Bromelain as a Source of Debridement for Infected Orthopedic Implants

<b><i>Introduction:</i></b> Enzymatic debridement has emerged as an alternative method to combat biofilms. Bromelain is an enzyme derived from pineapple stems that has been used in several studies as a method of biofilm dissolution (BD). As a result, researchers hypothesized that bromelain could be used to debride contaminated orthopedic implants. <b><i>Methods:</i></b> In this study, cortical bone screws were incubated in methicillin-resistant <i>Staphylococcus aureus</i> inoculated broth. Treatment groups were exposed to low-dose bromelain solution, high-dose bromelain solution, or bromelain powder with or without manual scrubbing of the implant. The screws were then stained with crystal violet dye and analyzed using optical density (OD). OD means were compared between each treatment group and their respective control group using analysis of variance. <b><i>Results:</i></b> Six screws were used for each group. The average OD of the low-dose bromelain solution group (0.104 ± 0.047) was no different compared with the control group (p = 0.345). The average ODs of the low-dose + scrub bromelain solution (0.068 ± 0.020) and high-dose + scrub solution (0.045 ± 0.014) were significantly different from their respective control group (p = 0.012; p = 0.001). The average ODs of screws in the high-dose (0.056 ± 0.012), powder (0.041 ± 0.010), and powder + scrub (0.032 ± 0.005) groups were also significantly different from their respective control group (p = 0.003; p = 0.001; p < 0.0001). <b><i>Discussion:</i></b> On the basis of these outcomes, bromelain is a promising alternative for the debridement of biofilm-contaminated orthopedic implants. Further investigation is required to assess how different concentrations and exposure times may affect the percentage of BD.