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Background: The 2015 forest fire disaster affected almost 2.6 million hectares of land in Indonesia, and Riau was among the worst. Firefighters were the first responders to deal with the disaster, but a little was known about the influence of extinguishing forest fire activities with their health. This study aimed to evaluate respiratory symptoms and lung function among firefighters 6 months after forest fire exposure.Methods: Interviews were conducted regarding sociodemographic factors, respiratory symptoms, and history of forest fire exposure during the disaster. Spirometry and chest X-ray were also carried out with standard techniques. Statistical analysis was performed based on the existing data. Ninety firefighters participated in this study, most were male with mean age of 33 years old. About 66% were smoker, had been working as firefighters for 2 to 10 years, and had been on extinguishing forest fire duty around 2–5 hours/day during the disaster.Results: All firefighters reported respiratory symptoms after 3 months. Pulmonary function was abnormal in 50% of subjects with mild restrictive characteristic. The analysis showed that body mass index (BMI) and duration of exposure had a significant correlation with pulmonary function abnormality.Conclusion: Pulmonary function was found abnormal in most subjects 6 months after forest fire exposure in Riau.

Background: Traffic policemen are very susceptible to respiratory problems due to the potential for exposure to air pollution. Therefore, this study aimed to assess respiratory health aspects of traffic policemen in Bogor, West Java. Method: Registered traffic policemen in Bogor were evaluated for respiratory symptoms, smoking habits, Fagerström Test for Nicotine Dependence (FTND) Questionnaire, chest x-ray, and spirometry. Air quality measurements were also carried out as a reference. Result: During the study period, the air quality in Bogor was classified as “Good” and below the ambient air pollutant standard. A total of 95 traffic policemen participated with a mean age of 37.3±8.7 years (range 23–57 years), mean Body Mass Index (BMI) of 28.1±4.2 kg/m2, and a length of service of 3-38 years (mean of 12.3 years). Mild pulmonary function impairment was found in 7.4% of subjects. About 61% of subjects had a smoking habit but with a low addiction index (FTND) and exCO. Decreased lung function was correlated to BMI and age (P

Backgorunds: Mediastinal germ cell tumors are relatively rare. These tumors can be benign or malignant, which has a poor prognosis malignant. Nowadays, multimodality therapy can improve the survival rate of patients’ mediastinal germ cell tumors. This study aims to determine the characteristics and factors affecting the 1-year survival rate of mediastinal germ cell tumors patients in the Persahabatan Hospital, Jakarta. Methods: The study was conducted using retrospective cohort of mediastinal germ cell tumors patients medical records in Persahabatan Hospital, Jakarta from January 1, 2007 to December 31, 2012. Data obtained were analyzed using Kaplan Meier analysis of survival. Results: As much as 60 subjects participated in this study. Mediastinal germ cell tumors were found more in male (80%) with a median age of 21 years and especially in the age group of 20-29 years (43.3%). Most clinical symptoms found were shortness of breath (66.7%), most patients came with performance status (PS) 2 (50%). The majority of the mediastinal germ cell tumors found were teratomas (53.3%), followed with nonseminoma (40%) and seminomas (6.7%). Factors affecting the survival rate of mediastinal germ cell tumors were performance status of, the patients, treatment, complications and location of the tumors. One-year survival rate of mediastinal germ cell tumors in this study was 41.67% and affected by patients’ performance status, tumor location, complications and treatment. Conclusion: Mediastinal germ cell tumors were mostly found in male, with the chief complain of dypnea and mostly was teratoma. Mediastinal germ cell tumors have high mortality rate. The 1-year survival was influenced by patient’s performance status, tumor location, complications and treatment. (J Respir Indo. 2020; 40(2): 97-102)

