No efficacy of silver bone cement in the prevention of methicillin‐sensitive Staphylococcal infections in a rabbit contaminated implant bed model

Abstract

Data from literature showed that a new type of metallic silver PMMA cement had good results in infection prophylaxis. This study investigated the in vivo efficacy of silver cement in the prevention of methicillin-sensitive Staphylococcal infections, compared to plain and tobramycin-containing cement. In 48 rabbits, 0.6% silver, 1% silver, plain, or tobramycin PMMA cement was injected into the femoral medullary canal after contamination with 10 5 , 10 6 , or 10 7 colony forming units (CFU) Staphylococcus aureus. After 14 days, bone was collected for bacteriology and histopathology. All plain and silver cement rabbits were infected, whereas only two tobra rabbits were infected (p < 0.001). The number of bacteria cultured ( 10 logCFU) from bone adjacent to the cement, was 6.4 AE 0.3 and 6.1 AE 0.3 for the 0.6% and 1% silver rabbits. For the rabbits with plain and tobra cement, this was 6.2 AE 0.2 (p > 0.95) and 0.0 AE 0.0 (p < 0.001), respectively. Two tobra rabbits had a positive culture of a distal bone sample. Histological sections of plain, 0.6%, and 1% silver rabbits all showed signs of infection; these signs were absent in the tobra rabbits. Silver and plain cement were not effective in preventing infection, whereas tobra cement was effective. As silver cement predominantly exhibits an antimicrobial effect at the direct cement surface, this cement seems less useful in situations where there are bacteria present in surrounding tissues, like revision surgery. Whether silver cement has relevance in the prevention of bacterial colonization of cement remains to be determined. ß

Antimicrobial biocompatible bioscaffolds for orthopaedic implants

“…The average percentage reduction changed from 38.6% to 80.38% and 28% to 86.11% ( p < 0.05) for E. coli and S. aureus , respectiovely (Figure A, B). These results are improvements compared to recent reports on antibiotics (Neut et al ., ) and silver (Moojen et al ., ) injected bone cements or silver‐containing polymeric scaffolds (Olgun et al ., ).…”

Nanomaterials: The Next Step in Injectable Bone Cements

“…However, in vivo studies of PMMA/1 wt% n-Ags in rabbit models showed no antimicrobial effect against methicillin-sensitive S. aureus in all 12 rabbits, whereas PMMA incorporated with tobramycin lead to infection in only two out of 12 rabbits [94]. These results suggest that although 1 wt% n-Ags might be effective in preventing bacterial growth on the surface of PMMA itself, it is not effective in inhibiting the growth of bacteria in the surrounding tissue [94]; therefore, more investigation into the optimal n-Ag size and concentration may be required in order to obtain optimum antibacterial properties and minimal cytotoxicity. Chitosan nanoparticles have also been shown to introduce antibacterial properties into PMMA [91].…”

Effects of Materials Containing Antimicrobial Compounds on Food Hygiene

“…There are many reports of an effect of silver-containing materials when tested in vitro, but in most cases the in vivo effects are limited or absent (32,58,74,81). One exception is the investigation by Kumar and Munstedt (47), who reported antibacterial effect in vivo with polymers releasing silver in its oxidized form.…”