In Vivo Prevention of Implant-Associated Infections Caused by Antibiotic-Resistant Bacteria through Biofunctionalization of Additively Manufactured Porous Titanium

I.A.J. van Hengel*, B. van Dijk, K. Modaresifar, J. Fred F. Hooning van Duyvenbode, F. Ruben H.A. Nurmohamed, M.A. Leeflang, A.C. Fluit, E.L. Fratila-Apachitei, I. Apachitei, Harrie Weinans, A.A. Zadpoor

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Additively manufactured (AM) porous titanium implants may have an increased risk of implant-associated infection (IAI) due to their huge internal surfaces. However, the same surface, when biofunctionalized, can be used to prevent IAI. Here, we used a rat implant infection model to evaluate the biocompatibility and infection prevention performance of AM porous titanium against bioluminescent methicillin-resistant Staphylococcus aureus (MRSA). The specimens were biofunctionalized with Ag nanoparticles (NPs) using plasma electrolytic oxidation (PEO). Infection was initiated using either intramedullary injection in vivo or with in vitro inoculation of the implant prior to implantation. Nontreated (NT) implants were compared with PEO-treated implants with Ag NPs (PT-Ag), without Ag NPs (PT) and infection without an implant. After 7 days, the bacterial load and bone morphological changes were evaluated. When infection was initiated through in vivo injection, the presence of the implant did not enhance the infection, indicating that this technique may not assess the prevention but rather the treatment of IAIs. Following in vitro inoculation, the bacterial load on the implant and in the peri-implant bony tissue was reduced by over 90% for the PT-Ag implants compared to the PT and NT implants. All infected groups had enhanced osteomyelitis scores compared to the noninfected controls.
Original languageEnglish
Article number520
Number of pages20
JournalJournal of Functional Biomaterials
Volume14
Issue number10
DOIs
Publication statusPublished - 2023

Keywords

  • additive manufacturing
  • titanium bone implants
  • surface biofunctionalization
  • MRSA
  • implant-associated infection
  • bone infection model

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