Local delivery of tobramycin and vancomycin in primary total knee arthroplasty achieves minimum inhibitory concentrations for common bacteria causing acute prosthetic joint infection

Abstract

Aims The aim of this study was to determine if the local delivery of vancomycin and tobramycin in primary total knee arthroplasty (TKA) can achieve intra-articular concentrations exceeding the minimum inhibitory concentration thresholds for bacteria causing acute prosthetic joint infection (PJI). Methods Using a retrospective single-institution database of all primary TKAs performed between January 1 2014 and May 7 2019, we identified patients with acute PJI that were managed surgically within 90 days of the initial procedure. The organisms from positive cultures obtained at the time of revision were tested for susceptibility to gentamicin, tobramycin, and vancomycin. A prospective study was then performed to determine the intra-articular antibiotic concentration on postoperative day one after primary TKA using one of five local antibiotic delivery strategies with tobramycin and/or vancomycin mixed into the polymethylmethacrylate (PMMA) or vancomycin powder. Results A total of 19 patients with acute PJI after TKA were identified and 29 unique bacterial isolates were recovered. The mean time to revision was 37 days (6 to 84). Nine isolates (31%) were resistant to gentamicin, ten (34%) were resistant to tobramycin, and seven (24%) were resistant to vancomycin. Excluding one Fusobacterium nucleatum, which was resistant to all three antibiotics, all isolates resistant to tobramycin or gentamicin were susceptible to vancomycin and vice versa. Overall, 2.4 g of tobramycin hand-mixed into 80 g of PMMA and 1 g of intra-articular vancomycin powder consistently achieved concentrations above the minimum inhibitory concentrations of susceptible organisms. Conclusion One-third of bacteria causing acute PJI after primary TKA were resistant to the aminoglycosides commonly mixed into PMMA, and one-quarter were resistant to vancomycin. With one exception, all bacteria resistant to tobramycin were susceptible to vancomycin and vice versa. Based on these results, the optimal cover for organisms causing most cases of acute PJI after TKA can be achieved with a combination of tobramycin mixed in antibiotic cement, and vancomycin powder. Cite this article: Bone Joint J 2020;102-B(6 Supple A):163–169.

Determination of the Elution Capacity of Dalbavancin in Bone Cements: New Alternative for the Treatment of Biofilm-Related Peri-Prosthetic Joint Infections Based on an In Vitro Study

“…PJI is one of the most relevant complications in orthopedic surgery [ 3 ], which is well known to be a biofilm-related infection [ 36 , 37 ]. The use of local antibiotics is one of the recommended approaches to treat PJI, antibiotic-loaded bone cements being the most widely used [ 8 , 38 , 39 , 40 , 41 ] and, in particular, dual-antibiotic high-loaded bone cements are more effective and cost efficient than single ones for the prevention of PJI [ 33 ]. One of the most used antibiotics is vancomycin, which has shown a suitable elution capacity and antimicrobial activity in several studies [ 42 , 43 , 44 ].…”

Longitudinal in vivo biodistribution of nano and micro sized hydroxyapatite particles implanted in a bone defect

“…To overcome this shortcoming, carriers for local delivery of drugs targeting bone diseases have been widely explored for enhanced efficacy in fracture healing, deep infection and bone cancer ( Stevens, 2008 ; Montoya et al, 2021 ; Sebastian et al, 2022 ). However, clinically available biomaterials used today for local drug delivery in bone are ceramic materials comprising of micrometer sized HA particles or poly methyl methacrylate (PMMA) cements ( Pascual et al, 1996 ; Lawrie et al, 2020 ; Niemann et al, 2022 ). An important limitation with these materials is that they deliver the drug extracellularly.…”

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“…Of the Enteroccous faecalis germs, 100% were resistant to aminoglycosides. The remaining gram-negative germs were universally resistant to vancomycin but susceptible to gentamicin and tobramycin [ 85 ].…”