Clinical Evaluation of Patients With Vancomycin Spacer Retained for More Than 12 Months

Abstract

Objective:There is no consensus in the literature regarding the time taken to remove antibiotic spacers in the treatment of bone infections. The aim of this study is to evaluate the clinical results of patients with prolonged retention of the same.Methods:Patients selected were diagnosed with post-osteosynthesis infection and/or osteomyelitis and were submitted to treatment using an orthopedic cement spacer (polymethylmethacrylate) with vancomycin, retaining it for a period of more than 12 months. They were clinically evaluated to determine the presence of local or systemic infectious signs via hemogram, investigations of inflammatory markers, liver, renal and, with radiographic control.Results:Eighteen patients were included in the study. The mean retention time of the spacer was 30.4 months (15 – 61 months). No patient had clinical signs of local or systemic infectious relapse at the time of evaluation. Seven patients (39%) presented non-disabling pain in the operated limb. Seventeen patients (94%) presented a reduction in C-reactive protein values compared to the preoperative period. Radiographically, no migration, no spacer failure, or bone sequestration occurred.Conclusion:In this retrospective case series, cement spacer retention with vancomycin for more than 12 months was associated with good clinical results, without relapse of the infectious condition. Nível de Evidência IV. Estudos Terapêuticos - Investigação dos Resultados do Tratamento.

A dual PMMA/calcium sulfate carrier of vancomycin is more effective than PMMA‐vancomycin at inhibiting Staphylococcus aureus growth in vitro

“…Local antibiotic‐loaded delivery systems are commonly adapted as effective vehicles for chronic osteomyelitis, to maintain antibiotics at a high level at the local site of osteomyelitis [2,3]. Antibiotics‐loaded poly(methyl acrylate, methyl methacrylate) (PMMA) was the effective antibiotic carrier system to control chronic osteomyelitis, because it can provide the following advantages: a high releasing level of antibiotics at the local site of infection, synchronously eliminating the surgically debridement‐derived dead space, low toxicity and less in serum [3–4]. Although PMMA has been widely studied, some of its disadvantages have been discovered by many studies.…”