A Preliminary Report on the Usage of an Intracorporal Antibiotic Cast with Synthetic High Purity CaSO4 for the Treatment of Infected Penile Implant

Swords, Kelly; Martinez, Daniel R; Lockhart, Jorge L.; Carrión, Rafael

doi:10.1111/jsm.12060

Cited by 34 publications

(20 citation statements)

References 10 publications

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“…Also, the SEM data demonstrate the potential for eluting materials to be a nidus for infection and biofilm formation once antibiotic concentrations fall below bacterial MBCs and, therefore, emphasize the benefit of absorbable substrates. Studies have shown complete absorption of highpurity calcium sulfate within 4 to 6 weeks when combined with effective management of penile implant infection and of osteomyelitis (25,(40)(41)(42), indicating potentially wide-ranging benefits in the management of PIs.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic-Loaded Synthetic Calcium Sulfate Beads for Prevention of Bacterial Colonization and Biofilm Formation in Periprosthetic Infections

Howlin

Brayford

Webb

et al. 2015

Antimicrob Agents Chemother

189

185

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e Periprosthetic infection (PI) causes significant morbidity and mortality after fixation and joint arthroplasty and has been extensively linked to the formation of bacterial biofilms. Poly(methyl methacrylate) (PMMA), as a cement or as beads, is commonly used for antibiotic release to the site of infection but displays variable elution kinetics and also represents a potential nidus for infection, therefore requiring surgical removal once antibiotics have eluted. Absorbable cements have shown improved elution of a wider range of antibiotics and, crucially, complete biodegradation, but limited data exist as to their antimicrobial and antibiofilm efficacy. Synthetic calcium sulfate beads loaded with tobramycin, vancomycin, or vancomycin-tobramycin dual treatment (in a 1:0.24 [wt/wt] ratio) were assessed for their abilities to eradicate planktonic methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis relative to that of PMMA beads. The ability of the calcium sulfate beads to prevent biofilm formation over multiple days and to eradicate preformed biofilms was studied using a combination of viable cell counts, confocal microscopy, and scanning electron microscopy of the bead surface. Biofilm bacteria displayed a greater tolerance to the antibiotics than their planktonic counterparts. Antibiotic-loaded beads were able to kill planktonic cultures of 10 6 CFU/ml, prevent bacterial colonization, and significantly reduce biofilm formation over multiple days. However, established biofilms were harder to eradicate. These data further demonstrate the difficulty in clearing established biofilms; therefore, early preventive measures are key to reducing the risk of PI. Synthetic calcium sulfate loaded with antibiotics has the potential to reduce or eliminate biofilm formation on adjacent periprosthetic tissue and prosthesis material and, thus, to reduce the rates of periprosthetic infection. P eriprosthetic infection (PI) is a serious complication of total joint arthroplasty with high rates of associated morbidity (1, 2), and a growing body of data suggests that bacterial biofilms are the underlying cause (3-9). Within a biofilm, bacteria display a Ն1,000-fold tolerance to antibiotics than their planktonic counterparts (10) and significant resistance to innate and adaptive host immunity (11). Moreover, biofilms associated with orthopedic hardware are typically difficult to culture using conventional clinical microbiological methods, and the lack of a definitive diagnosis may result in an underestimate of infection rates (12, 13). Consequently, the underlying infection is difficult to diagnose and treat (6, 7), and often the only effective intervention is the twin strategy of thorough debridement and prostheses removal (14).Existing prevention strategies include the use of antibiotic-loaded poly(methyl methacrylate) (PMMA) cement spacers or beads to elevate local antibiotic levels at the surgical site. Studies have demonstrated a significant reduction in infection rates using antibiotic-impregnated ce...

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Section: Discussionmentioning

confidence: 99%

Antibiotic-Loaded Synthetic Calcium Sulfate Beads for Prevention of Bacterial Colonization and Biofilm Formation in Periprosthetic Infections

Howlin

Brayford

Webb

et al. 2015

Antimicrob Agents Chemother

189

185

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“…One such material is calcium sulfate, with recent literature discussing its application in combination with antibiotics [16,25,26], including its safe and efficacious use in infected soft tissue sites [27].…”

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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“…17 The investigators describe filling the corpora cavernosa with a cast made of high-purity calcium sulfate that had been mixed with tobramycin and vancomycin and acts as a spacer before reimplantation of an inflatable PP several weeks later. This technique, however, is still in the experimental phase.…”

Section: Treatment Of Infections Associated With Prosthesesmentioning

confidence: 99%

Current Concepts in Infections Associated with Penile Prostheses and Artificial Sphincters

Hofer

Gonzalez²

2015

Urologic Clinics of North America

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A Preliminary Report on the Usage of an Intracorporal Antibiotic Cast with Synthetic High Purity CaSO4 for the Treatment of Infected Penile Implant

Cited by 34 publications

References 10 publications

Antibiotic-Loaded Synthetic Calcium Sulfate Beads for Prevention of Bacterial Colonization and Biofilm Formation in Periprosthetic Infections

Antibiotic-Loaded Synthetic Calcium Sulfate Beads for Prevention of Bacterial Colonization and Biofilm Formation in Periprosthetic Infections

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

Current Concepts in Infections Associated with Penile Prostheses and Artificial Sphincters

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