethane (PU) foam, and polymer matrix. Additionally, non-silver-based products including an extracellular polymeric substance (EPS)-dissolving antimicrobial wound gel (BDWG), a collagenase-based debriding ointment and a fish skin-based skin substitute were also evaluated. The products were evaluated on Staphylococcus aureus and Pseudomonas aeruginosa mixed-species biofilms grown using colony drip flow reactor (CDFR) and standard drip flow reactor (DFR) methodologies. Anti-biofilm efficacy was measured by viable plate counts and confocal scanning laser microscopy (CSLM). Four of the eight wound care products tested were efficacious in inhibiting growth of new biofilm when compared with untreated controls. These four products were further evaluated against mature biofilms. BDWG was the only product that achieved greater than 2-log growth reduction (5.88 and 6.58 for S. aureus and P. aeruginosa, respectively) of a mature biofilm. Evaluating both biofilm prevention and mature biofilm disruption capacity is important to a comprehensive understanding of the anti-biofilm efficacy of wound care products.

A randomized controlled trial to evaluate the effectiveness of a novel mouth rinse in patients with gingivitis.

BACKGROUND: This single-center, randomized controlled trial aimed to determine the effectiveness of a novel, biofilm-disrupting, mouth rinse that combines Cetylpyridinium chloride (CPC) and essential oils in preventing re-accumulation of supragingival plaque and supragingival microbiome in patients with gingivitis after dental prophylaxis. METHODS: One hundred eighteen participants were randomly assigned in a 1:1 ratio to receive twice-daily test mouth rinse (59) or carrier rinse control (59) for 12 weeks after dental prophylaxis. RESULTS: In a per-protocol analysis that included patients who completed the intervention, the treatment group (39) had significantly lower supragingival plaque scores at 6 and 12 weeks compared to the control group (41; p = 0.022). Both groups showed similar improvement in gingivitis score, but neither group had improvement in bleeding score or probing depth. Thirty-eight (29%) patients did not complete the study due to loss of follow-up (17) or early discontinuation of the assigned intervention (21). Microbiome sequencing showed that the treatment rinse significantly depleted abundant and prevalent members of the supragingival plaque microbiome consortium. CONCLUSIONS: Among patients with gingivitis, the novel mouth rinse significantly reduced re-accumulation of supragingival plaque following dental prophylaxis by depleting supragingival plaque microbiome. However, long-term adherence to the rinse may be limited by adverse effects ( ClinicalTrials.gov number, NCT03154021).

Urinary Catheters Coated with a Novel Biofilm Preventative Agent Inhibit Biofilm Development by Diverse Bacterial Uropathogens.

Despite the implementation of stringent guidelines for the prevention of catheter-associated (CA) urinary tract infection (UTI), CAUTI remains one of the most common health care-related infections. We previously showed that an antimicrobial/antibiofilm agent inhibited biofilm development by Gram-positive and Gram-negative bacterial pathogens isolated from human infections. In this study, we examined the ability of a novel biofilm preventative agent (BPA) coating on silicone urinary catheters to inhibit biofilm formation on the catheters by six different bacterial pathogens isolated from UTIs: three Escherichia coli strains, representative of the most common bacterium isolated from UTI; one Enterobacter cloacae, a multidrug-resistant isolate; one Pseudomonas aeruginosa, common among patients with long-term catheterization; and one isolate of methicillin-resistant Staphylococcus aureus, as both a Gram-positive and a resistant organism. First, we tested the ability of these strains to form biofilms on urinary catheters made of red rubber, polyvinyl chloride (PVC), and silicone using the microtiter plate biofilm assay. When grown in artificial urine medium, which closely mimics human urine, all tested isolates formed considerable biofilms on all three catheter materials. As the biofilm biomass formed on silicone catheters was 0.5 to 1.6 logs less than that formed on rubber or PVC, respectively, we then coated the silicone catheters with BPA (benzalkonium chloride, polyacrylic acid, and glutaraldehyde), and tested the ability of the coated catheters to further inhibit biofilm development by these uropathogens. Compared with the uncoated silicone catheters, BPA-coated catheters completely prevented biofilm development by all the uropathogens, except P. aeruginosa, which showed no reduction in biofilm biomass. To explore the reason for P. aeruginosa resistance to the BPA coating, we utilized two specific lipopolysaccharide (LPS) mutants. In contrast to their parent strain, the two mutants failed to form biofilms on the BPA-coated catheters, which suggests that the composition of P. aeruginosa LPS plays a role in the resistance of wild-type P. aeruginosa to the BPA coating. Together, our results suggest that, except for P. aeruginosa, BPA-coated silicone catheters may prevent biofilm formation by both Gram-negative and Gram-positive uropathogens.

