Background: Infection around an implanted orthopaedic device is a
devastating complication, and the treatment of infections involving
slime-forming bacteria is especially difficult. The purpose of the present
study was to evaluate the effectiveness of a proteolytic enzyme,
serratiopeptidase, in the eradication of a periprosthetic infection in an in
vivo animal model.
Methods: In sixty Sprague-Dawley rats, the medullary canal of the
right femur was drilled through the intercondylar notch and was inoculated
with a Staphylococcus epidermidis strain (ATCC 35984) with a high
slime-producing capacity. The cavity was filled with polymethylmethacrylate
cement, and a Kirschner wire that had contact with the knee joint was
inserted. None of the animals received any treatment for two weeks. Twenty
rats were killed at two weeks after the inoculation in order to determine if
the infection had become established. The remaining forty rats were randomized
into two groups. One group received serratiopeptidase enzyme injections into
the knee joint in addition to antibiotic therapy for four weeks, and the other
group received intra-articular saline solution injections together with the
same antibiotic therapy. The animals from both groups were killed two weeks
after the end of therapy (on Day 56). The knee specimens were evaluated
bacteriologically and histologically to determine the prevalence of persistent
infection and the effects of the enzyme on local tissue.
Results: At two weeks, inoculated bacteria grew on culture of
specimens from twelve (63.2%) of nineteen animals in the no-treatment group.
Microbiological testing suggested that infection persisted in only one (5.6%)
of eighteen animals in the serratiopeptidase-and-antibiotic group, whereas it
was present in six (37.5%) of sixteen animals in the antibiotic-only group (p
= 0.001). Histological evaluation showed similar results (kappa = 0.92).
Conclusions: Serratiopeptidase was effective for eradicating
infection caused by biofilm-forming bacteria in this experimental animal
model. The antibiofilm property of the enzyme may enhance antibiotic efficacy
in the treatment of staphylococcal infections.