Successful Clinical Use of Daptomycin-Impregnated Bone Cement in Two-Stage Revision Hip Surgery for Prosthetic Joint Infection

Cortes, Nicholas; Lloyd, John; Kozioł, Leszek; O'Hara, Lawrence J.

doi:10.1345/aph.1r486

Cited by 17 publications

(11 citation statements)

References 9 publications

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“…In clinical trials, daptomycin was found to be equal with standard antibiotics in severe skin infections, bacteremia, and endocarditis caused by Gram-positive bacteria [23]. A case report documented a successful treatment of a recurrent prosthetic hip infection in a 70-year-old female with a past history of MRSA infection by using two-stage revision surgery with PMMA impregnated with daptomycin and gentamicin [24]. …”

Section: Discussionmentioning

confidence: 99%

Activity of Fosfomycin- and Daptomycin-Containing Bone Cement on Selected Bacterial Species Being Associated with Orthopedic Infections

Eick

Hofpeter

Sculean

et al. 2017

BioMed Research International

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The purpose of this study was to determine activity of fosfomycin/gentamicin and daptomycin/gentamicin-containing PMMA bone-cement against Staphylococcus aureus (MRSA, MSSA), Staphylococcus epidermidis, Enterococcus faecium (VRE), and E. coli (ESBL; only fosfomycin). Test specimens of the bone cement were formed and bacteria in two concentrations were added one time or repeatedly up to 96 h. All fosfomycin-containing cement killed ultimately all MSSA, Staphylococcus epidermidis, and E. coli within 24 h; growth of MRSA was suppressed up to 48 h. Activity of daptomycin-containing cement depended on the concentration; the highest concentrated bone cement used (1.5 g daptomycin/40 g of powder) was active against all one-time added bacteria. When bacteria were added repeatedly to fosfomycin-containing cement, growth was suppressed up to 96 h and that of MRSA and VRE only up to 24 h. The highest concentration of daptomycin suppressed the growth of repeated added bacteria up to 48 h (VRE) until 96 h (MSSA, MRSA). In conclusion, PMMA bone cement with 1.5 g of daptomycin and 0.5 g of gentamicin may be an alternative in treatment of periprosthetic infections caused by Gram-positive bacteria.

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Section: Discussionmentioning

confidence: 99%

Activity of Fosfomycin- and Daptomycin-Containing Bone Cement on Selected Bacterial Species Being Associated with Orthopedic Infections

Eick

Hofpeter

Sculean

et al. 2017

BioMed Research International

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“…The actual dosage of daptomycin added in the bone cement as a spacer to treat PJI is unclear. Cortes et al reported the first case report of use of daptomycin 10 g and gentamicin 10 g in the bone cement (each agent at 5 % w/w) in two-stage revision hip surgery for prosthetic joint infection [ 17 ]. In an international consensus meeting on periprosthetic joint infection, 2 g daptomycin (5 % w/w) was recommended in spacers [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several in vitro studies also showed that daptomycin could be locally delivered from PMMA bone cement without impairing cement strength [ 15 , 16 ]. Only one clinical report showed combined use of daptomycin in bone cement and intravenously to treat chronic PJI in a 2-stage surgery [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Methicillin-resistant Staphylococcal periprosthetic joint infections can be effectively controlled by systemic and local daptomycin

