Elution Profiles of Cefazolin from PMMA and Calcium Sulfate Beads Prepared from Commercial Cefazolin Formulations

Udomkusonsri, Pareeya; Kaewmokul, Santi; Arthitvong, Surapong; Phaochoosak, Napasorn

doi:10.1292/jvms.11-0095

Cited by 20 publications

(25 citation statements)

References 27 publications

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“…22 Most recently, Udomkusonsri et al compared three varieties of PMMA (Cemfix, Depuy I, and SmartSet HV) with pure calcium sulfate and found that the total elution of cefazolin from calcium sulfate was greater than any of the PMMA types during the 15-day study, and the daily elution of calcium sulfate was significantly (p < 0.05) higher than the PMMA on days 1-11. 23 In addition to advancing the characterization of calcium sulfate, this report ( Figure 5) also supported our previous work that smaller beads eluted much quicker than the larger beads. 17 The clinical relevance of this difference between the elution rates of 3.0 vs. 4.8 mm beads must be further examined in an animal model.…”

Section: Discussionsupporting

confidence: 88%

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

McConoughey

Howlin

Wiseman

et al. 2014

J. Biomed. Mater. Res.

107

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Antibiotic-loaded bone cement is a primary option for treatment of orthopedic infections. Poly(methyl methacrylate) (PMMA) is a widely used cement that, when loaded with antibiotics in spacer or bead form, has been shown to reduce infection rates. However, PMMA is not resorbable and requires a second surgery for removal, while also acting as a potential foreign body for bacterial colonization. Alternatively, resorbable bone cements, such as calcium sulfate, have been proposed and present the advantage of being completely reabsorbed. It is unknown whether the antibiotic elution characteristics of absorbable bone cements are similar to PMMA. This study (1) characterized antibiotic elution from synthetic, highly purified calcium sulfate cement beads of varying sizes against pathogenic bacteria both in liquid culture and seeded on agar plates, (2) tested calcium sulfate beads against PMMA beads loaded with the same antibiotics, and (3) analyzed the structural differences between how PMMA and calcium sulfate bind to antibiotics. In every assay, the calcium sulfate beads performed as well as, or better than, the PMMA beads in inhibition of bacterial growth and elution of vancomycin in vitro with complete elution observed from calcium sulfate within three days. These data suggest that calcium sulfate, functions, as well as PMMA in the patient setting for infection control.

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Section: Discussionsupporting

confidence: 88%

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

McConoughey

Howlin

Wiseman

et al. 2014

J. Biomed. Mater. Res.

107

View full text Add to dashboard Cite

show abstract

“…Recent orthopedic literature has noted good clinical efficacy in the treatment of chronic osteomyelitis with bio-absorbable, antibiotic impregnated calcium sulfate beads, with no recurrent episodes of infection and a low rate of self-limiting, wound drainage. 10,11,14–16 Moreover, studies have demonstrated that the concentration of antibiotic released from calcium sulfate beads was three times that of the concentration released from the PMMA beads in vitro, 18 with more consistent, prolonged levels of local antibiotic delivery. 15,16 These beads provide adequate local antibiotic levels for approximately 6–10 weeks, at which time they dissolve.…”

Section: Discussionmentioning

confidence: 99%

Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections

et al. 2016

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Objective There is limited investigation into the use of bio-absorbable antibiotic beads for the treatment of prosthetic vascular graft infections. Our goal was to investigate the rates of infection eradication, graft preservation, and limb salvage in patients who are not candidates for graft explant or extensive reconstruction. Methods A retrospective review of patients implanted with antibiotic impregnated bio-absorbable calcium sulfate beads at a major university center was conducted. Results Six patients with prosthetic graft infections were treated with bio-absorbable antibiotics beads from 2012–2014. Grafts included an aortobifemoral, an aorto-hepatic/superior mesenteric artery, and four extra-anatomic bypasses. Pathogens included Gram-positive and Gram-negative bacteria. Half of the patients underwent graft explant with reconstruction and half debridement of the original graft, all with antibiotic bead placement around the graft. Mean follow-up was 7.3±8.3 months; all patients had infection resolution, healed wounds, and 100% graft patency, limb salvage, and survival. Conclusion This report details the successful use of bio-absorbable antibiotic beads for the treatment prosthetic vascular graft infections in patients at high risk for graft explant or major vascular reconstruction. At early follow-up, we demonstrate successful infection suppression, graft preservation, and limb salvage with the use of these beads in a subset of vascular patients.

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“…Furthermore, when compared, to PMMA, calcium sulfate beads have showed a better "in vitro" elution profile 17 especially when cefazolin was used as a mixed antibiotic and a better "in vitro" inhibition of bacterial growth. [25][26][27][28] The use of calcium sulfate beads is not free from complications. McPherson et al 25 reported the presence of a copious exudate from the wound requiring surgical intervention in 3.2% of patients following the use of calcium sulfate beads to treat PJI.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, when compared, to PMMA, calcium sulfate beads have showed a better “in vitro” elution profile 17 especially when cefazolin was used as a mixed antibiotic and a better “in vitro” inhibition of bacterial growth. 25 –28…”

Section: Discussionmentioning

confidence: 99%

Debridement, antibiotic pearls, and retention of the implant (DAPRI): A modified technique for implant retention in total knee arthroplasty PJI treatment

Calanna

Chen

Risitano

et al. 2019

J Orthop Surg (Hong Kong)

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We describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining an infected total knee arthroplasty. This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration using calcium sulfate beads. The combination of three different surgical techniques (methylene blue staining, argon beam electrical stimulation, and chlorhexidine gluconate brushing) might enhance the identification, disruption, and finally removal of the bacterial biofilm, which is the main responsible of antibiotics and antibodies resistance. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous periprosthetic joint infection.

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Elution Profiles of Cefazolin from PMMA and Calcium Sulfate Beads Prepared from Commercial Cefazolin Formulations

Cited by 20 publications

References 27 publications

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections

Debridement, antibiotic pearls, and retention of the implant (DAPRI): A modified technique for implant retention in total knee arthroplasty PJI treatment

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