Bone grafts as vancomycin carriers in local therapy of resistant infections

Abstract

The level of an antibiotic capable of inhibiting the etiological agent at the site of infection is an essential prerequisite for successful antibiotic therapy. In some cases, locally applied antibiotics may compensate for limitations of systemic administration and shorten systemic therapy. We aimed at verifying to what extent vancomycin (Van) bound to ground bone grafts is usable in the treatment of serious infections. The levels of released Van significantly exceeded the Van minimum inhibitory concentration, which can suppress Van-sensitive staphylococci and Van intermediate Staphylococcus aureus, for the whole period of a 16-day measurement. Our results indicate that bone grafts can be used as Van carriers in therapy of osteomyelitis caused by Van-sensitive Staphylococcus strains.

The effect of Vancomycin degradation products in the topical treatment of osteomyelitis

“…For the in vitro experiment, morselized cancellous bone grafts were chosen as local antibiotic carriers due to their appropriate properties and availability (1,3,5,8,9,10). For antibiotic impregnation of bone grafts, Vancomycin powder (Vancomycin Mylan ®) was used.…”

“…One of the ways to increase therapeutic potential is to use local antibiotic delivery system (3,8,10,13,14,15). The topical antibiotic treatment of musculoskeletal infections has the advantage over systemic antibiotics of achieving high antibiotic concentrations, exceeding the minimum inhibitory concentration (MIC) without increasing systemic toxicity.…”

“…The most often utilized materials are polymethyl methacrylate (PMMA), bone grafts, calcium sulphate and carbonate, and collagen (8,9,10).…”

Vancomycin-bearing Synthetic Bone Graft Delivers rhBMP-2 and Promotes Healing of Critical Rat Femoral Segmental Defects

“…As the incidence of orthopaedic infection increases [21], there is an increasing clinical need for the development of new grafts that can locally deliver therapeutic proteins and antibiotics simultaneously to treat traumatic defects prone to infections [29,30]. Vancomycin, an antibiotic often used in orthopedics to treat gram-positive organisms and as the last line of defense in treating antibiotic resistant infections [15,23], is an appealing candidate for incorporation with synthetic bone grafts [11,18] to minimize the risks for infections while avoiding the negative effects associated with the systemic delivery of vancomycin. However, the success of such a strategy requires that the incorporation of vancomycin does not compromise the structural integrity of the graft nor its ability to promote bone healing.…”

Current Insights in the Application of Bone Grafts for Local Antibiotic Delivery in Bone Reconstruction Surgery

“…Elution kinetics were described for cancellous fresh frozen bone grafts mixed with vancomycin powder (1% w/w). Elution was well above the MIC for S. aureus during 16 days, with a maximum of 499.7 μg/ml at day 2-4 22. In another study, highly purified cancellous grafts impregnated with vancomycin (100 mg/ml) reached initial concentrations up to 20000 μg/ml 28…”