Implant-associated infections are the primary cause of complications following orthopaedic surgery. Due
to biofilm and persister formation, current treatments, i.e. surgical debridement followed by antibiotics,
often fail. There is an urgent need for alternative strategies to combat such infections. Therefore, the present
study investigated the effects of non-contact induction heating (NCIH), the antimicrobial peptide SAAP-148
and combinations thereof on bacterial counts in 7 d mature biofilms and in persister-enriched biofilms of
methicillin-resistant Staphylococcus aureus (MRSA) on titanium-aluminium-niobium (TAN) discs. Enrichment
of persisters was achieved by daily exposure of mature biofilms to high doses of rifampicin and ciprofloxacin
for 3 consecutive days. To heat up the TAN discs, a miniaturised induction heater was built and successfully
validated. Using this apparatus, NCIH resulting in surface temperatures up to 85 °C eradicated all the
bacteria in immature biofilms but not in mature biofilms, whereas persisters were already eliminated at
surface temperatures ≥ 70 °C. SAAP-148 at concentrations > 25.6 µmol/L reduced the persister counts in
antibiotics-exposed, mature biofilms. As surface temperatures > 60 °C can have detrimental effects on the
surrounding tissues, the maximum temperature of NCIH used in combination with SAAP-148 on persisters
was set to 60 °C. Results revealed that this combination was slightly more effective than the peptide or NCIH
alone in eliminating biofilm-embedded persisters. NCIH and SAAP-148 can be applied both invasively and
non-invasively in various treatment scenarios. Together, combinations of NCIH and SAAP-148 might be a
promising treatment strategy to combat metal-implant-associated infections.
