Abstract

Background: Staphylococcus aureus (S. aureus) is the most common pathogen responsible for osteomyelitis. Objectives: Our objective was to investigate the potential of a probiotic as a treatment for S. aureus-induced infection following fracture fixation in a rat model. Methods: Fifty male Sprague-Dawley rats were assigned to five groups (Control, S. aureus, S. aureus +ceftriaxone, S. aureus + once weekly probiotic, and S. aureus + twice weekly probiotic). Lactobacillus casei subsp. casei (ATCC: 39392) was selected from eight strains of probiotic bacteria with anti-staphylococcal activity. Infection was induced by inoculation with106 colony-forming units (CFU) of S. aureus in a closed femur fracture model stabilized with an intramedullary pin. Three weeks after the surgery, the development of infection and response to the therapy was documented using radiographs, microbiological and histopathological analysis. Results: No bacteria were recovered from rats in the Control group. The analysis of variance revealed a significant difference in the CFU/femur (P < 0.001) and CFU/pin (P = 0.001) across all five treatment groups. When the results were compared, the CFU/femur was significantly lower in the S. aureus + Probiotic twice weekly in comparison with S. aureus (P = 0.008) and the S. aureus + ceftriaxone (P = 0.012) groups. Repeated measure ANOVA to test the radiographic scores during the follow-up time between the intervention groups revealed no significant differences (P = 0.179). Conclusions: Parenteral administration of viable L. casei inhibits S. aureus-induced infection as shown by the bacteriologic analysis, but makes no difference to the radiological union rates. This could be the first step towards developing an effective, biologic adjunctive therapy for the management of osteomyelitis following fracture fixation.