Antibacterial Activity of Joint Fluid in Cemented Total-Knee Arthroplasty: an
            <i>In Vivo</i>
            Comparative Study of Polymethylmethacrylate with and without Antibiotic Loading

Ueng, Steve Wen–Neng; Hsieh, Pang‐Hsin; Shih, Hsin-Nung; Chan, Yi-Shan; Lee, Mel S.; Chang, Yu‐Han

doi:10.1128/aac.01067-12

Cited by 33 publications

(21 citation statements)

References 25 publications

(37 reference statements)

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“…15,16 In the treatment of skeletal infections, a high-dose ALBC (≥ 3.6 g of antibiotic per 40 g of PMMA powder) is desirable for effective elution kinetics and sustained therapeutic levels of the antibiotic. 17 In contrast to therapeutic measures, prophylaxis requires low-dose antibiotics in the bone cement to avoid adverse mechanical effects on cement that is intended for fixation of the prosthesis.…”

Section: Discussionmentioning

confidence: 99%

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Gentamicin in bone cement

Chang

Hsieh

et al. 2013

Bone & Joint Research

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Objectives The objective of this study is to determine an optimal antibiotic-loaded bone cement (ALBC) for infection prophylaxis in total joint arthroplasty (TJA).MethodsWe evaluated the antibacterial effects of polymethylmethacrylate (PMMA) bone cements loaded with vancomycin, teicoplanin, ceftazidime, imipenem, piperacillin, gentamicin, and tobramycin against methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant Staph. aureus (MRSA), coagulase-negative staphylococci (CoNS), Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Standardised cement specimens made from 40 g PMMA loaded with 1 g antibiotics were tested for elution characteristics, antibacterial activities, and compressive strength in vitro. ResultsThe ALBC containing gentamicin provided a much longer duration of antibiotic release than those containing other antibiotic. Imipenem-loading on the cement had a significant adverse effect on the compressive strength of the ALBC, which made it insufficient for use in prosthesis fixation. All of the tested antibiotics maintained their antibacterial properties after being mixed with PMMA. The gentamicin-loaded ALBC provided a broad antibacterial spectrum against all the test organisms and had the greatest duration of antibacterial activity against MSSA, CoNS, P. aeruginosa and E. coli. ConclusionWhen considering the use of ALBC as infection prophylaxis in TJA, gentamicin-loaded ALBC may be a very effective choice.Cite this article: Bone Joint Res 2013;2:220–6.

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Section: Discussionmentioning

confidence: 99%

“…15 This longer duration of antibacterial activity in joint fluid may contribute to a lower infection rate in TKA performed using ALBC. However, only resistant or non-resistant strains of Staph.…”

Section: Discussionmentioning

confidence: 99%

Gentamicin in bone cement

Chang

Hsieh

et al. 2013

Bone & Joint Research

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“…PMMA, the current standard of care, loaded with vancomycin showed a retention of bioactivity for 48 h (37). Recently, a novel SiO 2 -TiO 2 -ZnO-CaO-SrO-based glass polyalkenoate cement loaded with vancomycin was also shown to be effective against S. aureus for 48 h (38).…”

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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“…The therapeutic rationale for combining G and V depends on the susceptibility of the infecting pathogens, and vancomycin use should be limited to infections likely to be caused by more resistant Gram-positive bacteria, such as S. epidermidis , methicillin-resistant staphylococci, CoNS, or enterococci [30, 31]. Cefazolin, not dosed, could contribute to antimicrobial activity of drainage fluids; it is effective mainly against susceptible strains, S. aureus (9A28) and S. aureus (3A10), and ineffective against the multiresistant strains as confirmed recently [32]. …”

Section: Discussionmentioning

confidence: 99%

Release of Gentamicin and Vancomycin from Preformed Spacers in Infected Total Hip Arthroplasties: Measurement of Concentrations and Inhibitory Activity in Patients’ Drainage Fluids and Serum

Regis

Sandri

Samaila

et al. 2013

The Scientific World Journal

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Gentamicin (G) and vancomycin (V) concentrations in drainage fluids obtained from patients during the first 24 hours after implantation of antibiotic-loaded polymethylmethacrylate (PMMA) spacers in two-stage revision of infected total hip arthroplasty were studied. The inhibitory activity of drainage fluids against different multiresistant clinical isolates was investigated as well. Seven hips were treated by implantation of industrial G-loaded spacers. Vancomycin was added by manually mixing with PMMA bone cement. Serum and drainage fluid samples were collected 1, 4, and 24 hours after spacer implantation. Antibiotics concentrations and drains bactericidal titer of combination were determined against multiresistant staphylococcal strains. The release of G and V from PMMA cement at the site of infection was prompt and effective. Serum levels were below the limit of detection. The local release kinetics of G and V from PMMA cement was similar, exerting a pronounced, combined inhibitory effect in the implant site. The inhibitory activity of drainage fluids showed substantial intersubject variability related to antibiotic concentrations and differed according to the pathogens tested. Gentamicin and vancomycin were released from temporary hip spacers at bactericidal concentrations, and their use in combination exerted strong inhibition against methicillin-resistant S. aureus and Coagulase Negative Staphylococci strains.

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Antibacterial Activity of Joint Fluid in Cemented Total-Knee Arthroplasty: an In Vivo Comparative Study of Polymethylmethacrylate with and without Antibiotic Loading

Cited by 33 publications

References 25 publications

Gentamicin in bone cement

Gentamicin in bone cement

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

Release of Gentamicin and Vancomycin from Preformed Spacers in Infected Total Hip Arthroplasties: Measurement of Concentrations and Inhibitory Activity in Patients’ Drainage Fluids and Serum

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