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Bacterial Infection of Spine Instrumentation and Microbial Influenced Corrosion (MIC): Chicken or Egg

Volume 1 - Issue 6

Reed Ayers*, Christopher Kleck, Mackenzie Miller and Evalina Burger

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    • Department of Orthopedics, University of Colorado, United States

    *Corresponding author: Reed Ayers, Ph.D, Department of Orthopedics, University of Colorado, School of Medicine, 12631 E. 17th Avenue, B202 Room 4603, Aurora, CO 80045, United States, ORCID: 0000-0003-1646-251X

Received: November 03, 2017;   Published: November 13, 2017

DOI: 10.26717/BJSTR.2017.01.000521

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Abstract

There is evidence that microbes including bacteria and macrophages are associated with in the presence biomedical alloys implants for orthopedic procedures [1-4]. The corrosion of metal alloys (A316L Surgical stainless steel; ASTM F136 ELI Ti6Al4V; ASTM F75/F1537/F799 CoCrMoC) in-vivo has also been well documented [5-8]. Proprionibacterium acnes as well as Staphylococcus Epidermis are considered sulfur reducing bacteria in the petroleum industry and have been found in petroleum stockpiles and pipelines [9,10]. These bacteria are associated with pipeline corrosion in oil fields and refineries [9]. In our own clinical experiences, we have noted a large number of spine metallosis cases and believe that the corrosion of implants and surgical site infections with P. acnes bacteria, or other sulfur reducing bacteria, are intimately connected in revisions and clinical infections. In our practice we observed an association between infection and implant corrosion leading to the initiation of a study examining revision of spinal instrumentation and patient outcomes. In patients who underwent spine instrumentation revision, who had grey or black stained tissues taken for culture in the OR and subsequent to the revision, we found 4 of 10 having P. acnes and Staph. epidermis present as a latent infection. A few patients showed clinical signs of infection, requiring subsequent drains and wash-out to clear all presence of bacteria. As early as 1999, P. acnes and Staph spp. were shown to be associated with orthopedic infections, where it was detected in 63% of sonicated samples taken from 120 patients receiving total hip revision [4]. As recently as 2016, P. acnes were highlighted as a possible contributor to post operative infections in orthopedic procedures [1]. These commensal skin dwelling microbes are anaerobic, sulfur reducing bacteria [11-13]. P. acnes, Staph. aureus and epidermis have been isolated as biofilm forming bacteria in orthopedics as well [3].

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