Efficacy of Povidone Iodine Against Microbial Biofilms in Breast Implants With Different Textures: Results From an in vitro Study

Borja Fernández-Ibarburu; Marta Díaz-Navarro; Gorka Ibarra; Andrés Rivera; Rama Hafian; Ãlvaro Irigoyen; Raquel Carrillo; Rosa Pérez-Cano; Patricia Muñoz; Ángela García-Ruano; José M Lasso; María Guembe

doi:10.3389/fmicb.2022.868347

Efficacy of Povidone Iodine Against Microbial Biofilms in Breast Implants With Different Textures: Results From an in vitro Study

Front Microbiol. 2022 Mar 29:13:868347. doi: 10.3389/fmicb.2022.868347. eCollection 2022.

Authors

Borja Fernández-Ibarburu¹, Marta Díaz-Navarro^{2

3}, Gorka Ibarra¹, Andrés Rivera¹, Rama Hafian^{2

3}, Ãlvaro Irigoyen³, Raquel Carrillo³, Rosa Pérez-Cano^{1

2}, Patricia Muñoz^{2

3

4

5}, Ángela García-Ruano¹, José M Lasso^{1

2}, María Guembe^{2

3}

Affiliations

¹ Department of Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
² Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
³ Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
⁴ CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.
⁵ Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.

Abstract

Background: In the practice of breast augmentation and reconstruction, implant irrigation with various solutions has been widely used to prevent infection and capsular contracture, but to date, there is no consensus on the optimal protocol to use. Recently, application of povidone iodine (PI) for 30 min has shown in vitro to be the most effective irrigating formula in reducing contamination in smooth breast implants. However, as 30 min is not feasible intraoperatively, it is necessary to determine whether shorter times could be equally effective as well as to test it in both smooth and textured implants.

Methods: We tested the efficacy of 10% PI at 1', 3', and 5' against biofilms of 8 strains (2 ATCC and 6 clinical) of Staphylococcus spp. on silicone disks obtained from Mentor^® and Polytech^® implants of different textures. We analyzed the percentage reduction of cfu counts, cell viability and bacterial density between treatment (PI) and control (sterile saline, SS) groups for each time of application. We consider clinical significance when > 25% reduction was observed in cell viability or bacterial density.

Results: All textured implants treated with PI at any of the 3 exposure times reduced 100% bacterial load by culture. However, none of the implants reached enough clinical significance in percentage reduction of living cells. Regarding bacterial density, only 25-50 μm Polytxt^® Polytech^® implants showed significant reduction at the three PI exposure times.

Conclusion: PI is able to inhibit bacterial growth applied on the surface of breast implants regardless of the exposure time. However, no significant reduction on living cells or bacterial density was observed. This lack of correlation may be caused by differences in texture that directly affect PI absorption.

Keywords: biofilm; breast implant; in vitro model; irrigating solutions; pocket irrigation; povidone iodine.