Effect of commonly used lavage solutions on the polymerization of bone cement.

INTRODUCTION: Little is known about the impact irrigation solutions have on the material properties of cement used in hip and knee arthroplasty. We sought to compare the effect of three commonly used lavage solutions on cement polymerization. METHODS: Ten groups were used for cure and mechanical testing: two cement controls, and eight cement groups mixed with test solutions. Test solutions included a commercially available benzalkonium chloride/citric acid solution (BCS), chlorhexidine gluconate (0.05%) (CHG), povidone-iodine 0.35%, and normal saline added at cement mixing onset. Cement dough-time, set-time, and compression testing were performed following The American Society for Testing and Materials guidelines. RESULTS: Povidone-iodine had shorter dough-time (1min 34sec, sd 1min 5sec) versus controls (1min 56sec, sd 1min 35sec), p=0.0419. Cement exposed to all lavage samples had significantly reduced set-time. Compressive strength was reduced for all surgical lavages (p<0.001). Pairwise testing revealed that all lavage treatments reduced offset strength versus controls (p<0.001). CONCLUSION: Bone cement exposed to lavage solutions during the cement mixing-phase showed accelerated set-times and decreased compressive strength. If bone is not dry, and cement has not finished mixing at the time of application, cement curing time may be shortened. Additionally, bone cement should reach dough phase prior to pre-closure surgical lavage. LEVEL OF EVIDENCE: III; case control study.

Can We Approach a Zero Percent Infection Rate In Total Knee Arthroplasty? A Program To Achieve This Goal With Antimicrobial Agents.

Periprosthetic joint infections (PJIs) are one of the most feared complications in the realm of adult reconstruction due to the substantial morbidity and mortality associated with these cases. Advancements in arthroplasty have been made across a variety of areas of interest including implant surfaces, implant design, material science, etc., but a focus on infection prevention and treatment is of utmost importance. A new technology has been created that targets biofilm and aims to prevent infection in total joint arthroplasty. In this manuscript we aim to describe the benefits of this technology and describe the ideal use in a case scenario format. We believe that with this technology that we can approach the goal of a zero periprosthetic infection rate.

Efficacy of Common Antiseptic Solutions Against Clinically Relevant Planktonic Microorganisms.

Prosthetic joint infections (PJIs) are among the most devastating complications after joint replacement. There is limited evidence regarding the efficacy of different antiseptic solutions in reducing planktonic microorganism burden. The purpose of this study was to test the efficacy of different antiseptic solutions against clinically relevant planktonic microorganisms. We designed an experiment examining the efficacy of several antiseptic solutions against clinically relevant planktonic microorganisms in vitro. Regarding planktonic microorganisms, povidone-iodine had 99.9% or greater reduction for all microorganisms tested except for methicillin-resistant Staphylococcus aureus, which was reduced by 60.44%. Irrisept (Irrimax Corp) had 99.9% or greater reduction for all microorganisms except Staphylococcus epidermidis (98.31%) and Enterococcus faecalis (48.61%). Bactisure (Zimmer Surgical Inc) had 99.9% or greater reduction for all microorganisms tested. Various measures exist for PJI prevention, one of which is intraoperative irrigation. We tested irrigants against clinically relevant planktonic microorganisms in vitro and found significant differences in efficacy among them. Further clinical outcome data are necessary to determine whether these solutions can impact PJI in vivo. [Orthopedics. 2022;45(2):122-127.].

The influence of a biofilm-dispersing wound gel on the wound healing process.