Background: Lung cancer and pulmonary tuberculosis (TB) are two major public health problems associated with significant morbidities and mortalities. The increased prevalence of active TB and latent TB reactivation in lung cancer patients and negative effect of pulmonary TB in lung cancer prognosis needed screening of lung cancer patients for latent TB infection (LTBI). This study aimed to determine the proportion of LTBI in lung cancer patients, their characteristics and the relationship between them. Methods: This study used cross-sectional design. Collecting sample used consecutive sampling of 86 newly diagnosed treatment-naive lung cancer patients from RSUP Persahabatan in 2015 to 2016. The presence of LTBI was determined by Quantiferon-TB Gold-In-Tube (QFT- GIT) after having Mycobacterium TB not detected result from Xpert MTB/RIF sputum test. Demographic characteristics and cancer-related factors associated with LTBI were investigated. Results: The results of latent TB tests were IGRA(+) 12.8%, IGRA(-) 68.6% and IGRA(I) 18.6%. Number of male patients with lung cancer with latent were 68.6%, as many as 55.8% were immunized with BCG, 4.6% had close contact with TB and 64% were using smoking. Most types of cancer were adenocarcinomas (77.9%) with advanced stage (82.6%) and general display status 2 (50%). The characteristics that show an association with IGRA results are the location of the cancer and the total lymphocyte count. Conclusion: The proportion of latent TB in lung cancer patients at the RSUP Persahabatan was 12.8%. The location of the cancer associated with the area of typical TB was related to latent TB, although it cannot be canceled. Results of IGRA(I) in lung cancer patients with low total lymphocyte counts prove IGRA sensitivity in the protection of latent TB infection in immunocompromised patients. (J Respir Indo. 2019; 39(4): 256-65)

Background: Indonesia has the highest cigarette consumption in the world. We explored the clinical impact of smoking on the prevalence of EGFR and K-RAS mutations and survival in this prospective study. Methods: 143 treatment naive lung cancer patients were recruited from Persahabatan Hospital, a national tertiary hospital. DNA from cytological specimens had been extracted and genotyped for both EGFR and K-RAS mutations using a combination of PCR high resolution melting, restriction fragment length polymorphism (RFLP) and direct DNA sequencing. Results: EGFR mutation frequency in never smokers (NS) and ever smokers (ES) were 75% and 56% (p = 0.0401), respectively. In this cohort, the overall K-RAS mutation rate was 7%. Neither gender nor smoking history were associated with K-RAS mutation significantly. However, K-RAS transversion mutations were more common in male ES than transition mutations. Smoking history did not affect EGFR and K-RAS mutation frequencies in women. Concurrent EGFR/K-RAS mutation rate was 2.8% (4 of 143 patients). Four out of 91 EGFR mutation positive patients (4.4%) had simultaneous K-RAS mutation. Conclusions: In region where cigarette consumption is prevalent, smoking history affected frequencies of EGFR and K-RAS mutations, mainly in males.

The emergency hospital is intended to prevent transmission of COVID-19 in the community by isolating patients without symptoms, with mild or moderate symptoms. This study evaluated the clinical characteristics and outcomes of COVID-19 patients who were admitted to this facility. This retrospective study reviewed data of patients treated at the National Emergency Hospital Wisma Atlet Kemayoran in Jakarta, Indonesia, from March 23 to April 30, 2020. Patient characteristics (clinical symptoms, laboratory test results, Chest X-Ray, SARS-CoV-2 immunoserology, and RT-PCR results from nasopharyngeal/ oropharyngeal preparations) were compared between severity groups. There were 413 COVID-19 cases analyzed, of which 190 (46%) were asymptomatic, 93 (22.5%) were mild, and 130 (31.5%) were moderate cases. Most asymptomatic cases were male, with young age, and without comorbidity. Mild cases were dominated by female and young patients, while most moderate cases were male and older patients. The number of patients with comorbidities was higher in mild and moderate cases. The patient’s overall outcome was good and did not differ based on the severity of symptoms. Despite the many challenges, patients with moderate symptoms can be safely treated in the emergency hospital.

The detection of Aspergillus antibody has a key role in the diagnosis of chronic pulmonary aspergillosis. Western blot (WB) and immunochromatography (ICT) lateral flow detection of Aspergillus antibody can be used as confirmatory and screening assays but their comparative performance in TB patients is not known. This study investigated the performance of these assays among 88 post-tuberculosis patients with suspected CPA. Sensitivity, specificity, receiver operating curve (ROC), area under-curve (AUC) and the agreement between two assays were evaluated. Both WB and ICT showed good sensitivity (80% and 85%, respectively) for detection of Aspergillus antibodies. Substantial agreement (0.716) between these assays was also obtained. The highest AUC result (0.804) was achieved with the combination of WB and ICT. The global intensity of WB correlated with the severity of symptoms in CPA group (p = 0.001). The combination of WB and ICT may increase specificity in CPA diagnosis.

