The Use of an Antibiotic-Impregnated, Osteoconductive, Bioabsorbable Bone Substitute in the Treatment of Infected Long Bone Defects: Early Results of a Prospective Trial

McKee, Michael D.; Wild, Lisa M.; Schemitsch, Emil H.; Waddell, James P.

doi:10.1097/00005131-200210000-00002

Cited by 211 publications

(180 citation statements)

References 26 publications

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“…3 This enables levels of local concentration that can be many times the minimum bactericidal concentration (MBC) for the infecting pathogens, while at the same time the risk of high systemic levels and associated toxicity remain low. 7 Poly(methylmethacrylate) (PMMA) beads and spacers were most commonly used for localized antibiotic delivery, introduced by Buchholz and Engelbrecht in 1970. 8 While PMMA has the benefit of being able to bear weight, its variable antibiotic elution rates 9 and the requirement of a secondary surgery for explanation, has led to the investigation of absorbable alternatives to PMMA for more complete antibiotic delivery.…”

Section: Introductionmentioning

confidence: 99%

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

McConoughey

Howlin

Wiseman

et al. 2014

J. Biomed. Mater. Res.

107

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Antibiotic-loaded bone cement is a primary option for treatment of orthopedic infections. Poly(methyl methacrylate) (PMMA) is a widely used cement that, when loaded with antibiotics in spacer or bead form, has been shown to reduce infection rates. However, PMMA is not resorbable and requires a second surgery for removal, while also acting as a potential foreign body for bacterial colonization. Alternatively, resorbable bone cements, such as calcium sulfate, have been proposed and present the advantage of being completely reabsorbed. It is unknown whether the antibiotic elution characteristics of absorbable bone cements are similar to PMMA. This study (1) characterized antibiotic elution from synthetic, highly purified calcium sulfate cement beads of varying sizes against pathogenic bacteria both in liquid culture and seeded on agar plates, (2) tested calcium sulfate beads against PMMA beads loaded with the same antibiotics, and (3) analyzed the structural differences between how PMMA and calcium sulfate bind to antibiotics. In every assay, the calcium sulfate beads performed as well as, or better than, the PMMA beads in inhibition of bacterial growth and elution of vancomycin in vitro with complete elution observed from calcium sulfate within three days. These data suggest that calcium sulfate, functions, as well as PMMA in the patient setting for infection control.

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Section: Introductionmentioning

confidence: 99%

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

McConoughey

Howlin

Wiseman

et al. 2014

J. Biomed. Mater. Res.

107

View full text Add to dashboard Cite

show abstract

“…The main bactericidal function of vancomycin is to inhibit the bacterial cell wall synthesis and disturb the osmotic ability of the cell membrane. Vancomycin is effective against infections caused by methicillin resistant staphylococci and S. epidermidis [6,20,35] and it also is useful in mixed infections involving streptococci and enterococci. However, it has no significant effect on gram negative bacteria or anaerobes.…”

Section: Discussionmentioning

confidence: 99%

In vivo study of biodegradable alginate antibiotic beads in rabbits

Ueng

Yuan

Liao

et al. 2004

Journal Orthopaedic Research

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The authors investigated the lyophilized poly-L-lysine-coated alginate antibiotic delivery system in vivo for the treatment of musculoskeletal infections. The sodium alginate was mixed with vancomycin, coated with poly-L-lysine and lyophilized to form 3 mm in diameter biodegradable antibiotic beads. The antibiotic beads were implanted in the distal femoral cavities of rabbits for in vivo investigation. The local concentration of vancomycin was well above the minimal inhibitory Concentration of Stuph~d~vloco~us uureus for 21 days. The release was most marked during the first two days. The diameters of sample inhibition zone ranged from 8 to 16 mm, the relative activity of vancomycin ranged from 12.5'%1 to 100'%1. The blood level of vancomycin reached its peak (46.0 mgll) two days after implantation and fell to 3.2 mgll at two weeks. It was undetectable after three weeks. There was no increase in the concentration of blood urea nitrogen and serum creatiiiine after the implantation. Histological observations showed that bead materials were biodegradable, resorbed slowly and only cause mild host reaction. This study offers a biodegradable delivery system of antibiotics to treat musculoskeletal infections.

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“…Because CaSO 4 degrades over time, the need for surgical removal is eliminated. Clinical studies and animal models suggest using antibiotic-loaded calcium sulfate pellets minimizes infection [1,17,25]. Although there are numerous potential applications in which calcium sulfate is beneficial as a drug delivery material, the mechanical properties of calcium sulfate do make it insufficient for load-bearing applications [8].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Two Sources of Calcium Sulfate for a Local Drug Delivery System: A Pilot Study

Parker

Smith

Courtney

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Local drug delivery has substantial potential to prevent infections compared with systemic delivery. Although calcium sulfate (CaSO 4 ) has been studied for local drug delivery and two types are commercially available, it is unknown whether they differentially release antibiotics. Questions/purposes We determined the differences between two sources of CaSO 4 and the K 2 SO 4 catalyst's presence on the degradation, daptomycin elution, and activity against Staphylococcus aureus. Methods We formed pellets from synthetic and naturally sourced (from gypsum) CaSO 4 and loaded with 5% daptomycin and 3% or 0% K 2 SO 4 . We used in vitro experiments to determine the daptomycin concentration and degradation profiles over 10 days. Turbidity assays were used to evaluate the activity of the daptomycin eluates against S. aureus.

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The Use of an Antibiotic-Impregnated, Osteoconductive, Bioabsorbable Bone Substitute in the Treatment of Infected Long Bone Defects: Early Results of a Prospective Trial

Cited by 211 publications

References 26 publications

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

In vivo study of biodegradable alginate antibiotic beads in rabbits

Evaluation of Two Sources of Calcium Sulfate for a Local Drug Delivery System: A Pilot Study

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