{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:42:10Z","timestamp":1790919730334,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,9,18]]},"abstract":"\n Background:<\/jats:title>\n Many surgeons add topical antibiotics to irrigation solutions assuming that this has a local effect and eliminates bacteria. However, prior studies have suggested that the addition of antibiotics to irrigation solution confers little benefit, adds cost, may potentiate anaphylactic reactions, and may contribute to antimicrobial resistance. We sought to compare the antimicrobial efficacy and cytotoxicity of an irrigation solution containing polymyxin-bacitracin with other commonly used irrigation solutions.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n Staphylococcus aureus<\/jats:italic>\n and\n Escherichia coli<\/jats:italic>\n were exposed to irrigation solutions containing topical antibiotics (500,000-U\/L polymyxin and 50,000-U\/L bacitracin; 1-g\/L vancomycin; or 80-mg\/L gentamicin), as well as commonly used irrigation solutions (saline solution 0.9%; povidone-iodine 0.3%; chlorhexidine 0.05%; Castile soap 0.45%; and sodium hypochlorite 0.125%). Following 1 and 3 minutes of exposure, surviving bacteria were manually counted. Failure to eradicate all bacteria in any of the 3 replicates was considered not effective for that respective solution. Cytotoxicity analysis in human fibroblasts, osteoblasts, and chondrocytes exposed to the irrigation solutions was performed by visualization of cell structure and was quantified by lactate dehydrogenase (LDH) activity. Efficacy and cytotoxicity were assessed in triplicate experiments, with generalized linear mixed models.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Polymyxin-bacitracin, saline solution, and Castile soap at both exposure times were not effective at eradicating\n S. aureus<\/jats:italic>\n or\n E. coli<\/jats:italic>\n . In contrast, povidone-iodine, chlorhexidine, and sodium hypochlorite irrigation were effective against both\n S. aureus<\/jats:italic>\n and\n E. coli<\/jats:italic>\n (p < 0.001). Vancomycin irrigation was effective against\n S. aureus<\/jats:italic>\n but not against\n E. coli,<\/jats:italic>\n whereas gentamicin irrigation showed partial efficacy against\n E. coli<\/jats:italic>\n but none against\n S. aureus.<\/jats:italic>\n Within fibroblasts, the greatest cytotoxicity was seen with chlorhexidine (mean [and standard error], 49.38% \u00b1 0.80%; p < 0.0001), followed by Castile soap (33.57% \u00b1 2.17%; p < 0.0001) and polymyxin-bacitracin (8.90% \u00b1 1.40%). Povidone-iodine showed the least cytotoxicity of the efficacious solutions (5.00% \u00b1 0.86%). Similar trends were seen at both exposure times and across fibroblasts, osteoblasts, and chondrocytes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Irrigation with polymyxin-bacitracin was ineffective at bacterial eradication, and statistically inferior to povidone-iodine. Chlorhexidine lavage conferred the greatest in vitro cytotoxicity.<\/jats:p>\n <\/jats:sec>\n \n Clinical Relevance:<\/jats:title>\n These data suggest that the addition of polymyxin-bacitracin to saline solution irrigation has little value. Given the cost and antimicrobial resistance implications, our findings, combined with prior clinical literature, provide adequate reason to avoid widespread use of antibiotics in irrigation solutions. Povidone-iodine may be a more effective and safer option.<\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.18.01362","type":"journal-article","created":{"date-parts":[[2019,9,25]],"date-time":"2019-09-25T11:13:16Z","timestamp":1569409996000},"page":"1689-1697","source":"Crossref","is-referenced-by-count":34,"title":["Polymyxin and Bacitracin in the Irrigation Solution Provide No Benefit for Bacterial Killing in Vitro"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0217-4752","authenticated-orcid":false,"given":"Karan","family":"Goswami","sequence":"first","affiliation":[{"name":"Parvizi Surgical Innovation, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8910-1216","authenticated-orcid":false,"given":"Jeongeun","family":"Cho","sequence":"additional","affiliation":[{"name":"Parvizi Surgical Innovation, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2997-1316","authenticated-orcid":false,"given":"Carol","family":"Foltz","sequence":"additional","affiliation":[{"name":"Parvizi Surgical Innovation, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0895-2586","authenticated-orcid":false,"given":"Jorge","family":"Manrique","sequence":"additional","affiliation":[{"name":"Parvizi Surgical Innovation, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2015-3162","authenticated-orcid":false,"given":"Timothy L.","family":"Tan","sequence":"additional","affiliation":[{"name":"Parvizi Surgical Innovation, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6626-9913","authenticated-orcid":false,"given":"Yale","family":"Fillingham","sequence":"additional","affiliation":[{"name":"Parvizi Surgical Innovation, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9143-2455","authenticated-orcid":false,"given":"Carlos","family":"Higuera","sequence":"additional","affiliation":[{"name":"Parvizi Surgical Innovation, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2913-7513","authenticated-orcid":false,"given":"Craig","family":"Della Valle","sequence":"additional","affiliation":[{"name":"Parvizi Surgical Innovation, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-5870","authenticated-orcid":false,"given":"Javad","family":"Parvizi","sequence":"additional","affiliation":[{"name":"Parvizi Surgical Innovation, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"4","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1308\/1478708051847","article-title":"Intra-operative peritoneal lavage\u2014who does it and why?","volume":"87","author":"Whiteside","year":"2005","journal-title":"Ann R Coll Surg Engl."},{"issue":"1","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.arth.2011.03.034","article-title":"Dilute Betadine lavage before closure for the prevention of acute postoperative deep periprosthetic joint infection","volume":"27","author":"Brown","year":"2012","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s00268-010-0862-0","article-title":"Measures to prevent surgical site infections: what surgeons (should) do","volume":"35","author":"Diana","year":"2011","journal-title":"World J Surg."},{"issue":"4","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1089\/sur.2016.272","article-title":"Systematic review and meta-analysis of randomized controlled trials evaluating prophylactic intra-operative wound irrigation for the prevention of surgical site infections","volume":"18","author":"de Jonge","year":"2017","journal-title":"Surg Infect (Larchmt)."},{"issue":"7","key":"bib6-20230810","first-page":"1415","article-title":"Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. 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