BACKGROUND Indonesia forest fire in 2015 emitted a huge amount of pollutants into the air. This study was aimed to assess the health consequences of forest fire smoke in healthy residents in Riau during forest fire disaster in 2015. METHODS This cross-sectional study was performed in healthy residents who lived in Pekanbaru, Riau Province, Sumatera, for at least 6 months during forest fire disaster in 2015, and data were taken in October 2015. Questionnaires consisting of respiratory and non-respiratory symptoms were collected. Lung function was assessed by spirometry (MIR II Spirolab™ spirometer, Medical International Research, Italy) and exhaled carbon monoxide (CO) was assessed using piCO+ Smokerlyzer®. Heart rate at rest and oxygen saturation in the room air were measured using Onyx 9591 Pulse Oximeter®. RESULTS A total of 89 subjects were mostly female (75.3%), housewife (37.7%), nonsmoker (86.5%) with mean age of 38.9 years old. The non-respiratory and respiratory symptoms were reported in 84.7% and 71.4% subjects, respectively. Lung function was impaired in 72.6% subjects, mostly with mild obstruction and mild restriction. Exhaled CO was highly detected over normal values (mean [standard deviation] = 32.6 [9.97] ppm) with predicted carboxyhemoglobin (COHb) of 5.74 (1.56). CONCLUSIONS Forest fire smoke exposure increased the respiratory and nonrespiratory symptoms among healthy individuals, which showed impairment in lung function, exhaled CO, and predicted COHb. Long term health effects on healthy individuals exposed to forest fire smoke warrant further evaluation.

Introduction. Combinations of gefitinib and radiotherapy have been observed to have synergistic and anti-proliferative effects on lung cancer in vitro. In the clinical setting, patients who presented with respiratory difficulties such as superior vena cava syndrome (SVCS), radiotherapy should be given immediately to address the emergency while waiting for the results of epidermal growth factor receptor (EGFR) mutation test. However, there has been no study that described the role of radio-therapy in Indonesian patients with EGFR-mutant lung adenocarcinoma. Methods. This preliminary study aimed to evaluate the efficacy and toxicities of gefitinib and radiotherapy combination in lung adenocarcinoma patients in Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia. Subjects were consecutively recruited between January 2013 and December 2016. Results. Thirty-one lung adenocarcinoma with EGFR mutations were enrolled. Most of them were male (51.61%) with a median age of 54.5 years old (range 38-70 years old). EGFR mutation characteristics were on exon 21 L858R point mutation (61.30%), exon 21 L861Q point mutation (16.12%) and exon 19 deletion (22.58%). Radiotherapy was given at doses between 30-60 Gy. Among these subjects, median progression-free survival (PFS) was 185 days (95%CI; 123.69 – 246.30), 1-year survival rate (1-yr) was 45.2%, and median overall survival (OS) was 300 days (95%CI; 130.94 – 469.06). There were no grade 3/4 hematological and nonhematological toxicities recorded. The most frequent grade 1 and 2 non-hematological toxicities were skin rash, diarrhea, and paronychia that might be related to tyrosine kinase inhibitor (TKI). Conclusion. The combination of TKI with radiation may be considered in EGFR-mutant lung adenocarcinoma subjects.

Background: Benzopyrene is a carcinogenic agent found in cigarette smoke. Benzo(a)pyrene diol epoxide (BPDE) is one of the benzopyrene metabolites. In this study, we investigated the level of serum BPDE in kretek cigarette smokers compared to non-smokers. Methods: A cross-sectional study which involved 32 “healthy” kretek cigarette smokers and 32 “healthy” nonsmokers were conducted. We collected the blood sample and the serum BPDE level was assayed using enzyme-linked immunosorbent assay kit. The BPDE serum level in kretek cigarette smokers was compared to the level in nonsmokers. Results: A total of 32 kretek smokers and 32 controls underwent an examination of the BPDE-protein adducts level. In the kretek smokers group, 59.4% were aged over 45 years and 56.3% have a high educational background, while in the control group, 87.5% were aged under 45 years and 75% have high educational backgrounds. The level of BPDE-protein adducts in the kretek smokers subject was 12.15 (8.87–33.55) ng/ml and the levels in the control group were 11.4 (3.87–13.27) ng/ml, P = 0.004. The factors which influence the levels BDPE-protein adducts in smokers cigarettes, as determined by multivariate analysis, were sucking pattern (P = 0.002) and the degree of addiction (P = 0.047). Conclusion: The serum BPDE-protein adducts level was higher in smokers compared to nonsmokers, and the sucking pattern and degree of addiction are the influencing factors.