Topical antimicrobials that reduce the bacterial bioburden within a chronically-infected wound may have helpful or harmful effects on the healing process. We used murine models of full-thickness skin wounds to determine the effects of the novel biofilm-dispersing wound gel (BDWG) and its gel base on the healing of uninfected wounds. The rate of wound closure over 19 days was comparable among the BDWG-treated (BT) wounds and the controls. Compared with the controls, histology of the BT wounds showed formation of a stable blood clot at day 1, more neovascularisation and reepithelialisation at day 3, and more organised healing at day 7. Fluorescence-activated cell sorting analysis showed a lower percentage of neutrophils in wounded tissues of the BT group at days 1 and 3, and significantly more M2 macrophages at day 3. Levels of proinflammatory cytokines and chemokines were increased over the uninjured baseline within the wounds of all treatment groups but the levels were significantly lower in the BT group at day 1, modulating the inflammatory response. Our results suggest that BDWG does not interfere with the wound healing process and may enhance it by lowering inflammation and allowing transition to the proliferative stage of wound healing by day 3.

The effect of a biofilm-disrupting wound gel vs. a broad-spectrum antimicrobial ointment on a chronic wound microbiome: a secondary analysis associating clinical and laboratory findings.

INTRODUCTION: Advancement in wound bioburden diagnostics continues to evolve highlighting the need to link laboratory findings to clinical practice. OBJECTIVE: This study aims to determine if laboratory data from a previously published study supports a correlation between use of a novel biofilm-disrupting wound gel and lower bacterial bioburden, wound size reduction, and improved healing. MATERIALS AND METHODS: This is a secondary data analysis of a multicenter, prospective, randomized, open-label clinical trial performed from September 2014 through March 2016. The trial compares treatment outcomes of standard of care either with a wound gel (experimental) or triple-antibiotic maximum-strength ointment (control) looking at differences in bioburden measured at time zero (baseline) and after 4 weeks of treatment. Quantitative real-time PCR testing for bacteria and fungi, including testing for resistance factors to vancomycin and methicillin or using proprietary genetic sequencing, was used for analysis. RESULTS: Low or medium bacterial load at baseline correlated to an average reduction in wound size of 40% and 24%, respectively, whereas there was a 19% increase in size among wounds with a high bioburden. CONCLUSION: Reducing wound bioburden could result in a clinically relevant change in the healing trajectory. In this study, wound size reduction and increased healing percentages were superior in the experimental group.

Efficacy of common antiseptic solutions against clinically relevant microorganisms in biofilm.

AIMS: Periprosthetic joint infections (PJIs) are among the most devastating complications after joint arthroplasty. There is limited evidence on the efficacy of different antiseptic solutions on reducing biofilm burden. The purpose of the present study was to test the efficacy of different antiseptic solutions against clinically relevant microorganisms in biofilm. METHODS: We conducted an in vitro study examining the efficacy of several antiseptic solutions against clinically relevant microorganisms. We tested antiseptic irrigants against nascent (four-hour) and mature (three-day) single-species biofilm created in vitro using a drip-flow reactor model. RESULTS: With regard to irrigant efficacy against biofilms, Povidone-iodine treatment resulted in greater reductions in nascent MRSA biofilms (logarithmic reduction (LR) = 3.12; p < 0.001) compared to other solutions. Bactisure treatment had the greatest reduction of mature Pseudomonas aeruginosa biofilms (LR = 1.94; p = 0.032) and a larger reduction than Vashe or Irrisept for mature Staphylococcus epidermidis biofilms (LR = 2.12; p = 0.025). Pooled data for all biofilms tested resulted in Bactisure and Povidone-iodine with significantly greater reductions compared to Vashe, Prontosan, and Irrisept solutions (p < 0.001). CONCLUSION: Treatment failure in PJI is often due to failure to clear the biofilm; antiseptics are often used as an adjunct to biofilm clearance. We tested irrigants against clinically relevant microorganisms in biofilm in vitro and showed significant differences in efficacy among the different solutions. Further clinical outcome data is necessary to determine whether these solutions can impact PJI outcome in vivo. Cite this article: Bone Joint J 2021;103-B(5):908-915.

Cost-utility of a biofilm-disrupting gel versus standard of care in chronic wounds: a Markov microsimulation model based on a randomised controlled trial.

