In Vivo Comparison of the Efficacy and Duration of Local Antibiotics on Smooth, Textured and Polyurethane Implant Surfaces

Abstract

Background: Capsular contracture is one of the most common complications after breast surgery involving silicone implants. The most likely cause of this condition is biofilm formation. In this study, the efficacy of local antibiotherapy against biofilm formation on implant surfaces was investigated.

Methods: Thirty-six rats were divided into six groups. Three pockets were created on the dorsum of each rat, and 1 × 2 cm implant surface samples from smooth, polyurethane and textured implants were randomly placed into pockets. All samples were inoculated with staphylococcus epidermidis. In groups 1-2-3, inoculated samples were placed into the pockets and removed after 1, 6 and 24 h, respectively. In groups 4-5-6, inoculated samples immersed with rifamycin were placed and removed after 1, 6 and 24 h, respectively. Bacterial load was measured with plate count method.

Results: Bacterial load was lower in groups 4-5-6 than in groups 1-2-3 (p < 0.05). In groups 4-5-6, bacterial load was lower for polyurethane than for textured surfaces at all time points (1, 6 and 24 h; p < 0.05). Again, in groups 4-5-6, bacterial load was lower for smooth than for textured surfaces at 24 h (p < 0.05). In groups 4-5-6, bacterial load was lower for polyurethane than for smooth surfaces at all time points, but difference was not statistically significant (1, 6 and 24 h; p < 0.05).

Conclusion: The results suggest that local antibiotic therapy was effective in reducing the bacterial load on all surfaces. The effectiveness of local rifamycin on the polyurethane surface was higher, and the duration of activity was longer than other surfaces.

No level assigned: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Antibiotics; BIA-ALCL; Bacteria; Biofilm; Breast implants; Microorganism; Polyurethane textured smooth.

Fig. 1

Smooth (S), polyurethane (P), textured (T) implant surface (without antibiotic) (Above left). Smooth (S), polyurethane (P) and textured (T) implant surfaces (with antibiotic) (Above right). Preoperative incision markings for submuscular pockets (Below left). Implant surface are placed in the submuscular pocket with sterile forceps (Below right)

Fig. 2

The mean number of bacterial colonies over time on surfaces to which local antibiotic treatment has not been applied

Fig. 3

The mean number of bacterial colonies over time on surfaces to which local antibiotic treatment has been applied

Fig. 4

Graph showing statistical comparisons with error bars, without local antibiotic therapy (Groups 1-2-3). Small values could not be shown in the graph due to large differences between the data. Therefore, the data were made suitable for display by using the standardization method

Fig. 5

Graph showing statistical comparisons with error bars, without local antibiotic therapy (Groups 4-5-6). Small values could not be shown in the graph due to large differences between the data. Therefore, the data were made suitable for display by using the standardization method

Fig. 6

Graph showing statistical comparisons of groups without local antibiotics and with local antibiotics according to hours with error bars. Small values could not be shown in the graph due to large differences between the data. Therefore, the data were made suitable for display by using the standardization method