Chronic pulmonary aspergillosis (CPA) is a common sequela of pulmonary tuberculosis (TB). The diagnosis of CPA is difficult and often misdiagnosed as smear-negative TB in endemic settings. Aspergillus IgG detection is the cornerstone of CPA diagnosis. There are a lack of studies on the prevalence of CPA in GeneXpert/smear-negative TB patients in Indonesia, despite a high number of TB cases. This study aims to determine the CPA rate in HIV-negative, GeneXpert-negative patients presenting with symptoms following completion of TB therapy and to evaluate the performance of LDBio Aspergillus immunochromatographic technology (ICT) lateral flow assay in the diagnosis of CPA. CPA was diagnosed on the basis of symptoms for &ge, 3 months, characteristic chest imaging and positive Aspergillus culture. Twenty (22%) out of 90 patients met the criteria for CPA. The LDBio test was positive in 16 (80%) CPA patients and in 21 (30%) non-CPA patients (p &lt, 0.001) with 80% sensitivity and 70% specificity. Logistic regression revealed a positive LDBio Aspergillus ICT result, smoking history and diabetes to be important predictors of CPA diagnosis. Although CPA is an unrecognised disease in Indonesia, this study suggests that more than one in five GeneXpert negative patients with persistent symptoms following completion of TB therapy may have CPA.

Background: COPD is a disease due to oxidative stress causing low pulmonary function, resulting in low quality of life. A standard test to measure the quality of life in COPD is COPD Assessment Test (CAT). Vitamin C as antioxidant is widely available in the pulmonary epithelial fluid. This study aimed to investigate the correlation between serum vitamin C level and CAT score in COPD.Methods: This cross-sectional study was conducted at Persahabatan Hospital, East Jakarta, involving 47 subjects using consecutive sampling method. Interview was used to assess subjects’ characteristics and vitamin C intake using semi-quantitative FFQ. Clinical classification, lung function, comorbidity, and CAT scores were gathered from medical records or interview. BMI was used to determine nutritional status, while vitamin C serum level was assessed using spectrophotometry. Results and conclusions: All subjects were male, mean age was 66.6 years, mostly ex-heavy smokers, with decreased lung function, and 25% were undernourished. Vitamin C intake was sufficient, but low in serum vitamin C level and CAT score.There was no correlation between serum vitamin C level and CAT score.

Background : Radiation-induced pulmonary toxicity occurs in patients with lung cancer who received irradiation. The objective of this study was to determine the proportion of radiation pneumonitis among lung cancer patients that were exposed to radiation treatment in Persahabatan Hospital. There is no data about proportion of radiation pneumonitis in Indonesia.Methods: This was a retrospective study conducted in Persahabatan Hospital during June 2013– July 2015 using the medical record of lung-cancer patients who received irradiation.Results: 33 lung-cancer patients fulfilled the inclusion criteria. Most of them were male (66.7%), in age ≥ 51 years (63.6%), had a smoking history (75.8%) with moderate Brinkman Index (60%), were given irradiation doses of 3,000–4,000 (60.6%) with irradiation fractions of 10–19 (60.6%), had no history of chemotherapy (54.5%), and were diagnosed with adenocarcinoma (66.7%) and stage-IV cancer (84.84%). The proportion of radiation pneumonitis based on chest X-ray (CXR) was 39.4%; which consisted of hazy ground-glass opacities, hazy ground-glass opacities, and fibrosis, and only fibrosis. There were significant differences in age, radiation doses, and history of chemotherapy with the proportion of radiation pneumonitis (p < .05).Conclusion: The proportion of radiation pneumonitis based on CXR was 39.4%. There were significant differences in age, radiation doses, and history of chemotherapy with the proportion of radiation pneumonitis.

