The stability of carbapenems before and after admixture to PMMA-cement used for replacement surgery caused by Gram-negative bacteria

Schmid, Matthias; Steiner, Oliver; Fasshold, Lisa; Goessler, Walter; Holl, Anna-Maria; Kühn, Klaus-Dieter

doi:10.1186/s40001-020-00428-z

Cited by 8 publications

(4 citation statements)

References 29 publications

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“…In recurrent infections, higher rates of Gram-negative germs as well as polymicrobial infections should be expected [35]. Local carbapenems, which have been previously shown that they can be safely added to PMMA bone cement, could be a valuable option in these cases [36]. Hence, approaches involving vancomycin and gentamicin, but also carbapenemcarrying bone substitutes, bone cement or coated implants seem reasonable [37][38][39].…”

Section: Local Antibiotic Therapymentioning

confidence: 99%

What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?

et al. 2022

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Antibiotic treatment strategies for fracture-related infections (FRI) are often extrapolated from periprosthetic joint infections (PJI), although, in contrast to PJI, detailed analysis of pathogens and their antibiotic resistance is missing. Therefore, this study aimed to investigate antibiotic susceptibility profiles to identify effective empiric antibiotic treatment for early-, delayed-, and late-onset FRI. Patients treated for FRI from 2013 to 2020 were grouped into early (<2 weeks), delayed (3–10 weeks), and late (>10 weeks) onset of infection. Antibiotic susceptibility profiles were examined with respect to broadly used antibiotics and antibiotic combinations. In total, 117 patients (early n = 19, delayed n = 60, late n = 38) were enrolled. In early-onset FRI, 100.0% efficacy would be achieved by meropenem + vancomycin, gentamicin + vancomycin, co-amoxiclav + glycopeptide, ciprofloxacin + glycopeptide and piperacillin/tazobactam + glycopeptide. For patients with delayed FRI, the highest susceptibility was revealed for meropenem + vancomycin, gentamicin + vancomycin and ciprofloxacin + glycopeptide (96.7%). Meropenem + vancomycin was the most effective empiric antimicrobial in patients with late-onset of infection with 92.1% coverage. No subgroup differences in antibiotic sensitivity profiles were observed except for the combination ciprofloxacin + glycopeptide, which was significantly superior in early FRI (F = 3.304, p = 0.04). Across all subgroups meropenem + vancomycin was the most effective empiric treatment in 95.7% of patients with confirmed susceptibility. Meropenem + vancomycin, gentamicin + vancomycin, co-amoxiclav + glycopeptide are the best therapeutic options for FRI, regardless of the onset of infection. To avoid multidrug resistance, established antibiotic combinations such as co-amoxiclav with a glycopeptide seem to be reasonable as a systemic antibiotic therapy, while vancomycin + gentamicin could be implemented in local antibiotic therapy to reduce adverse events during treatment.

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Section: Local Antibiotic Therapymentioning

confidence: 99%

What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?

et al. 2022

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“…Meropenem is a suitable antibiotic for use in ALC spacers because it comes in powder form, is heat stable and has good elusion characteristics. [35,36] Meropenem might thus be the antibiotic of choice for empiric Gramnegative coverage.…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic joint infection:A South African perspective

