Abstract
Background
Postoperative spine infections cause considerable morbidity. Patients are subjected to long-term antibiotic regimens and may require further surgery. Delivery of electric current through instrumentation can detach biofilm, allowing better antibiotic penetration and assisting in eradicating infection.
Question/purposes
We asked (1) whether capacitive coupling treatment in combination with a single dose of antibiotics would reduce infection rates when compared with antibiotics alone in a rabbit spine infection model, (2) whether it would decrease the overall bacterial burden, and (3) whether there was a time-dependent response based on days treated with capacitive coupling.
Methods
Thirty rabbits were subjected to a well-established spine infection model with a single dose of intravenously administered systemic ceftriaxone (20 mg/kg of body weight) prophylaxis. Two noncontiguous rods were implanted inside dead space defects at L3 and L6 challenged with 106 colony-forming units of Staphylococcus aureus. Rabbits were randomly treated with a capacitive coupling or control device. Instrumentation and soft tissue bacterial growth were assessed after 7 days.
Results
Sites treated with capacitive coupling showed a decrease in the incidence of positive culture: 36% versus 81% in the control group. We observed no difference in the soft tissue’s infectious burden. Overall bacterial load was not decreased with capacitive coupling.
Conclusions
Capacitive coupling in conjunction with antibiotics reduced the instrumentation-related infection rate compared with antibiotics alone.
Clinical Relevance
Capacitive coupling noninvasively delivers an alternating current that may detach biofilm from instrumentation. Treatment of infection may be successful without removal of instrumentation, allowing for improved stability and overall decreased morbidity.
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References
Benazzo F, Mosconi M, Beccarisi G, Galli U. Use of capacitive coupled electric fields in stress fractures in athletes. Clin Orthop Relat Res. 1995;310:145–149.
Calderone RR, Garland DE, Capen DA, Oster H. Cost of medical care for postoperative spinal infections. Orthop Clin North Am. 1996;27:171–182.
Craig MR, Poelstra KA, Sherrell JC, Kwon MS, Belzile EL, Brown TE. A novel total knee arthroplasty infection model in rabbits. J Orthop Res. 2005;23:1100–1104.
Del Pozo JL, Rouse MS, Euba G, Kang CI, Mandrekar JN, Steckelberg JM, Patel R. The electricidal effect is active in an experimental model of Staphylococcus epidermidis chronic foreign body osteomyelitis. Antimicrob Agents Chemother. 2009;53:4064–4068.
del Pozo JL, Rouse MS, Mandrekar JN, Sampedro MF, Steckelberg JM, Patel R. Effect of electrical current on the activities of antimicrobial agents against Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis biofilms. Antimicrob Agents Chemother. 2009;53:35–40.
del Pozo JL, Rouse MS, Mandrekar JN, Steckelberg JM, Patel R. The electricidal effect: reduction of Staphylococcus and pseudomonas biofilms by prolonged exposure to low-intensity electrical current. Antimicrob Agents Chemother. 2009;53:41–45.
Del Pozo JL, Rouse MS, Patel R. Bioelectric effect and bacterial biofilms: a systematic review. Int J Artif Organs. 2008;31:786–795.
Department of Health and Human Services. HHS Action Plan to Prevent Healthcare-associated Infections. Washington, DC, USA: US Government Printing Office; 2009.
Gan JC, Glazer PA. Electrical stimulation therapies for spinal fusions: current concepts. Eur Spine J. 2006;15:1301–1311.
Glazer PA, Heilmann MR, Lotz JC, Bradford DS. Use of electromagnetic fields in a spinal fusion: a rabbit model. Spine (Phila Pa 1976). 1997;22:2351–2356.
Gold HS, Moellering RC Jr. Antimicrobial-drug resistance. N Engl J Med. 1996;335:1445–1453.
Goodwin CB, Brighton CT, Guyer RD, Johnson JR, Light KI, Yuan HA. A double-blind study of capacitively coupled electrical stimulation as an adjunct to lumbar spinal fusions. Spine (Phila Pa 1976). 1999;24:1349–1356.
