Alternative Materials to Acrylic Bone Cement for Delivery of Depot Antibiotics in Orthopaedic Infections

102

Local antibiotic delivery is an emerging area of study designed to provide alternative methods of treatment to clinicians for compromised wound sites where avascular zones can prevent the delivery of antibiotics to the infected tissue. Antibiotic-loaded bone cement is the gold standard for drug-eluting local delivery devices but is not ideal because it requires a removal surgery. Chitosan is a biocompatible, biodegradable polymer that has been used in several different drug delivery applications. We evaluated chitosan as a potential localized drug delivery device. We specifically determined if chitosan could elute antibiotics in an active form that would be efficacious in inhibiting S. aureus growth. Elution of amikacin was 24.67 ± 2.35 lg/mL (85.68%) after 1 hour with a final cumulative release of 27.31 ± 2.86 lg/mL (96.23%) after 72 hours. Elution of daptomycin was 10.17 ± 3.83 lg/mL after 1 hour (31.61% release) and 28.72 ± 6.80 lg/mL after 72 hours (88.55%). The data from the elution study suggested effective release of amikacin and daptomycin. The activity studies indicated the eluants inhibited the growth of S. aureus. Incorporating antibiotics in chitosan could provide alternative methods of treating musculoskeletal infections.

Section: Introductionmentioning

confidence: 99%

“…Incorporation of either amikacin or daptomycin into chitosan can possibly lead to a desirable local drug delivery system that uses the inherent properties of chitosan. The need for improved delivery of antibiotics to infected wound sites remains a challenge that faces clinicians abroad [16,23,27].…”

Section: Introductionmentioning

confidence: 99%

Chitosan Films: A Potential Local Drug Delivery System for Antibiotics

Noel

Courtney

Bumgardner

et al. 2008

102

“…In one report, 18 of 20 cement spacers cultured using sophisticated techniques at the time of spacer removal and final reimplantation grew resistant organisms [39]. Finally, depot methods for antibiotic delivery require extensive surgery for removal of the depot materials in cases with toxic effects of the antibiotics [36].…”

Section: Discussionmentioning

confidence: 99%

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

Whiteside

Roy

2017

Background Two-stage revision surgery for infected total hip arthroplasty (THA) is commonly advocated, but substantial morbidity and expense are associated with this technique. In certain cases of infected THA, treatment with one-stage revision surgery and intraarticular infusion of antibiotics may offer a reasonable alternative with the distinct advantage of providing a means of delivering the drug in high concentrations. Questions/purposes We describe a protocol for intraarticular delivery of antibiotics to the hip through an indwelling catheter combined with one-stage revision surgery and examine (1) the success as judged by eradication of infection at 1 year when treating chronically infected cemented stems; (2) success in treating late-onset acute infections in well-ingrown cementless stems; and (3) what complications were associated with this approach in a small case series. Methods Between

“…Our study is limited by several factors. First, a common limitation of most in vitro research is the difficulty of translating in vitro studies to in vivo studies [18]. Release characteristics in an in vivo environment, especially associated with a wound, are different than antibiotic release characteristics in vitro, in which a set volume of eluate and PBS is exchanged at certain intervals [18].…”

Section: Cumulative Daptomycin Mass Released Elution Time (Days)mentioning

confidence: 99%

“…Another, and the most common, material used for local drug delivery is polymethylmethacrylate (PMMA) [5]. Although PMMA implants are not biodegradable, their removal may be necessary at times for planned staged reconstruction or late bead failure [18]. Because CaSO 4 degrades over time, the need for surgical removal is eliminated.…”

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

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.