2. Shocking: Elimination of S. Aureus Biofilm from Stainless Steel by Electrolysis Matthew J. Dietz, MD; Jacob Conjeski MD; Vincent L. Kish AS; Brian R. Hamlin, MD West Virginia University Department of Orthopaedics

4. Orthopaedic Biofilm Orthopaedic Biofilm Adherent Bacteria Adherent Bacteria EPS (extra-cellular polysaccharide) EPS (extra-cellular polysaccharide) Polymicrobial Polymicrobial

5. S. Aureus S. Epi EPS Implant Spork

6. “race for the surface” -- Gristina, A. “Biomaterial-Centered Infection: Microbial Adhesion Versus Tissue Integration. Science. Vol. 237, No. 4822. (Sep. 25, 1987), pp. 1588-1595 Bacterial Colonization vs. Tissue Integration Bacterial Colonization vs. Tissue Integration 100 - 1000x Antibioticsto Eliminate Biofilm

7. “Strategerie”

8. Debridement with Retention Staged Explant/Exchange Resection Arthroplasty ArthrodesisAmputation

9. Hypothesis

10. S. aureus S. aureusBIOFILM

11. Biofilm and WVU Orthopaedics Create Biofilm --Goeres et. al. “Statistical assessment of a laboratory method for growing biofilms.” Microbiology. 2005; 151: 757-762.

12. Where’s the Biofilm?

13. -- Rabinovitch, C et al. “Removal and Inactivation of Staphylococcus epidermidis Biofilms by Electrolysis.” App and Enviromental Microbiology. Sept 2006: 6364-66.

14. Control1 Volts Avg. 52.65% reduction in CFU’s/cm2 Anode (n=5) (n=5) Cathode Avg. 92.59% reduction in CFU’s/cm2

15. Biofilm and WVU Orthopaedics

16. Control 4 V 2 V 1 V 0.5 V

17. However…

18. Conclusions Need for adjuntive measures Connection to Cathode for S. aureus CFU reduction independent of voltage 98% of CFU’s via electrolysis 98% of CFU’s via electrolysis

19. To Do List…  Biofilm Models  Detection of Biofilm  Electrolysis  Various Metals  In-vivo  Vary biofilm makeup  Means of Removal

20. The War Continues… Thank You