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. 2022 Aug 6;22(1):192.
doi: 10.1186/s12866-022-02606-x.

What is the best technic to dislodge Staphylococcus epidermidis biofilm on medical implants?

Vivien Moris  1   2 , Mylan Lam  3 , Lucie Amoureux  4   5 , Arnaud Magallon  4   5 , Adrien Guilloteau  6 , Thomas Maldiney  7   8 , Narcisse Zwetyenga  9   7 , Céline Falentin-Daudre  3 , Catherine Neuwirth  4   5
Affiliations

What is the best technic to dislodge Staphylococcus epidermidis biofilm on medical implants?

Vivien Moris et al. BMC Microbiol. .

Abstract

Background: Bacterial biofilm can occur on all medical implanted devices and lead to infection and/or dysfunction of the device. In this study, artificial biofilm was formed on four different medical implants (silicone, piccline, peripheral venous catheter and endotracheal tube) of interest for our daily clinical and/or research practice. We investigated the best conventional technic to dislodge the biofilm on the implants and quantified the number of bacteria. Staphylococcus epidermidis previously isolated from a breast implant capsular contracture on a patient in the university hospital of Dijon was selected for its ability to produce biofilm on the implants. Different technics (sonication, Digest-EUR®, mechanized bead mill, combination of sonication plus Digest-EUR®) were tested and compared to detach the biofilm before quantifying viable bacteria by colony counting.

Results: For all treatments, the optical and scanning electron microscope images showed substantial less biofilm biomass remaining on the silicone implant compared to non-treated implant. This study demonstrated that the US procedure was statistically superior to the other physical treatment: beads, Digest-EUR® alone and Digest-EUR® + US (p < 0.001) for the flexible materials (picc-line, PIV, and silicone). The number of bacteria released by the US is significantly higher with a difference of 1 log on each material. The result for a rigid endotracheal tube were different with superiority for the chemical treatment dithiothreitol: Digest-EUR®. Surprisingly the combination of the US plus Digest-EUR® treatment was consistently inferior for the four materials.

Conclusions: Depending on the materials used, the biofilm dislodging technique must be adapted. The US procedure was the best technic to dislodge S. epidermidis biofilm on silicone, piccline, peripheral venous catheter but not endotracheal tube. This suggested that scientists should compare themselves different methods before designing a protocol of biofilm study on a given material.

Keywords: Biofilm quantification; Endotracheal tube; Enzymatic treatment; Medical implant; Peripheral venous catheter; Piccline; Silicone; Sonication; Staphylococcus epidermidis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Scanning electron microscopy (200 µm) shows the formation and removal of biofilms (white spots on images) on silicone for Staphylococcus epidermidis
Fig. 2
Fig. 2
Optical microscopy (X10) shows the formation and removal of biofilms (pink color on images) on silicone for Staphylococcus epidermidis
Fig. 3
Fig. 3
Scanning electron microscopy (200 µm) shows the residual biofilms (white spots on images) on different biomaterials for Staphylococcus epidermidis after each treatment
Fig. 4
Fig. 4
Comparison of biofilm removal procedure on piccline. US procedure dislodged 1.75 × 107 CFU/ml, Digest-EUR® and US dislodged 4.75 × 106 CFU/ml, beads dislodged 1.06 × 106 CFU/ml and Digest-EUR® dislodged 1.9 × 106 CFU/ml. *: p < 0.001 / ns: p > 0.05
Fig. 5
Fig. 5
Comparison of biofilm removal procedure on Peripheral Intravenous Catheter (PIV). US procedure dislodged 1.45 × 107 CFU/ml, Digest-EUR® and US dislodged 3.13 × 106 CFU/ml, Beads dislodged 2.55 × 106 CFU/ml and Digest-EUR® dislodged 5.01 × 106 CFU/ml. *: p < 0.001 / ns: p > 0.05
Fig. 6
Fig. 6
Comparison of biofilm removal procedure on silicone. The US procedure dislodged 3.59 × 107 CFU/ml, Digest-EUR® and US dislodged 7 × 106 CFU/ml, Beads dislodged 3.61 × 106 CFU/ml and Digest-EUR® dislodged 6.36 × 106 CFU/ml. *: p < 0.001 / ns: p > 0.05
Fig. 7
Fig. 7
Comparison of biofilm removal procedure on endotracheal tube. the US procedure dislodged 1.19 × 107 CFU/ml, Digest-EUR® and US dislodged 3.59 × 106 CFU/ml, Beads dislodged 2.53 × 106 CFU/ml and Digest-EUR® dislodged 3.05 × 107 CFU/ml. *: p < 0.001 / ns: p > 0.05
Fig. 8
Fig. 8
Comparison of a 5 days biofilm removal procedure on piccline. US procedure dislodged 5 × 109 CFU/ml, Digest-EUR® and US dislodged 1.2 × 107 CFU/ml, beads dislodged 3.4 × 108 CFU/ml and Digest-EUR® dislodged 3.03 × 106 CFU/ml. *: p < 0.001 / ns: p > 0.05
Fig. 9
Fig. 9
Comparison of a 5 days biofilm removal procedure on Peripheral Intravenous Catheter (PIV). US procedure dislodged 5 × 109 CFU/ml, Digest-EUR® and US dislodged 1.15 × 107 CFU/ml, Beads dislodged 3.53 × 108 CFU/ml and Digest-EUR® dislodged 3.02 × 107 CFU/ml. *: p < 0.001 / ns: p > 0.05
Fig. 10
Fig. 10
Comparison of a 5 days biofilm removal procedure on silicone. The US procedure dislodged 8.63 × 109 CFU/ml, Digest-EUR® and US dislodged 3.01 × 108 CFU/ml, Beads dislodged 2.74 × 108 CFU/ml and Digest-EUR® dislodged 4.52 × 108 CFU/ml. *: p < 0.001 / ns: p > 0.05
Fig. 11
Fig. 11
Comparison of a 5 days biofilm removal procedure on endotracheal tube. the US procedure dislodged 5.34 × 108 CFU/ml, Digest-EUR® and US dislodged 7.41 × 108 CFU/ml, Beads dislodged 3.18 × 108 CFU/ml and Digest-EUR® dislodged 6.91 × 109 CFU/ml. *: p < 0.001 / ns: p > 0.05
Fig. 12
Fig. 12
Experimental Flow chart
Fig. 13
Fig. 13
Experimental plan
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