Electrodes with low work functions are required to efficiently inject electrons into semiconductor devices. However, when the work function drops below about 4 electronvolts, the electrode suffers oxidation in air, which prevents its fabrication in ambient conditions. Here we show that multivalent anions such as oxalate, carbonate and sulfite can act as powerful latent electron donors when dispersed as small ion clusters in a matrix, while retaining their ability to be processed in solution in ambient conditions. The anions in these clusters can even n-dope the semiconductor core of π-conjugated polyelectrolytes that have low electron affinities, through a ground-state doping mechanism that is further amplified by a hole-sensitized or photosensitized mechanism in the device. A theoretical analysis of donor levels of these anions reveals that they are favourably upshifted from ionic lattices by a decrease in the Coulomb stabilization of small ion clusters, and by irreversibility effects. We attain an ultralow effective work function of 2.4 electronvolts with the polyfluorene core. We realize high-performance, solution-processed, white-light-emitting diodes and organic solar cells using polymer electron injection layers with these universal anion donors, demonstrating a general approach to chemically designed and ambient-processed Ohmic electron contacts for semiconductor devices. Multivalent anions are found to be capable of electron-doping polymer semiconductors to realize conductive films with very low work functions, which enable efficient electron injection into materials with low electron affinity.

Amiodarone is an antiarrhythmic agent commonly used to treat supraventricular and ventricular arrhythmias. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients. This drug is an iodine-containing compound that tends to accumulate in several organs, including the lungs. It has been associated with a variety of adverse events. Of these events, the most serious is amiodarone pulmonary toxicity. Although the incidence of this complication has decreased with the use of lower doses of amiodarone, it can occur with any dose. Because amiodarone is widely used, all clinicians should be vigilant of this possibility. Pulmonary toxicity usually manifests as an acute or subacute pneumonitis, typically with diffuse infiltrates on chest x-ray and high-resolution computed tomography. Other, more localized, forms of pulmonary toxicity may occur, including pleural disease, migratory infiltrates, and single or multiple nodules. With early detection, the prognosis is good. Most patients diagnosed promptly respond well to the withdrawal of amiodarone and the administration of corticosteroids, which are usually given for four to 12 months. It is important that physicians be familiar with amiodarone treatment guidelines and follow published recommendations for the monitoring of pulmonary as well as extrapulmonary adverse effects.

Background Lung cancer patients with mutations in epidermal growth factor receptor (EGFR) gene are treated with tyrosine kinase inhibitor (TKI). Aims We aimed to evaluate polymerase chain reaction (PCR)-high-resolution melting (HRM), restriction fragment length polymorphism (RFLP), and direct sequencing (DS) to detect EGFR mutations in cell-free DNA (cfDNA) before and after TKI treatment in real-world settings of a developing country. Methods Paired cytology and plasma samples were collected from 116 treatment-naive lung cancer patients. DNA from both plasma and cytology specimens was isolated and analyzed using PCR-HRM (to detect exon 19 insertion/deletion), RFLP (to genotypes L858R and L861Q), and DS (to detect uncommon mutations G719A, G719C, or G719S [G719Xaa] in exon 18 and T790M and insertion mutations in exon 20). Results EGFR genotypes were obtained in all 116 (100%) cfDNA and 110/116 (94.82%) of cytological specimens of treatment-naive patient (baseline samples). EGFR-activating mutations were detected in 46/110 (40.6%) plasma samples, and 69/110 (63.2%) mutations were found in routine cytology samples. Using cytological EGFR genotypes as reference, we found that sensitivity and specificity of baseline plasma EGFR testing varied from 9.1% to 39.39% and 83.12% to 96.55%, respectively. In particular, the sensitivity and specificity of this assay in detecting baseline T790M mutations in exon 20 were 30% and 89.58%, respectively. Three months after TKI treatment, plasma T790M and insertion exon 20 mutations appeared in 5.4% and 2.7% patients, respectively. Conclusions Despite low sensitivity, combined DS, RFLP, and PCR-HRM was able to detect EGFR mutations in plasma cfDNA with high specificity. Moreover, TKI resistance exon 20 insertions mutation was detected as early as 3 months post TKI treatment.

