Lokale Antibiotikatherapie

Kühn, Klaus-Dieter; Renz, Nora; Trampuž, Andrej

doi:10.1007/s00113-017-0372-8

Cited by 42 publications

(43 citation statements)

References 62 publications

(18 reference statements)

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“…Furthermore, our study was limited to the antibiotics gentamicin and vancomycin. Other combinations need to be investigated, but the chosen combination is in clinical use [ 1 , 4 ]. Finally, Copal® spacem has shown better wear behavior compared to Palacos® R in vitro [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Manual loading was performed following the recommendations by Kuhn et al The antibiotics were thoroughly ground in a mortar and then the cement powder was successively added while stirring [ 4 ]. After that, the mixture was combined with the liquid of the cement, to produce a dough which then was poured into a mold to yield short, cylindrical specimens (diameter and height = 6 mm and 12 mm, respectively).…”

Section: Methodsmentioning

confidence: 99%

“…To date, some bone cement brands that are intended for the use for fixation of total joint replacements are also used to fabricate spacers, one example being Palacos® R+G [ 4 , 5 ]. At the same time, cement modifications with improved antibiotic elution are tested [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…The combination of gentamicin and vancomycin ensures effective action against a broad range of PJI-causing pathogens [ 11 ]. Thus, there are reports of clinical use of spacers fabricated using manual loading of the gentamicin premixed powder of Palacos® R+G with vancomycin [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Elution Characteristics and Compressive Strength of Biantibiotic-Loaded PMMA Bone Cement for Spacers: Copal® Spacem with Gentamicin and Vancomycin versus Palacos® R+G with Vancomycin

Boelch¹,

Rüeckl²,

Fuchs³

et al. 2018

BioMed Research International

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Purpose Copal® spacem is a new PMMA bone cement for fabricating spacers. This study compares elution of gentamicin, elution of vancomycin, and compressive strength of Copal® spacem and of Palacos® R+G at different vancomycin loadings in the powder of the cements. We hypothesized that antibiotic elution of Copal® spacem is superior at comparable compressive strength. Methods Compression test specimens were fabricated using Copal® spacem manually loaded with 0.5 g gentamicin and additionally 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (COP specimens) and using 0.5 g gentamicin premixed Palacos® R+G manually loaded with 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (PAL specimens). These specimens were used for determination of gentamicin and vancomycin elution (in fetal calf serum, at 22°C) and for determination of compressive strength both prior and following the elution tests. Results Cumulative gentamicin concentrations (p < 0.005) and gentamicin concentration after 28 days (p ≤ 0.043) were significantly lower for COP specimens compared to PAL specimens. Cumulative vancomycin concentrations were significantly higher (p ≤ 0.043) for COP specimens after the second day. Vancomycin concentrations after 28 days were not significantly higher for the Copal specimens loaded with 2 g and 4 g of vancomycin. Compressive strength was not significantly different between COP specimens and PAL specimens before elution tests. Compressive strength after the elution tests was significantly lower (p = 0.005) for COP specimens loaded with 2 g of vancomycin. Conclusion We could not demonstrate consistent superior antibiotic elution from Copal® spacem compared to Palacos® R+G for fabricating gentamicin and vancomycin loaded spacers. The results do not favor Copal® spacem over Palacos® R+G for the use as a gentamicin and vancomycin biantibiotic-loaded spacer.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of Elution Characteristics and Compressive Strength of Biantibiotic-Loaded PMMA Bone Cement for Spacers: Copal® Spacem with Gentamicin and Vancomycin versus Palacos® R+G with Vancomycin

Boelch¹,

Rüeckl²,

Fuchs³

et al. 2018

BioMed Research International

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“… 45 Bacteria persist in this biofilm colony as they stick to each other and adhere to the implant protected by the production of extracellular polymeric matrix. 46 , 47 Local antibiotics such as gentamicin-loaded bone cement may attack biofilms more effectively than systemic antibiotics due to higher locally available doses, 48 , 49 but nonetheless radical surgical debridement and changing the implant are required and are part of the administered diamond concept. We also recommend partially covering the metal implant with additional bone cement if possible to further reduce biofilms on the implant.…”

Section: Discussionmentioning

confidence: 99%

Initial peri- and postoperative antibiotic treatment of infected nonunions: results from 212 consecutive patients after mean follow-up of 34 months

Helbig¹,

Bechberger²,

Aldeeri³

et al. 2018

TCRM

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PurposeInfected nonunions of the long bones belong to the most feared complications in the field of orthopedic and trauma surgery. Optimal antibiotic therapy should start early with the first revision surgery. Therefore, the aim of this study was to evaluate our peri- and postoperative antibiotic regime in context with the microbial spectrum and antibiotic resistances of patients with infected nonunions and to assess the possible impact on healing rates.MethodsWe included all patients with first revision surgery during 2010–2015 due to nonunion of long bones with a clinical history of infection treated with radical debridement, local application of a gentamicin-impregnated bone cement, and systemic cefuroxime. Mean follow-up was 34.2 months. Data collection was performed retrospectively using a computerized databank with information about microbial species from intraoperatively acquired tissue samples and respective antibiograms. Bone fusion rates were evaluated based on findings of the latest X-rays and computed tomography scans.ResultsTwo hundred and twelve patients with nonunion and history of infection were selected; 171 patients had positive intraoperative microbial evidence of infection. Bacterial testing was mostly positive in fractures of the tibia (47.4%) and the femur (27.5%). Coagulase-negative Staphylococcus spp. were the most frequently detected (44.4%) followed by mixed infections (18.7%) and Staphylococcus aureus (10.5%). Antibiograms revealed that 62.6% of our cases were cefuroxime sensitive; 87.7% were gentamicin sensitive. Only 10.5% showed resistance to both cefuroxime and gentamicin. There was no statistically significant difference of fusion rates between patients with different microbial species or different antibiograms.ConclusionOur data suggest that besides the high variety of different detected species, initial antibiotic treatment with a combination of systemic cefuroxime and local gentamicin-loaded bone cement is effective and in almost 90% the later determined microbial infection was sensitive to this treatment. Therefore, we recommend initial treatment according to this algorithm until specific antibiograms are available from intraoperatively acquired tissue samples.

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