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

McConoughey, Stephen J.; Howlin, Robert P.; Wiseman, Jessica M.; Stoodley, Paul; Calhoun, Jason H.

doi:10.1002/jbm.b.33247

Cited by 103 publications

(109 citation statements)

References 22 publications

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“…In an in vitro study, McConoughey et al (13) found that calcium sulfate beads achieved similar or a more improved efficacy compared to the PMMA beads in inhibiting bacterial growth. Grimsrud et al (23) reported similar characteristics of in vitro elution between voriconazole-loaded PMMA bone cement and calcium sulfate bone substitute.…”

Section: Discussionmentioning

confidence: 99%

“…iii) With regards to the definitive outcomes of the combination of calcium sulfate with additives in reconstruction of bone defects, Howlin et al (18) identified that calcium sulfate with antibiotics may have a potential ability to reduce or eliminate biofilm formation on adjacent periprosthetic tissue and prosthesis material, thus reducing the rates of periprosthetic infection. Following the comparison of PMMA with calcium sulfate as antibiotic carriers at the infected sites, McConoughey et al (13) indicated that calcium sulfate led to similar or improved outcomes compared to PMMA in the inhibition of bacterial growth. In a pilot study regarding the assessment of clinical outcomes of grafted sockets using either calcium sulfate-PRP or calcium sulfate alone in the socket preservation procedure, Cheah et al (19) reported that calcium sulfate-PRP-grafted sites had a higher mineralized bone content compared to the calcium sulfate-grafted sites.…”

Section: Calcium Sulfate Can Induce the Formation Of Membranementioning

confidence: 99%

“…Firstly, calcium sulfate can be totally degraded, entirely with its antibiotic load. Secondly, the rise in (13). The present study assessed whether if PMMA is replaced by calcium sulfate as a cement spacer in the Masquelet technique, reconstruction of bone defects may be achieved through one-stage surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the variable antibiotic elution rates of PMMA may affect the antibacterial effect. Furthermore, local implantation of PMMA may lead to a rise in temperature, which limits its combination with heat-sensitive antibiotics (13).…”

Section: Introductionmentioning

confidence: 99%

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Possibility of one-stage surgery to reconstruct bone defects using the modified Masquelet technique with degradable calcium sulfate as a cement spacer: A case report and hypothesis

Jiang

Qin

et al. 2016

Biomedical Reports

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Abstract. In addition to autologous bone graft, vascularized fibular autograft and Ilizarov bone transfer, the Masquelet technique is another effective method to reconstruct bone defects. This technique was initially proposed in 1986 and consists of two stages. At the first stage, radical debridement is required and subsequently, a polymethylmethacrylate (PMMA) cement spacer is implanted at the site of the bone defects. At the second stage, when the PMMA-induced membrane is formed 6-8 weeks later, the cement spacer is carefully removed in order to not disturb the induced membrane and the bone graft is performed to fill the bone defects. Although this technique has resulted in satisfactory outcomes in the reconstruction of bone defects, the PMMA spacer used to induce membrane is not degradable and requires surgical removal. In recent years, calcium sulfate has been used as a localized antibiotic delivery vehicle and bone substitute due to its superiorities over PMMA, particularly its completely degradable nature. The present study identified that calcium sulfate can also induce the formation of a membrane. In addition, we hypothesized that the degradability of calcium sulfate may allow one-stage reconstruction of bone defects. The current study presents a clinical case report and review of the literature. IntroductionThe aim of bone defect reconstruction is to regenerate bone loss and restore limb function (1). Several approaches can be adopted in the clinic, including autologous bone graft, vascularized fibular autograft and the Ilizarov bone transfer technique. Autologous bone graft is not recommended for reconstruction of massive bone defects due to its increased risk of resorption (2). Vascularized fibular autograft and the Ilizarov bone transfer technique are the most frequently used methods for reconstruction of extensive bone defects (3-5).The Masquelet technique is another effective way to repair extensive bone defects. This two-staged method for bone reconstruction was first described by Masquelet et al in 1986 (6). The first-stage surgery includes radical debridement of bone and soft tissues, followed by implantation of a polymethylmethacrylate (PMMA) cement spacer at the site of the bone defects. The cement spacer is expected to obviate invasion of fibrous tissue at the recipient site (mechanical role) and induce the surrounding membrane (biological role) (7). After a duration of 6 to 8 weeks, a PMMA-induced pseudosynovial membrane formed. At the second-stage surgery, the cement spacer is removed carefully in order to maintain the already formed membrane and cause minimal disturbance. Following this, the defect is filled with morcellised cancellous autologous bone graft. Masquelet et al (6) reported that this method could repair a bone defect of 25 cm in length.Since the first study, the Masquelet technique has been widely used to resolve massive bone defects caused by different diseases and achieved clinical efficacy (8-12). However, efficacy in the cases managed by the Masquelet technique does not me...

