The biofilm eradication activity of acetic acid in the management of periprosthetic joint infection

Objectives
Periprosthetic joint infection following joint replacement surgery is one of the most feared complications. The key to successful revision surgery for periprosthetic joint infections, regardless of treatment strategy is a thorough deep debridement. In an attempt to limit antimicrobial and disinfectant use, there has been increasing interest in the use of acetic acid as an adjunct to debridement strategies in the management of periprosthetic joint infections. However, its effectiveness in the eradication of established biofilms following clinically-relevant treatment times has not yet been established. Using an in vitro biofilm model this study aimed to establish the minimum biofilm eradication concentration (MBEC) of acetic acid following a clinically-relevant treatment time.
Methods
Using a methicillin-sensitive Staphylococcus aureus (MSSA) reference strain and the dissolvable bead assay, biofilms were challenged by 0-20% acetic acid (pH 4.7) for 10 minutes, 20 minutes, 180 minutes, and 24 hours.
Results
The MBEC of acetic acid was found to be; 15%, 11%, 3.2%, and 0.8% following a 10-minute, 20-minute, 180-minute, and 24-hour treatment, respectively.
Conclusion
This study found that the MBEC of acetic acid following a 10- or 20-minute treatment time exceeded its safety threshold, making these concentrations unsuitable as a topical debridement adjunct. However, a clinically acceptable concentration (5%) was still found to eliminate 96.1% of biofilm-associated MSSA following a 20-minute treatment time.