OX40-OX40 ligand (OX40L) interactions have been proposed to support induction of allergic airway inflammation, which may be attributable to OX40 signaling in CD4(+) helper T cells for adaptive immune responses. However, a possible involvement of natural killer T (NKT) cells in the pathogenesis suggests that the underlying mechanisms are not yet fully elucidated.We aimed to characterize the OX40-modulated cellular contribution to allergic airway inflammation in a mouse model of house dust mite (HDM) allergen exposure.Mice were sensitized to HDM and, 3 weeks later, challenged with HDM on three consecutive days through the airways. Two days after the last exposure, bronchoalveolar lavage fluids and blood samples and lung tissues were evaluated for the airway inflammation.The development of HDM-induced eosinophilic airway inflammation was dependent on OX40 of both CD4(+) T cells and NKT cells; OX40 engagement on CD4(+) T cells in the sensitization led to pulmonary OX40L augmentation after the allergen challenge, which stimulated pulmonary NKT cells through OX40 to provide the pathogenic cytokine milieu. This was ablated by OX40L blockade by inhalation of the neutralizing antibody during the challenge, suggesting the therapeutic potential of targeting pulmonary OX40-OX40L interactions. Moreover, OX40 expression in CD4(+) T cells, but not in NKT cells, was reciprocally regulated by the helper T cell type 1-skewing transcription factor Runx3.OX40 on not only CD4(+) T cells but also NKT cells is involved in allergic airway inflammation. Notably, pulmonary blockade of OX40 ligation on NKT cells has therapeutic implications.

The aim of this study was to determine whether Andrographus paniculata capsule induces clinical and sputum conversion in pulmonary tuberculosis (TB) patients. Randomized, placebo-controlled, double-blind pilot study was conducted to pulmonary tuberculosis patient who admitted to Pulmonology Polyclinic of Persahabatan Central General Hospital, Jakarta. A total of 44 pulmonary TB patients were randomly divided into two groups including one group received standard antituberculosis drugs + Andrographis paniculata (n=21) (AP) and one group received standard antituberculosis drugs + placebo (n=23). APC was given 500 milligram per day for eight weeks. The distribution of sex, body weight and body mass index (BMI) as well as the frequency of cough and feature of chest radiography were not significantly different between groups (P >0.05). The proportion of posi¬tive smears in both groups decreased over time until by the twelve weeks, none remained positive. The rate of decline was more pronounced in the AP group reach statistically at weeks 4 and 6 compared to placebo group (P

Mycobacteria are among the most common causes of hypersensitivity pneumonitis (HP), but controversy persists with regard to the involvement of the infectious potency of the organism in mycobacterial HP (hot tub lung). This study aimed to establish a mouse model of hot tub lung to clarify its pathophysiology. Mice were exposed intranasally to formalin-killed Mycobacterium avium from a patient with hot tub lung (HP strain) or chronic pulmonary infection (non-HP strain), and bronchoalveolar lavage fluids and lung tissues were evaluated for allergic inflammation. Dead M. avium HP strain, but not non-HP strain, elicited marked HP-like pulmonary inflammation in wild-type mice. Although the inflammation was induced in mice lacking CD4 or CD8, the induction of HP-like responses was prevented in mice lacking myeloid differentiation factor (MyD)88 or Toll-like receptor (TLR)9. Cultured lung CD11c+ cells responded to M. avium in a TLR9-dependent manner, and reconstitution of TLR9-/- mice with lung CD11c+ cells from wild-type mice restored the inflammatory responses. Further investigation revealed that pulmonary exposure to M. avium HP strain increased the number of lung CD11b+ CD11c+ cells (dendritic cells) through TLR9 signalling. Our results provide evidence that hot tub lung develops via the mycobacterial engagement of TLR9-MyD88 signalling in lung CD11b+ dendritic cells independent of the mycobacterial infectious capacity.

Staphylococcal biofilms pose an important problem, especially after orthopedic surgery using foreign implants. Clarithromycin (CAM) eliminates the biofilms formed by a wide variety of aerobic and anaerobic bacteria. In a previous in vitro study, we showed that treatment with CAM and vancomycin (VCM) eradicated staphylococcal biofilms from surgical implants. To investigate the efficacy of this eradication therapy, we assessed its effects against Staphylococcus aureus on titanium plates implanted in mice.A titanium washer covered with S. aureus biofilms was implanted in the muscular tissue around the femoral bone. Mice were given intravenous injections of CAM and intraperitoneal injections of VCM twice daily beginning 72 h after implantation. To confirm eradication of biofilms and S. aureus strains, the resected washer was examined by scanning electron microscopy.Dense colonization and biofilms were seen on the washer implanted in the control mice that received saline, saline plus CAM, or saline plus VCM. Treatment with CAM plus VCM eliminated the biofilms, indicating an S. aureus eradication effect.Staphylococcal biofilms have demonstrated resistance to most antibiotics, including VCM. Our in vivo data support the hypothesis that combined treatment using CAM plus VCM may effectively eradicate staphylococcal biofilms in patients with implant-related infection.