et al. 2015

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BackgroundMethicillin-resistant Staphylococcus remains a serious problem in the treatment of periprosthetic joint infection (PJI). Higher failure rates were reported when vancomycin was used in 2-stage exchange arthroplasty. Therefore a better therapeutic drug is needed to treat PJI caused by methicillin-resistant organisms. The purpose of the study was to evaluate the safety and efficacy of daptomycin when administered in bone cement combined with systemic use for methicillin-resistant Staphylococci PJI.MethodsWe conducted a retrospective study from January 2010 to December 2012. Twenty-two patients (10 knees and 12 hips) with PJI caused by methicillin-resistant Staphylococcus species underwent 2-stage revision arthroplasty. In the first stage, 10 % daptomycin (weight daptomycin per weight bone cement) was incorporated into polymethylmethacrylate bone cement, and systemic daptomycin (6 mg/kg) was administered postoperatively for 14 days. In the second stage, 2.5 % w/w daptomycin was used in the bone cement. The minimum follow-up was 2 years or until recurrence of infection.ResultsThe infecting organisms included methicillin-resistant Staphylococcus aureus in 10 patients, methicillin-resistant Staphylococcus epidermidis in 8 patients and methicillin-resistant coagulase-negative Staphylococci in 4 patients. The mean follow-up duration was 33.7 months (range, 24–51 months). The treatment success rate was 100 %. Only one patient developed asymptomatic transient elevation of the creatine phosphokinase level. No patient experienced any adverse effects related to daptomycin such as myositis, rhabdomyolysis, peripheral neuropathy, derangement of liver function, or eosinophilic pneumonia.ConclusionsIn this series, no serious adverse events occurred. Our protocol, using daptomycin-impregnated cement combined with short duration of systemic daptomycin, appears to be an effective and safe treatment for methicillin-resistant Staphylococcus PJI.

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“…Furthermore, daptomycin appears to maintain bactericidal activity against stationary‐phase pathogens that may be embedded in biofilms associated with PJI . As is the case with many AIBC preparations, the optimal daptomycin dose has not been defined, and published clinical experience is limited to a total of 23 patients to date . The safety and resistance potential of daptomycin‐impregnated cements is largely unknown at this time.…”

Section: Antimicrobial Selectionmentioning

confidence: 99%

“…61 As is the case with many AIBC preparations, the optimal daptomycin dose has not been defined, and published clinical experience is limited to a total of 23 patients to date. 43,51 The safety and resistance potential of daptomycin-impregnated cements is largely unknown at this time. Given its status as the first-in-class lipopeptide, low resistance rates observed, and favorable safety profile when used systemically, stewardship of daptomycin cement use is imperative to preserve long-term effectiveness.…”

Section: Lipopeptidesmentioning

confidence: 99%

Trowels and Tribulations: Review of Antimicrobial‐Impregnated Bone Cements in Prosthetic Joint Surgery

2017

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Antimicrobial-impregnated bone cement (AIBC) is a staple of contemporary orthopedic surgery and has been used to either treat or prevent prosthetic joint infection. Applied intraoperatively during primary arthroplasty or prosthetic joint exchange, this drug-delivery vehicle has become a popular means of maximizing drug concentrations within a joint space while minimizing systemic exposure. Antimicrobial characteristics conducive to cement loading include availability of a crystalline powder formulation, molecular characteristics, minimal impact on cement integrity, and other variables promoting drug elution. Antimicrobials most commonly incorporated into cements are vancomycin and aminoglycosides, usually in combination due to synergistic antibacterial activity and enhanced cement elution. Other classes include the β-lactams, lipopeptides, oxazolidinones, and antifungals. With the exception of several commercially available AIBCs, most products are compounded extemporaneously without a formal safety or efficacy assessment. Few randomized controlled trials have been conducted to assess the benefit or optimal use of these cement preparations, and variable methodology renders cross-study comparison challenging. Given the lack of standardization and multidisciplinary oversight often seen with practical AIBC use, additional data are needed. This review presents information intended to guide AIBC preparation, selection, dosing, and safe use. In addition, opportunities for best practice development, antimicrobial stewardship, and future research are discussed.

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Successful Clinical Use of Daptomycin-Impregnated Bone Cement in Two-Stage Revision Hip Surgery for Prosthetic Joint Infection

Abstract: Daptomycin impregnation of PMMA bone cement may be an option in cases in which patient or pathogen factors preclude use of routinely incorporated agents.

Cited by 17 publications

References 9 publications

Activity of Fosfomycin- and Daptomycin-Containing Bone Cement on Selected Bacterial Species Being Associated with Orthopedic Infections

Activity of Fosfomycin- and Daptomycin-Containing Bone Cement on Selected Bacterial Species Being Associated with Orthopedic Infections

Methicillin-resistant Staphylococcal periprosthetic joint infections can be effectively controlled by systemic and local daptomycin

Trowels and Tribulations: Review of Antimicrobial‐Impregnated Bone Cements in Prosthetic Joint Surgery

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