OBJECTIVE: Analyse the cost-effectiveness and treatment outcomes of debridement (standard of care) plus BlastX, a biofilm-disrupting wound gel (group 1) or a triple-antibiotic, maximum-strength ointment (group 2), comparing a subset of patients who had not healed at four weeks using the ointment crossed-over to the biofilm-disrupting gel (group 3). METHODS: A series of Markov microsimulation models were built using health states of an unhealed non-infected ulcer, healed ulcer, and infected non-healed ulcer and absorbing states of dead or amputation. All patients started with unhealed non-infected ulcers at cycle 0. Complications and healing rates were based on a randomised controlled trial (RCT). Costs were incurred by patients for procedures at outpatient wound care clinics and hospitals (if complications occurred) and were in the form of Medicare allowable charges. Quality-adjusted life years (QALYs) were computed using literature utility values. Incremental cost-effectiveness ratios (ICERs) were calculated for group 1 versus group 2, and group 3 versus group 2. One-way, multi-way and probabilistic sensitivity analysis (PSA) was conducted. RESULTS: After one year, the base case ICER was $8794 per QALY for group 1 versus group 2, and $21,566 per QALY for group 3 versus group 2. Product cost and amputation rates had the most influence in one-way sensitivity analysis. PSA showed that the majority of costs were higher for group 1 but effectiveness values were always higher than for group 2. Average product use of 3.1ml per application represented 9.4% of the total group 1 cost (average $24.52 per application/$822.50 per group 1 patient). The biofilm-disrupting gel group performed substantially better than the current cost-effectiveness benchmarks, $8794 versus $50,000, respectively. Furthermore, when biofilm-disrupting gel treatment was delayed, as in group 3, the ICER outcomes were less substantial but it did remain cost-effective, suggesting the added benefits of immediate use of biofilm-disrupting gel. Also, when product cost assumptions used in the study were halved (Wolcott study usage), the model indicates important reductions in ICER to $966/QALY when comparing group 1 with group 2. It should be noted that product cost can hypothetically be affected not only by direct product purchase costs, but also by application intervals and technique. This suggests additional opportunities exist to optimise these parameters, maximising wound healing efficacy while providing significant cost savings to the payer. CONCLUSION: The addition of the biofilm-disrupting gel treatment to standard of care is likely to be cost-effective in the treatment of chronic wounds but when delayed by as little as 9-12 weeks the ICER is still far less than current cost-effectiveness benchmarks. The implication for payers and decision-makers is that biofilm-disrupting gel should be used as a first-line therapy at the first clinic visit rather than waiting as it substantially decreases cost-utility.

Clinical Assessment of a Biofilm-disrupting Agent for the Management of Chronic Wounds Compared With Standard of Care: A Therapeutic Approach.

OBJECTIVE: The authors study the use of a biofilm-disrupting wound gel designed for wound management to determine if disrupting chronic wound biofilm would be therapeutically efficacious. MATERIALS AND METHODS: This prospective, randomized, open-label clinical trial was performed from September 2014 through March 2016. Forty-three patients (22 experimental, 21 control) with chronic, recalcitrant wounds were randomized to a 12-week treatment with a biofilm-disrupting wound gel (experimental) or a broad-spectrum antimicrobial ointment (control). The wound healing rate was assessed by measuring wound size reduction and wound closure rates. RESULTS: Wound size in the experimental group decreased significantly with a 71% reduction in wound area compared with 24% for the control (P < .001). Wound closure was attained in more than half of the patients (14) treated with the experimental product. Fifty-three percent of these patients achieved closure by 12 weeks as opposed to 17% for the control (P < .01). No adverse events related to the experimental product were recorded, but 2 adverse reactions occurred with the control. CONCLUSIONS: The combination of the experimental product and wound debridement significantly improved wound healing rates by disrupting the biofilm, which protects multispecies bacteria within a chronic wound. Given the significant wound size reduction and closure rates observed in these long-term, nonhealing wounds, as well as the lack of related serious adverse events, the investigators believe the biofilm-disrupting wound gel to be a safe and effective treatment for recalcitrant chronic wounds.

Topical Treatment With an Agent Disruptive to P. acnes Biofilm Provides Positive Therapeutic Response: Results of a Randomized Clinical Trial.

