CORR Insights®: What Are the Effects of Irreversible Electroporation on a Staphylococcus aureus Rabbit Model of Osteomyelitis?

Osteomyelitis is a rare, but serious bone infection that may result from trauma, hematogenous spread, or chronic open wounds [12]. Treating osteomyelitis can be challenging because of antimicrobial resistance [9], biofilm formation [19], the presence of an avascular necrotic sequestrum [3], or internalization of bacteria within osteoblasts [25]. For elective surgical procedures like joint arthroplasty, antimicrobial therapy and aseptic techniques successfully prevent infection approximately 99% of the time [22], but once osteomyelitis has been established, the likelihood of treatment success varies widely, from 25% to 90% for established osteomyelitis, depending on many factors [6]. Early in the infectious process, antibiotic chemotherapy alone may eradicate osteomyelitis [5], though in moreadvanced or more severe infections, surgical débridement often comes into the picture [3], and surgical approaches may be augmented with targeted delivery of antibiotics directly to the affected tissue through local delivery devices such as antibiotic-loaded bone cement, calcium sulfate, or polymer sponges and gels [7, 10, 16, 24]. However, infection recurrence resulting from inadequate débridement or not clearing dormant biofilm bacteria can result in infection persistence, the need for repeat (andmore-aggressive) débridement, and even amputation of the affected limb [4, 8]. Novel therapeutics that both treat affected tissue and eradicate bacteria are desperately needed. The aim of the exploratory study by Muñoz and colleagues [13] is to determine whether a novel technique currently investigated for ablation of cancerous soft-tissue tumors might also have effective application in the treatment of osteomyelitis. The small preclinical study only followed animal outcomes for a 28-day period following treatment, but nonetheless provides promising evidence of a synergistic effect in killing Staphylococcus aureus within osteomyelitic bone.