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Section: Discussionmentioning

confidence: 99%

Section: Calcium Sulfate Can Induce the Formation Of Membranementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Possibility of one-stage surgery to reconstruct bone defects using the modified Masquelet technique with degradable calcium sulfate as a cement spacer: A case report and hypothesis

Jiang

Qin

et al. 2016

Biomedical Reports

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“…Antiinfective biomaterials are increasingly used as an adjunctive strategy to prevent implanted biomaterial infections and to inhibit biofilm-forming microorganisms [13,27,44,49,55,63,64]. Commonly used local antibiotic delivery systems range from antibiotic-loaded bone cement to calcium-based drug delivery systems to sprinkling antibiotics within the wound site [8,24,40,42]. Recent developments have been focused on degradable and customizable local delivery strategies to ensure coverage of the wound, effective antibiotic elution, and minimization of secondary procedures [15,30,60].…”

Section: Introductionmentioning

confidence: 99%

Novel Antibiotic-loaded Point-of-care Implant Coating Inhibits Biofilm

Jennings

Carpenter

Troxel

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Orthopaedic biomaterials are susceptible to biofilm formation. A novel lipid-based material has been developed that may be loaded with antibiotics and applied as an implant coating at point of care. However, this material has not been evaluated for antibiotic elution, biofilm inhibition, or in vivo efficacy.Questions/purposes (1) Do antibiotic-loaded coatings inhibit biofilm formation? (2) Is the coating effective in preventing biofilm in vivo? Methods Purified phosphatidylcholine was mixed with 25% amikacin or vancomycin or a combination of 12.5% of both. A 7-day elution study for coated titanium and stainless steel coupons was followed by turbidity and zone of inhibition assays against Staphylococcus aureus and Pseudomonas aeruginosa. Coupons were inoculated with bacteria and incubated 24 hours (N = 4 for each test group). Microscopic images of biofilm were obtained. After washing and vortexing, attached bacteria were counted. A mouse biofilm model was modified to include coated and uncoated stainless steel wires inserted into the lumens of catheters inoculated with a mixture of S aureus or P aeruginosa. Colony-forming unit counts (N = 10) and scanning electron microscopy imaging of implants were used to determine antimicrobial activity. Results Active antibiotics with colony inhibition effects were eluted for up to 6 days. Antibiotic-loaded coatings inhibited biofilm formation on in vitro coupons (log-fold reductions of 4.3 ± 0.4 in S aureus and 3.1 ± 0 for P aeruginosa in phosphatidylcholine-only coatings, 5.6 ± 0 for S aureus and 3.1 ± 0 for P aeruginosa for combinationloaded coatings, 5.5 ± 0.3 for S aureus in vancomycinloaded coatings, and 3.1 ± 0 for P aeruginosa for amikacinloaded coatings (p \ 0.001 for all comparisons of antibiotic-loaded coatings against uncoated controls for both bacterial strains, p \ 0.001 for comparison of antibioticloaded coatings against phosphatidylcholine only for S aureus, p = 0.54 for comparison of vancomycin versus combination coating in S aureus, P = 0.99 for comparison of antibiotic-and unloaded phosphatidylcholine coatings in P aeruginosa). Similarly, antibiotic-loaded coatings reduced attachment of bacteria to wires in vivo (log-fold

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

et al. 2020

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Both antibiotic‐impregnated poly(methyl acrylate, methyl methacrylate) (PMMA) and antibiotic‐impregnated calcium sulfate have been successfully used as local antibiotic delivery vehicles for the management of chronic osteomyelitis. Here, we examined the antibiotic elution characteristics and antibacterial properties of a composite drug delivery system consisting of PMMA/calcium sulfate carrying vancomycin (dual carrier‐v) against Staphylococcus aureus, with PMMA loaded with vancomycin (PMMA‐v) as a control. Vancomycin gradually degraded from dual carrier‐v and PMMA‐v up to about 8 and 6 weeks, respectively. At different elution time points, the inhibition zones of the dual carrier‐v were larger than the inhibition zones of the PMMA‐v (P < 0.05). The colony inhibition rate of the dual carrier‐v was 95.57%, whereas it was 77.87% for PMMA‐v. Scanning electron microscopy was used to demonstrate biofilm formation on the surface of plates treated with vancomycin‐unloaded PMMA, whereas there was no biofilm formation on the surface of plates treated with dual carrier‐v or PMMA‐v. The dual carrier‐v was more effective at antibacterial adhesion at each time point after immersion in simulated body fluid as compared with PMMA‐v (P < 0.05). In conclusion, our results suggest that the dual carrier‐v can release higher concentrations of antibiotics and inhibit bacteria growth more effectively in vitro as compared with PMMA‐v. The dual carrier‐v thus may have potential as an alternative strategy for osteomyelitis management.

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

Cited by 103 publications

References 22 publications

Possibility of one-stage surgery to reconstruct bone defects using the modified Masquelet technique with degradable calcium sulfate as a cement spacer: A case report and hypothesis

Possibility of one-stage surgery to reconstruct bone defects using the modified Masquelet technique with degradable calcium sulfate as a cement spacer: A case report and hypothesis

Novel Antibiotic-loaded Point-of-care Implant Coating Inhibits Biofilm

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

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