Preliminary Results of the Use of a Stabilized Hypochlorous Acid Solution in the Management of Ralstonia Pickettii Biofilm on Silicone Breast Implants

• Published in: Aesthetic surgery journal Vol. 38; no. suppl_2; p. S52
• Main Authors: Brindle, C Tod, Porter, Steve, Bijlani, Kiran, Arumugam, Sridhar, Matias, Rowena, Najafi, Ron, Fisher, Jack
• Format: Journal Article
• Language: English
• Published: England 15.05.2018
• Subjects: Anti-Bacterial Agents - administration & dosage; Biofilms - drug effects; Breast Implantation - adverse effects; Breast Implantation - instrumentation; Breast Implants - adverse effects; Breast Implants - microbiology; Humans; Hypochlorous Acid - administration & dosage; Microbial Sensitivity Tests; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - prevention & control; Ralstonia pickettii - drug effects; Ralstonia pickettii - isolation & purification; Ralstonia pickettii - physiology; Silicone Gels
• DOI: 10.1093/asj/sjx229

Ralstonia Pickettii biofilms are associated with pocket infections following breast implant surgeries. Biofilm protects bacteria most topically applied antimicrobial irrigations. To evaluate the effectiveness of four antimicrobial solutions on the planktonic form and established biofilm of Ralstonia Pickettii grown on 3 different types of silicone breast implants. Time kill assays at clinical concentrations of chlorhexidine gluconate, povidone iodine, triple-antibiotic solution, and a 0.025% hypochlorous acid solution stabilized in amber glass were evaluated. Normal saline was the control. Three types of silicone implants, two with a textured surface and one smooth surface, were selected. Planktonic assays were performed after implants were soaked for one, five, 30, and 120 minute time points. Biofilm assays were performed after 5 and 120 minutes of implant soak time. Both tests evaluated cell-forming units (CFU/mL). Triple antibiotic solution had no effect on R. pickettii and was dropped from the study. Remaining solutions showed total kill of planktonic bacteria at one minute. Saline control showed no significant effect on biofilm as anticipated. Stabilized hypochlorous acid was the only solution tested capable of eradicating R. pickettii biofilm on all implant surfaces tested within the first five minute soak time. Noncytotoxic, 0.025% hypochlorous acid in normal saline, stabilized in amber glass, successfully eradicated Ralstonia pickettii in planktonic and mature biofilm on three types of silicone implants during initial five minute soak time and may be the preferred antimicrobial solution for pocket lavage. This preliminary study requires further investigation. Leaching and implant compatibility testing is currently in progress.