Release of Gentamicin and Vancomycin from Preformed Spacers in Infected Total Hip Arthroplasties: Measurement of Concentrations and Inhibitory Activity in Patients’ Drainage Fluids and Serum

Regis, Dario; Sandri, Andrea; Samaila, Elena Manuela; Benini, Anna; Bondi, Manuel; Magnan, Bruno

doi:10.1155/2013/752184

Cited by 34 publications

(23 citation statements)

References 31 publications

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“…One of the most adopted materials for local release of antibiotics is polymethylmethacrylate (PMMA) [14,15]. However, this material has a number of significant disadvantages.…”

mentioning

confidence: 99%

Local Release of Antibiotics for Surgical Site Infection Management Using High-Purity Calcium Sulfate: An In Vitro Elution Study

Aiken

Cooper

Florance

et al. 2015

Surgical Infections

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Background: The aim of this study was to characterize the elution of four antibiotics from pharmaceuticalgrade calcium sulfate beads and show that the eluted antibiotics retained efficacy. Methods: Calcium sulfate was combined with gentamicin, tobramycin, vancomycin, or rifampicin (ratio: 20 g of calcium sulfate, to 240 mg, 500 mg, 900 mg, and 600 mg of antibiotic, respectively). Three grams of beads were immersed in 4 mL of sterile phosphate-buffered saline (PBS) at 37°C. At each time point (4, 8, 24 h; 2, 7, 14, 28, 42 d), eluates were removed for analysis by liquid chromatography-mass spectrometry. The antimicrobial efficacy of antibiotics combined with calcium sulfate beads after 42 d was tested by a modified KirbyBauer disc diffusion assay. Results: All samples showed a generally exponential decay in the eluted antibiotic concentration. At the first time point, both gentamicin and tobramycin had eluted to a peak concentration of approximately 10,000 mcg/mL. For rifampicin, the peak concentration occurred at 24 h, whereas for vancomycin, it occurred at 48 h. The eluted concentrations exceeded the minimum inhibitory concentration for common periprosthetic joint infection pathogens for the entire span of the 42 study days. Mass spectrometry confirmed all antibiotics were unchanged when eluted from the calcium sulfate carrier. Antimicrobial efficacy was unaltered after 42 d in combination with calcium sulfate at 37°C. Conclusions: Pharmaceutical-grade calcium sulfate has the potential for targeted local release of tobramycin, gentamicin, vancomycin, and rifampicin over a clinically meaningful time period.

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“…One of the most adopted materials for local release of antibiotics is polymethylmethacrylate (PMMA) [14,15]. However, this material has a number of significant disadvantages.…”

mentioning

confidence: 99%

Local Release of Antibiotics for Surgical Site Infection Management Using High-Purity Calcium Sulfate: An In Vitro Elution Study

Aiken

Cooper

Florance

et al. 2015

Surgical Infections

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“…Prefabricated ALBC spacers are fabricated with a low-dose antimicrobial formulation; however, the polymer technology and surface texturing used in their fabrication are reported to increase antimicrobial release [21]. Industrial mixing is intended to provide a high degree of homogeneity and clinical outcomes after the use of prefabricated spacers are reported to be good [19]. It is unknown how the antimicrobial release from prefabricated spacers compares with that achieved from the high-dose ALBC with 10 g antimicrobial powder or more per batch of cement [14].…”

Section: Discussionmentioning

confidence: 99%

“…Reported clinical outcomes using prefabricated spacers are good [18]. Antimicrobial release is expected to be uniform across the entire surface of each spacer and from spacer to spacer [19]. We therefore asked the following questions: (1) How do antimicrobial release characteristics from prefabricated spacers compare with those of hand-mixed cement over time?…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Release From Prefabricated Spacers Is Variable and the Dose Is Low

Goltzer

McLaren

Overstreet

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background High-dose antimicrobial-loaded bone cement (ALBC) is recommended to treat orthopaedic infections. Elution characteristics from prefabricated ALBC spacers and how they compare with hand-mixed ALBC are not well described. Questions/purposes (1) How does antimicrobial release from prefabricated spacers compare with release from hand-mixed ALBC over time? (2) Is antimicrobial release uniform across the surface of prefabricated ALBC spacers? (3) Do variations exist between different prefabricated spacer components? (4) Do textured surfaces release more antimicrobial than smooth surfaces? Methods Six prefabricated ALBC spacer components, two hip and four knee, and three hand-mixed ALBC formulations were studied in this comparative laboratory study. Gentamicin was eluted from 41 discrete sites over the surfaces of six spacer components and compared with elution from 15 ALBC specimens, five from each of three hand-mixed formulations. Elution was compared between spacer sites, components, and surface texture. Statistical analysis was performed by analysis of variance and Tukey's multiple-comparison test or t-test. Results Gentamicin release was highest in the first 24 hours for both prefabricated ALBC spacers and hand-mixed ALBC. Elution decreased over 7 days similarly for both. At Day 7, prefabricated ALBC spacers eluted more than hand-mixed 1 g ALBC (1 g ALBC: 1.49 ± 0.34, prefabricated: 3.59 ± 1.48, mean difference = 2.1 [0.2-4.0], p = 0.04) but eluted less than 5 g ALBC (9.21 ± 1.31, mean difference = À5.6 [À3.5 to À7.7], p \ 0.001) and less than 10 g ALBC (35.8 ± 1.69, mean difference = À32.2 [À29.8 to À34.6], p \ 0.001). Release varied from 2.7 to 9.9 lg/mm 2 over the surface of the spacers and from 3.5 to 5.5 lg/mm 2 between components with no component different than the others (Tukey). Release from textured surfaces was inconsistent. Conclusions Antimicrobial release from prefabricated ALBC spacers is consistent with low-dose ALBC. Variation across the surface and between components is small compared with changes in antimicrobial load. Clinical Relevance Antimicrobial release from prefabricated ALBC spacers is consistent with local antimicrobial delivered from other low-dose ALBC formulations.

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“…One of the most commonly used materials is polymethylmethacrylate (PMMA) [5]. It is not biodegradable therefore a second operation is required for it to be removed once the antibiotic is released.…”

Section: Discussionmentioning

confidence: 99%

A Case Report on the Treatment of Metcillin-Resistant Staphylococcus Aureus (Mrsa) Infected Tibial Internal Fixation with Calcium

Pillai¹

2015

Orthop Muscular Syst

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The formation of biofilm is one of the main contributing factors for unsuccessful treatment of osteomyelitis. It is formed through bacterial adhesion to the fragments of dead bone. Poor perfusion or devascularization of an infected bone with changes in local pH further limits the diffusion of parenteral antibiotics.Calcium Sulfate , a biocompatible and completely absorbable local carrier for antibiotics, has shown promising results in treating osteomyelitis. It is associated with less systemic effects and compliance issues when compared with conventional treatment of surgical debridement and prolonged systemic antibiotics.

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Release of Gentamicin and Vancomycin from Preformed Spacers in Infected Total Hip Arthroplasties: Measurement of Concentrations and Inhibitory Activity in Patients’ Drainage Fluids and Serum

Cited by 34 publications

References 31 publications

Local Release of Antibiotics for Surgical Site Infection Management Using High-Purity Calcium Sulfate: An In Vitro Elution Study

Local Release of Antibiotics for Surgical Site Infection Management Using High-Purity Calcium Sulfate: An In Vitro Elution Study

Antimicrobial Release From Prefabricated Spacers Is Variable and the Dose Is Low

A Case Report on the Treatment of Metcillin-Resistant Staphylococcus Aureus (Mrsa) Infected Tibial Internal Fixation with Calcium

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