Hiddema

2023

S Afr Med J

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Background. South African data on the bacteriology and sensitivity profile of periprosthetic joint infection is lacking. Current regimens for systemic and local antibiotic therapy are based on international literature. These regimens are different for the United States of America and Europe and might thus not be relevant to South Africa. Objectives. To determine the characteristics of periprosthetic joint infection in a South African clinical setting by identifying the most common organisms cultured and establishing their antibiotic sensitivities in order to propose the most appropriate empiric antibiotic treatment regimen. In the case of two-stage revision procedures, we aim to compare the organisms cultured during the first stage versus organisms cultured during the second stage in second-stage procedures that had positive cultures. Furthermore, in these culture-positive second-stage procedures we aim to correlate the bacterial culture with the erythrocyte sedimentation rate/ C-reactive protein result. Methods. We performed a retrospective cross-sectional study looking at all hip and knee periprosthetic joint infections in patients 18 years and older, treated at a government institution and a private revision practice in Johannesburg, South Africa between January 2015 and March 2020. Data were collected from the Charlotte Maxeke Johannesburg Academic Hospital hip and knee and the Johannesburg Orthopaedic hip and knee databanks. Results. We included 69 patients whom underwent 101procedures relating to periprosthetic joint infection. Positive cultures were found in 63 samples, 81 different organisms were identified. The most common organisms cultured were Staphylococcus aureus (n = 16, 19.8%) and Coagulase negative Staphylococcus (n = 16, 19.8%), followed by Streptococci species (n = 11, 13.6%). The positive yield in our cohort was 62.4% (n = 63). A polymicrobial growth was found in 19% (n = 12) of the culture positive specimens. Of all the microorganisms cultured, 59.2% (n = 48) were Gram-positive versus 35.8% (n = 29) Gram-negative. The remainder were fungal and anaerobic organisms at 2.5% (n = 2) each. Gram-positive cultures displayed 100% sensitivity to Vancomycin and Linezolid, whereas Gram-negative organisms displayed 82% sensitivity towards Gentamycin and 89% sensitivity towards Meropenem respectively. Conclusion. Our study identifies the bacteriology of periprosthetic joint infections and their sensitivities in a South African setting. We recommend that empiric antibiotic-loaded cement spacers and systemic antibiotic regimens should consist of Meropenem or Gentamycin; Vancomycin and Rifampicin to achieve the broadest spectrum of coverage and most likely success in eradicating infection.

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“…A previous study showed that meropenem as a drug in bone cement was relatively stable even after heat exposure. [19] The possible reason is that the study only exposed the drug for a maximum of 120 minutes. Our study corresponds to another previous study that showed that meropenem in normal saline solution was unstable at 37°C and that there was improved stability when the temperature was kept at below 25°C.…”

Section: Spectrophotometric Analysismentioning

confidence: 99%

Stability of four carbapenem antibiotics in discs used for antimicrobial susceptibility testing

Shahab,

Bexkens,

Kempenaars

et al. 2024

Preprint

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In low-to middle-income countries, microbiological laboratories often use disc diffusion for antimicrobial susceptibility testing (AST). Reliable AST of carbapenem antibiotics is crucial for treatment decisions and surveillance purposes. Transport and storage conditions of materials used for AST are critical and may be challenging in some settings, where temperature cannot always be controlled. This study aimed to test the stability of four carbapenems in discs for AST under unfavourable conditions,i.e., at room temperature and 35°C for up to 72 hours. Imipenem, meropenem, ertapenem, and doripenem discs from three brands, Oxoid, Becton Dickinson, and HiMedia, containing 10 μg of antibiotic were included. Discs were exposed to six unfavourable conditions and the recommended storage-condition as control. Subsequently, disc diffusion testing following the EUCAST guidelines was performed with four well-defined strains ofEscherichia coliwith different susceptibility profiles to carbapenems. The inhibition zone diameters were measured after 16-18 hours of incubation at 35±2°C. All experiments were executed in triplicate. In parallel, the carbapenems’ degradation was observed using a spectrophotometric method. Our study revealed that carbapenem discs were generally stable for AST although the concentration of most carbapenem antibiotics in discs decreased over time. Overall, imipenem (Oxoid and Becton Dickinson) discs were the most stable. Meropenem discs were less stable when exposed to 35°C than at room temperature. Concentrations of carbapenems in HiMedia discs were higher than those in Oxoid and Becton Dickinson. For carbapenem AST using disc diffusion in a rural area, we recommend using imipenem discs from Oxoid or Becton Dickinson.GRAPHICAL ABSTRACTHIGHLIGHTSIn remote areas, transportation conditions of AST discs may be challengingDiscs with four carbapenems from three brands were tested using six conditionsCarbapenem discs were generally stable for ASTIn unfavourable conditions, concentrations in the discs degraded over timeImipenem (Oxoid and Becton Dickinson) discs were the most stable

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The stability of carbapenems before and after admixture to PMMA-cement used for replacement surgery caused by Gram-negative bacteria

Cited by 8 publications

References 29 publications

What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?

What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?

Periprosthetic joint infection:A South African perspective

Stability of four carbapenem antibiotics in discs used for antimicrobial susceptibility testing

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