Activity of N-acetyl-L-cysteine against Biofilm of Staphylococcus Aureus and Pseudomonas Aeruginosa on Orthopedic Prosthetic Materials

Abstract

Purpose

Staphylococcus aureus and Pseudomonas aeruginosa are frequently isolated from biofilm-associated orthopedic implant infections. This study assessed the activity of N-acetyl-L-cysteine at inhibitory and subinhibitory concentrations against biofilm formed by S. aureus and P. aeruginosa on prosthetic materials.

Methods

S. aureus and P. aeruginosa biofilm on smooth polyethylene and sand-blasted titanium discs was determined by means of a spectrophotometric assay before and at 3, 6, and 18 hours after addition of N-acetyl-L-cysteine.

Results

N-acetyl-L-cysteine was able to disaggregate biofilm produced by S. aureus and P. aeruginosa on polyethylene and titanium discs after 3 h of incubation. A different rate in eradication of biofilm produced by P. aeruginosa was seen between polyethylene and titanium (50% vs. 20% respectively vs. biofilm formed before treatment). Results were confirmed by confocal laser scanning microscopy.

Conclusions

The results suggest a possible role of N-acetyl-L-cysteine in the treatment of orthopedic prosthetic infections.

Keywords

Prosthetic joint infections N-acetyl-L-cysteine Staphylococcus aureus Pseudomonas aeruginosa Bacterial biofilm

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References

Esposito

, Leone

Prosthetic joint infections: microbiology, diagnosis, management and prevention. Int J Antimicrob Agents. 2008; 32(4): 287–293.

Trampuz

, Zimmerli

Diagnosis and treatment of implant-associated septic arthritis and osteomyelitis. Curr Infect Dis Rep. 2008; 10(5): 394–403.

Hsieh

P.H.

, Lee

M.S.

, Hsu

K.Y.

, Chang

Y.H.

, Shih

H.N.

, Ueng

S.W.

Gram-negative prosthetic joint infections: risk factors and outcome of treatment. Clin Infect Dis. 2009; 49(7): 1036–1043.

Marculescu

C.E.

, Cantey

J.R.

Polymicrobial prosthetic joint infections: risk factors and outcome. Clin Orthop Relat Res. 2008; 466(6): 1397–1404.

Piper

K.E.

, Jacobson

M.J.

, Cofield

R.H.

Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol. 2009; 47(6): 1878–1884.

Wright

J.A.

, Nair

S.P.

Interaction of staphylococci with bone. Int J Med Microbiol. 2010; 300(2-3): 193–204.

Montanaro

, Speziale

, Campoccia

Scenery of Staphylococcus implant infections in orthopedics. Future Microbiol. 2011; 6(11): 1329–1349.

Gallo

, Landor

, Vavrík

Soucasné moznosti prevence infekcí kloubních náhrad (in Czech) [Current strategies for prevention of prosthetic joint infection]. Acta Chir Orthop Traumatol Cech. 2006; 73(4): 229–236.

Geipel

Pathogenic organisms in hip joint infections. Int J Med Sci. 2009; 6(5): 234–240.

10.

Matthews

P.C.

, Berendt

A.R.

, McNally

M.A.

, Byren

Diagnosis and management of prosthetic joint infection. BMJ. 2009; 338: 1773b.

11.

Rohde

, Burandt

E.C.

, Siemssen

Polysaccharide intercellular adhesin or protein factors in biofilm accumulation of Staphylococcus epidermidis and Staphylococcus aureus isolated from prosthetic hip and knee joint infections. Biomaterials. 2007; 28(9): 1711–1720.

12.

Aslam

Effect of antibacterials on biofilms. Am J Infect Control. 2008; 36(10): S175.e9-S175.e11.

13.

Olofsson

A.C.

, Hermansson

, Elwing

N-acetyl-L-cysteine affects growth, extracellular polysaccharide production, and bacterial biofilm formation on solid surfaces. Appl Environ Microbiol. 2003; 69(8): 4814–4822.

14.

Sheffner

A.L.

The mucolytic action of acetylcysteine. Tuberculol Thorac Dis. 1966; 23(2): 31–33.

15.

Christensen

G.D.

, Simpson

W.A.

, Younger

J.J.

Adherence of coagulase-negative staphylococci to plastic tissue culture plates: a quantitative model for the adherence of staphylococci to medical devices. J Clin Microbiol. 1985; 22(6): 996–1006.

16.

Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; Approved standard-Eighth Edition. M070-A8. Wayne, PA: CLSI; 2009.

17.

Trampuz

, Piper

K.E.

, Jacobson

M.J.

Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007; 357(7): 654–663.

18.

Pérez-Giraldo

, Rodríguez-Benito

, Morán

F.J.

, Hurtado

, Blanco

M.T.

, Gómez-García

A.C.

Influence of N-acetylcysteine on the formation of biofilm by Staphylococcus epidermidis.

J Antimicrob Chemother. 1997; 39(5): 643–646.

19.

Zhao

, Liu

N-acetylcysteine inhibit biofilms produced by Pseudomonas aeruginosa. BMC Microbiol. 2010; 10: 140.

20.

Aslam

, Trautner

B.W.

, Ramanathan

, Darouiche

R.O.

Combination of tigecycline and N-acetylcysteine reduces biofilm-embedded bacteria on vascular catheters. Antimicrob Agents Chemother. 2007; 51(4): 1556–1558.

21.

Aslam

, Darouiche

R.O.

Role of antibiofilm-antimicrobial agents in controlling device-related infections. Int J Artif Organs. 2011; 34(9): 752–758.

22.

El-Feky

M.A.

, El-Rehewy

M.S.

, Hassan

M.A.

, Abolella

H.A.

, Abd El-Baky

R.M.

, Gad

G.F.

Effect of ciprofloxacin and N-acetylcysteine on bacterial adherence and biofilm formation on ureteral stent surfaces. Pol J Microbiol. 2009; 58(3): 261–267.

23.

Oga

, Arizono

, Sugioka

Bacterial adherence to bioinert and bioactive materials studied in vitro.

Acta Orthop Scand. 1993; 64(3): 273-276.

24.

Arnold

J.W.

, Bailey

G.W.

Surface finishes on stainless steel reduce bacterial attachment and early biofilm formation: scanning electron and atomic force microscopy study. Poult Sci. 2000; 79(12): 1839–1845.

25.

Gordon

C.A.

, Hodges

N.A.

, Marriott

Use of slime dispersants to promote antibiotic penetration through the extracellular polysaccharide of mucoid Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1991; 35(6): 1258–1260.