Hodges SD, Eck JC, Humphreys SC. Use of electrical bone stimulation in spinal fusion. J Am Acad Orthop Surg. 2003;11:81–88.
Hosman AH, van der Mei HC, Bulstra SK, Busscher HJ, Neut D. Metal-on-metal bearings in total hip arthroplasties: influence of cobalt and chromium ions on bacterial growth and biofilm formation. J Biomed Mater Res A. 2009;88:711–716.
Ito M, Fay LA, Ito Y, Yuan MR, Edwards WT, Yuan HA. The effect of pulsed electromagnetic fields on instrumented posterolateral spinal fusion and device-related stress shielding. Spine (Phila Pa 1976). 1997;22:382–388.
Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725–730.
Levi AD, Dickman CA, Sonntag VK. Management of postoperative infections after spinal instrumentation. J Neurosurg. 1997;86:975–980.
Marcer M, Musatti G, Bassett CA. Results of pulsed electromagnetic fields (PEMFs) in ununited fractures after external skeletal fixation. Clin Orthop Relat Res. 1984;190:260–265.
Massie JB, Heller JG, Abitbol JJ, McPherson D, Garfin SR. Postoperative posterior spinal wound infections. Clin Orthop Relat Res. 1992;284:99–108.
Pickering SA, Bayston R, Scammell BE. Electromagnetic augmentation of antibiotic efficacy in infection of orthopaedic implants. J Bone Joint Surg Br. 2003;85:588–593.
Poelstra KA, Barekzi NA, Grainger DW, Gristina AG, Schuler TC. A novel spinal implant infection model in rabbits. Spine (Phila Pa 1976). 2000;25:406–410.
Rechtine GR, Bono PL, Cahill D, Bolesta MJ, Chrin AM. Postoperative wound infection after instrumentation of thoracic and lumbar fractures. J Orthop Trauma. 2001;15:566–569.
Sasso RC, Garrido BJ. Postoperative spinal wound infections. J Am Acad Orthop Surg. 2008;16:330–337.
Scott G, King JB. A prospective, double-blind trial of electrical capacitive coupling in the treatment of non-union of long bones. J Bone Joint Surg Am. 1994;76:820–826.
Slobogean GP, Kennedy SA, Davidson D, O’Brien PJ. Single- versus multiple-dose antibiotic prophylaxis in the surgical treatment of closed fractures: a meta-analysis. J Orthop Trauma. 2008;22:264–269.
Stall AC, Becker E, Ludwig SC, Gelb D, Poelstra KA. Reduction of postoperative spinal implant infection using gentamicin microspheres. Spine (Phila Pa 1976). 2009;34:479–483.
van der Borden AJ, Maathuis PG, Engels E, Rakhorst G, van der Mei HC, Busscher HJ, Sharma PK. Prevention of pin tract infection in external stainless steel fixator frames using electric current in a goat model. Biomaterials. 2007;28:2122–2126.
Vinh DC, Embil JM. Device-related infections: a review. J Long Term Eff Med Implants. 2005;15:467–488.
Young PM, Berquist TH, Bancroft LW, Peterson JJ. Complications of spinal instrumentation. Radiographics. 2007;27:775–789.
Acknowledgments
We thank Hyunchul Kim, MS, who analyzed and ensured the accuracy of the data, and Daniel Gelb, MD, and Eugene Koh, MD, who oversaw the project and contributed to the writing. We also thank Senior Editor and Writer Dori Kelly, MA, for invaluable assistance editing the manuscript.
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The institution of one or more of the authors (University of Maryland) has received, in any 1 year, grant funding from Biomet, EBI Medical Systems, Inc, and the Orthopaedic Research and Education Foundation. The institution also receives fellowship support from Synthes Spine. Each author certifies that he or she and members of his or her immediate family have no commercial associations that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at the University of Maryland, Baltimore, MD, USA.
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Gilotra, M., Griffith, C., Schiavone, J. et al. Capacitive Coupling Reduces Instrumentation-related Infection in Rabbit Spines: A Pilot Study. Clin Orthop Relat Res 470, 1646–1651 (2012). https://doi.org/10.1007/s11999-011-2231-1
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DOI: https://doi.org/10.1007/s11999-011-2231-1