Abstract
Periprosthetic joint infection (PJI) caused by fungi is rare but can lead to devastating outcomes. However, the best treatment for fungal PJI has not been established. This study aims to identify the optimal surgical irrigation solution to reduce the bioburden of Candida biofilm from prosthetic surfaces. Candida albicans biofilm was cultured on titanium screw caps and treated for 3 min and 10 min using five clinically used irrigation solutions: Normal Saline, Fluconazole solution (2000 µg/mL), Nystatin solution (5000 IU/mL), Chlorhexidine (0.05%), Povidone Iodine (0.35%), and Povidone Iodine (10%). The biofilm on the screw caps was quantified by counting colony-forming units after sonication to assess the effectiveness of the irrigation solutions. Irrigation with normal saline resulted in 5.9 ± 1.6 × 104 CFU/mL of Candida albicans per titanium screw cap. As compared to the normal saline, the most effective irrigation solution at 3 min was PI 10%, achieving over a 2-log reduction in CFU/ml. Other chemical irrigation solutions resulted in approximately a 1-log reduction. Extending the irrigation time to 10 min led to a further reduction in biofilm, with PI 0.35% and PI 10% achieving remarked removal. These findings suggest that PI 10% is the most effective irrigation solution for treating Candida-induced PJI when applied for 3 min. However, its efficacy is time dependent, and prolonged irrigation can achieve clinical significance even at lower concentrations.
Data availability
The datasets generated and analyzed during the current study are not publicly available but are available from the corresponding author upon reasonable request. The raw SEM images and experimental datasets (including Excel files) supporting the findings of this study can be accessed upon request.
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Acknowledgements
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (RS-2023-00217471) and by a research fund from Chosun University Hospital, 2025.
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J.H. and Y.M. performed the experiments, collected, analyzed, and interpreted the data, and wrote the manuscript. S.C. supervised the experiments and provided technical guidance. H.K. contributed to manuscript writing and provided clinical insights. S.J. conceptualized the study, interpreted the data, acquired the funding, and revised the manuscript. All authors contributed to the article and approved the submitted version.
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Hong, JY., Moon, Y.G., Choi, S.K. et al. Povidone iodine demonstrates strong efficacy in reducing Candida biofilm in an in vitro fungal prosthetic infection. Sci Rep (2026). https://doi.org/10.1038/s41598-026-42366-6
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DOI: https://doi.org/10.1038/s41598-026-42366-6
