Removal of Staphylococcus aureus from skin using a combination antibiofilm approach.

Staphylococcus aureus ( S. aureus ) including methicillin resistant S. aureus (MRSA) is one of the primary microorganisms responsible for surgical site infection (SSI). Since S. aureus contamination is known to originate from the skin, eradicating it on the skin surface at surgical sites is an important intervention to reduce the chance of SSIs. Here we developed and evaluated the efficacy of a combination probiotic/brush sonication strategy for skin preparation at surgical, injection and insertion sites in medicine. A 24 h biofilm on porcine skin explants was used as a worst-case scenario for the evaluation of preparation strategies. Conventional ethanol wipes achieved 0.8~2 log reduction in viable bacteria depending on how many times wiped (x4 or x6). Brush sonication or probiotic supernatant pre-treatment alone achieved a similar reduction as ethanol wipes (1.4 and 0.7~1.4 log reduction, respectively). Notably, combining sonication and probiotic pre-treatment achieved a 4 log reduction in viable bacteria. In addition, probiotic supernatant incubation times as short as 2 h achieved the full effect of this reduction in the combined strategy. These findings suggest the promising potential of combination-format skin preparation strategies that can be developed to more effectively penetrate cracks and folds in the skin to remove biofilms.