A long time ago in an Operating Room far, far away….

With apologies to George LucasBiofilmWars

Shocking:Elimination of S. Aureus

Biofilm from Stainless Steel by Electrolysis

Matthew J. Dietz, MD; Jacob Conjeski MD; Vincent L. Kish AS; Brian R. Hamlin, MDWest Virginia University Department of Orthopaedics

Orthopaedic Biofilm

TOP SECRET• Adherent Bacteria

• EPS (extra-cellular polysaccharide)

• Polymicrobial

S. Aureus

S. Epi

EPS

Implant

Spork

“race for the surface”

-- Gristina, A. “Biomaterial-Centered Infection: Microbial Adhesion Versus Tissue Integration. Science. Vol. 237, No. 4822. (Sep. 25, 1987), pp. 1588-1595

Bacterial Colonization

vs.

Tissue Integration

100 - 1000x Antibiotics

to Eliminate Biofilm

“Strategerie”

Debridement with Retention

Staged Explant/Exchange

Resection Arthroplasty

Arthrodesis

Amputation

Hypothesis

S. aureus

BIOFILM

Biofilm and WVU Orthopaedics

Create Biofilm

--Goeres et. al. “Statistical assessment of a laboratory method forgrowing biofilms.” Microbiology. 2005; 151: 757-762.

Where’s the Biofilm?

ba c

-- Rabinovitch, C et al. “Removal and Inactivation of Staphylococcus epidermidis Biofilms by Electrolysis.” App and Enviromental Microbiology. Sept 2006: 6364-66.

Anode vs. CathodeReduction CFU’s for S. aureus

Control 1 Volts

Avg.52.65%

reduction in CFU’s/cm2

Anode (n=5)

Cathode (n=5)

Avg.92.59%

reduction in CFU’s/cm2

Biofilm and WVU Orthopaedics

Control 4 Volts 2 Volts 1 Volt 0.5 Volts1

10

100

1000

10000

Control

99.3% Reduction

98.3% Reduction 99.1%

Reduction 99.6% Reduction

Reduction in Colony Forming Units

Experimental Group

Num

ber o

f Col

ony

Form

ing

Uni

ts(lo

g sc

ale)

Control

4 V 2 V 1 V 0.5 V

However…

ConclusionsNeed for adjuntive measures

Connection to Cathode for S. aureus

CFU reduction independent of voltage

98% of CFU’s via electrolysis

To Do List… Biofilm Models Detection of Biofilm Electrolysis Various Metals In-vivo Vary biofilm makeup

Means of Removal

The War Continues…Thank You