Ex Vivo Toxicity of Commonly Used Topical Antiseptics and Antibiotics on Human Chondrocytes. 2022

Erika Garbrecht, and Benjamin Packard, and Phuong A H Nguyen, and Nafisa A Elghazali, and Christina Salas, and Deirdre A Hill, and Heather E Canavan, and Michael Decker

Topical povidone-iodine, chlorhexidine, bacitracin, and vancomycin are commonly used antiseptic and antimicrobial agents to reduce risk and treat surgical site infections in numerous orthopedic procedures. Chondrocytes potentially may be exposed to these agents during operative procedures. The impact of these topical agents on chondrocyte viability is unclear. The goal of this study is to determine human chondrocyte viability ex vivo after exposure to commonly used concentrations of these topical antiseptic and antimicrobial agents. Human osteochondral plugs were harvested from the knee joint of a human decedent within 36 hours of death. Individual human osteochondral plugs were exposed to normal saline as a control; a range of concentrations of povidone-iodine (0.25%, 0.5%, and 1%), chlorhexidine (0.01% and 0.5%), and bacitracin (10,000 units/L, 50,000 units/L, and 100,000 units/L) for 1-minute lavage; or a 48-hour soak in vancomycin (0.16 mg/mL, 0.4 mg/mL, and 1.0 mg/mL) with nutrient media. Chondrocyte viability was evaluated with a live/dead viability assay at 0, 2, 4, and 6 days after exposure to bacitracin at 0, 3, and 6 days). Control subjects showed greater than 70% viability at all time points. Povidone-iodine, 0.5% chlorhexidine, and vancomycin showed significant cytotoxicity, with viability dropping to less than 40% by day 6. Chondrocytes exposed to 0.01% chlorhexidine maintained viability. Chondrocytes exposed to bacitracin showed viability until day 3, when there was a large drop in viability. Commonly used topical concentrations of povidone-iodine, vancomycin, and bacitracin are toxic to human chondrocytes ex vivo. A low concentration of chlorhexidine appears safe. Caution should be used when articular cartilage may be exposed to these agents during surgery. [Orthopedics. 2022;45(5):e263-e268.].

UI MeSH Term Description Entries
D011206 Povidone-Iodine An iodinated polyvinyl polymer used as topical antiseptic in surgery and for skin and mucous membrane infections, also as aerosol. The iodine may be radiolabeled for research purposes. PVP-Iodine,Polyvinylpyrrolidone Iodine,Alphadine,Betadine,Betaisodona,Disadine,Isodine,PVP-I,Pharmadine,Providine,Alphadines,Betadines,Disadines,Isodines,PVP Iodine,PVP-Iodines,Pharmadines,Polyvinylpyrrolidone Iodines,Povidone Iodine,Povidone-Iodines,Providines
D002710 Chlorhexidine A disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. Chlorhexidine Acetate,Chlorhexidine Hydrochloride,MK-412A,Novalsan,Sebidin A,Tubulicid,Acetate, Chlorhexidine,Hydrochloride, Chlorhexidine,MK 412A,MK412A
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000077330 Saline Solution A crystalloid solution that contains 9.0g of SODIUM CHLORIDE per liter of water. It has a variety of uses, including: as a CONTACT LENS SOLUTION, in OPHTHALMIC SOLUTIONS and NASAL LAVAGE, in wound irrigation, and for FLUID THERAPY. 0.9% NaCl,0.9% Saline,Normal Saline,Saline, 0.9%,Saline, Normal
D000891 Anti-Infective Agents, Local Substances used on humans and other animals that destroy harmful microorganisms or inhibit their activity. They are distinguished from DISINFECTANTS, which are used on inanimate objects. Anti-Infective Agents, Topical,Antiseptic,Antiseptics,Microbicides, Local,Microbicides, Topical,Antiinfective Agents, Local,Antiinfective Agents, Topical,Local Anti-Infective Agents,Local Antiinfective Agents,Topical Anti-Infective Agents,Topical Antiinfective Agents,Agents, Local Anti-Infective,Agents, Local Antiinfective,Agents, Topical Anti-Infective,Agents, Topical Antiinfective,Anti Infective Agents, Local,Anti Infective Agents, Topical,Local Anti Infective Agents,Local Microbicides,Topical Anti Infective Agents,Topical Microbicides
D000900 Anti-Bacterial Agents Substances that inhibit the growth or reproduction of BACTERIA. Anti-Bacterial Agent,Anti-Bacterial Compound,Anti-Mycobacterial Agent,Antibacterial Agent,Antibiotics,Antimycobacterial Agent,Bacteriocidal Agent,Bacteriocide,Anti-Bacterial Compounds,Anti-Mycobacterial Agents,Antibacterial Agents,Antibiotic,Antimycobacterial Agents,Bacteriocidal Agents,Bacteriocides,Agent, Anti-Bacterial,Agent, Anti-Mycobacterial,Agent, Antibacterial,Agent, Antimycobacterial,Agent, Bacteriocidal,Agents, Anti-Bacterial,Agents, Anti-Mycobacterial,Agents, Antibacterial,Agents, Antimycobacterial,Agents, Bacteriocidal,Anti Bacterial Agent,Anti Bacterial Agents,Anti Bacterial Compound,Anti Bacterial Compounds,Anti Mycobacterial Agent,Anti Mycobacterial Agents,Compound, Anti-Bacterial,Compounds, Anti-Bacterial
D001414 Bacitracin A complex of cyclic peptide antibiotics produced by the Tracy-I strain of Bacillus subtilis. The commercial preparation is a mixture of at least nine bacitracins with bacitracin A as the major constituent. It is used topically to treat open infections such as infected eczema and infected dermal ulcers. (From Goodman and Gilman, The Pharmacological Basis of Therapeutics, 8th ed, p1140) Ak-Tracin,Altracin,Baci-IM,Baci-Rx,Baciguent,Bacitin,Bacitracin Zinc,Bacitracin Zinc Complex,Bacitracine Martinet,Ocu-Tracin,Topitracin,Zeba-Rx,Zinc Bacitracin,Ak Tracin,Baci IM,Baci Rx,Bacitracin, Zinc,Martinet, Bacitracine,Ocu Tracin,OcuTracin,Zeba Rx,Zinc, Bacitracin
D014640 Vancomycin Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to RISTOCETIN that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. AB-Vancomycin,Diatracin,VANCO-cell,Vanco Azupharma,Vanco-saar,Vancocin,Vancocin HCl,Vancocine,Vancomicina Abbott,Vancomicina Chiesi,Vancomicina Combino Phar,Vancomicina Norman,Vancomycin Hexal,Vancomycin Hydrochloride,Vancomycin Lilly,Vancomycin Phosphate (1:2),Vancomycin Phosphate (1:2), Decahydrate,Vancomycin Sulfate,Vancomycin-ratiopharm,Vancomycine Dakota,Hydrochloride, Vancomycin,Sulfate, Vancomycin
D019902 Chondrocytes Polymorphic cells that form cartilage. Chondroblasts,Chondroblast,Chondrocyte

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