The traditional disease model of acne has been one of follicular plugging due to 'sticky epithelial cells' associated with increased sebum production with deep follicular anaerobic conditions favoring P. acnes- generated inflammation. P. acnes biofilms have been found more frequently in patients with acne than controls. Biofilms are genetically coded to create adhesion to the pilosebaceous unit followed by production of a mucopolysaccharide coating capable of binding to lipid surfaces. Traditional therapies for acne have involved mixtures of oral and topical antibiotics admixed with topical keratolytics and retinoids, which are aimed at traditional bacterial reduction as well as downregulating the inflammatory cascade. These approaches are limited by side effect and compliance/tolerability issues. As the P. acnes biofilm may, in fact, be the instigator of this process, we studied the use of a topical agent designed to reduce the P. acnes biofilm to see if reducing the biofilm would be therapeutically efficacious. We present data of a proprietary topical non-prescription agent with a novel pharmaco mechanism designed to attack the biofilm produced by P. acnes. Our data shows a decrease of inflammatory lesions by 44% and non-inflammatory lesions by 32% after 12 weeks and also provided for a meaningful improvement in the quality of life of the patients in the study. These improvements were achieved with a product that was not associated with burning, chafing, irritation, or erythema, which can be seen with topical treatments. It is apparent from this study that by addressing the biofilm which protects the P. acnes bacteria through the use of the Acne Gel, the incidence of acne symptoms can be greatly reduced, while having no negative impacts on the patients' skin (ClinicalTrials.gov registry number NCT02404285).

J Drugs Dermatol. 2016;15(6):677-683.

The antimicrobial agent, Next-Science, inhibits the development of Staphylococcus aureus and Pseudomonas aeruginosa biofilms on tympanostomy tubes.

OBJECTIVE: The purpose of this study was to determine if the recently developed novel antimicrobial/antibiofilm agent Next-Science (NS) inhibits biofilm development by Staphylococcus aureus or Pseudomonas aeruginosa on tympanostomy tubes (TT) and to define the concentration of NS at which this inhibition occurs. METHODS: Preliminary titration experiments determined the effective concentrations of NS that completely inhibit the planktonic growth of S. aureus and P. aeruginosa. Since NS has the potential to inhibit both planktonic growth and biofilm development, we examined the antibiofilm effect using the established concentrations that inhibited planktonic growth. Biofilms developed on TT using the microtiter plate assay were assessed quantitatively by determining the number of microorganisms per tube (CFU/tube) and qualitatively by visualization with confocal laser scanning microscopy (CLSM). RESULTS: Planktonic growth of S. aureus and P. aeruginosa was inhibited by 20.3 µg/mL and 325 µg/mL of NS, respectively. While S. aureus and P. aeruginosa formed well-developed biofilms on TT at 24 h without treatment, addition of the indicated concentrations of NS at the time of inoculation of the TT inhibited the formation of biofilms by both organisms. CLSM confirmed the absence of biofilms on either the inner or outer surface of the treated TTs. At 8 h post-inoculation, P. aeruginosa formed a partial biofilm on the TT when untreated. In comparison, the NS-treated biofilms failed to develop further and the CFU/TT were significantly reduced. CONCLUSION: The novel antimicrobial agent NS inhibited the development of S. aureus and P. aeruginosa biofilms on TTs. The same concentrations of NS inhibited both planktonic growth and biofilm development.

In vivo effects of citric acid/zwitterionic surfactant cleansing solution on rabbit sinus mucosa.

BACKGROUND: Chronic rhinosinusitis that is refractory to medical or surgical intervention may involve a particularly resistant form of infection known as a bacterial biofilm that is recalcitrant to antibiotics secondary to physical barrier characteristics. Recently, a novel sinus cleansing solution, citric acid/zwitterionic surfactant (CAZS) was shown to be extremely effective in disrupting biofilms in vitro. The purpose of this study was to determine the effects of CAZS on sinonasal epithelium In vivo compared with normal saline. METHODS: Indwelling catheters were placed into the right maxillary sinus of New Zealand white rabbits. CAZS solution or normal saline (10 mL) was instilled at a rate of 20 mL/minute into the sinus followed by aspiration. Rabbits were killed 1, 3, and 6 days after treatment. Mucosa from both maxillary sinuses was harvested and evaluated for physiological activity (ciliary beating) as well as morphological integrity of the epithelium by scanning electron microscopy. RESULTS: One day after treatment, beating cilia was evident with morphological analysis shown intact epithelium with 80-85% denudation of cilia compared with saline. Three days after treatment, ciliary activity was again noted with morphological evidence of persistent denuded cilia. By day 6 after treatment, the epithelium had regenerated cilia over the apical surface. Throughout the recovery period beating cilia was evident in CAZS-treated sinuses. CONCLUSION: This study shows that although CAZS acutely denudes respiratory cilia, the remaining cilia are active. Additionally, the epithelial barrier appears intact with active ciliogenesis, and reciliation of the mucosal surface occurring 6 days after treatment.