An Experimental Murine Model to Assess Biofilm Persistence on Commercial Breast Implant Surfaces
, Leire Fernández-Ciriza 3, Carlos Berniz 4, Cristina Gomez-Martinez de Lecea 4, Ana Ramos 3, Bernardo Hontanilla 2,4 and Jose L. del Pozo 1,2,3,*Round 1
Reviewer 1 Report
- Authors have found that “infection was achieved in 88.9% of macrotextured implants (i.e., 24 McGhan), 37.0% of microtexturized implants (i.e., Mentor), and 18.5% of smooth implants (i.e., 25 Allergan Smooth) in the short-term (p<0.001)”. Did the authors conduct the interaction of these materials with bacteria under in vitro situations before performing in vivo experiments? It would be interesting to perform in vitro investigation to differentiate the susceptibility of these implants toward bacterial colonization.
- In line 68, the authors mentioned that they removed residual silicone from the whole implant. What is the reason for doing this process?
- Line 72 to 76, Please provide an explicit explanation of the infection procedure. Were bacteria incubated with implants for 48 hours and then used for implantations, or was only 24 hours of incubation given before implantation?
- Table 1 indicates that the infection rate is not 100 per cent, particularly 37.0 % in microtexturized implants (i.e., Mentor) and 18.5% in smooth implants. How could this low infection rate be used to evaluate the efficacy of antibiotics? Please explain it in the discussion (lines 245 to 247).
- Why did the authors not decide on a single time point for short-term and long-term incubations? The short-term incubation was done after 1-2 weeks and the long-term incubation after 3-5 weeks. There is a considerable variation in time at each point, which could influence the biofilm formation on implants.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Dear Authors,
The topic of the manuscript “ An experimental murine model to assess biofilm persistence on commercial breast implant surfaces” is very interesting and connected with still actual and intensively studied the problem of infection connected with biofilm formation on implants. A few comments are listed below:
Materials & methods
Page 2, line 69: Has it been verified that this heat sterilization didn’t change the property of sterilized materials?
Page 2, line 71: I suggest „pieces of implant samples”
Sincerely
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 3 Report
Major:
1 - As mentioned in the discussion (line 308), a major limitation is the use of a single organism, S. epidermidis. The authors don't even mention S. aureus which is the predominant organism recovered from all surgical operations.
2 - Outside surgeons, the names of the implants are not important. It would be useful instead to label the figures and tables with the surface texture not the manufacturer. Also, be consistent with order. In Table 1 the order is Natrelle, Mentor, McGhan but in Table 2 the order is Natrelle, McGhan, Mentor. It makes comparisons difficult.
3 - A major advantage described is the use of multiple implants per animal and potentially different types to mitigate animal variability. However, I wonder with the long-term infections how you can be sure one implant doesn't seed another implant with bacteria. I.e. - how can you be sure bacteria don't transit between implants?
Minor:
1 - Line 77 - Why were the control implants vortexed and sonicated while the infected implants were not?
2 - Line 78 - It would be important for comparison to know the amount of adhered bacteria on the implant prior to implantation. That way an assessment of the potential increase or decrease in burden could be assessed.
3 - Line 100 - There is no result or discussion describing the clinical animal observations.
4 - Line 127 - Do you mean quantitative here?
5 - Figure 3 - Perhaps instead of "Panel A" use "Implant" with a small A in the upper corner for reference.
6 - Table 3 - Perhaps but this as a supplment and use * to indicate significant interactions in Table 2.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
The revised manuscript has been updated according to the suggestions.
Reviewer 3 Report
Authors made suggested changes or compelling arguments for all of my concerns and comments.
