In Vitro Evaluation of Antibiotic Elution from Polymethylmethacrylate (PMMA) and Mechanical Assessment of Antibiotic‐PMMA Composites

Weisman, Debra L.; Olmstead, Marvin L.; Kowalski, J.

doi:10.1053/jvet.2000.4389

Cited by 52 publications

(46 citation statements)

References 32 publications

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“…Agar diffusion is the most common in vitro testing method for studying the antimicrobial activities of loaded bone cement samples (23,27). The correlation of the MICs of gentamicin determined by agar gel tests and the proliferation behavior of bacteria in the proliferation assay of the present study showed the accuracy of this new testing method.…”

Section: Figsupporting

confidence: 61%

“…Therefore, testing the antimicrobial activity of bone cement with new antibiotics or other antimicrobial agents should begin with in vitro studies. Agar diffusion testing has been the standard method for many years for in vitro assessment of antibiotic-loaded bone cements (17,23,27,28). However, the assessment by agar diffusion testing of the anti-infective activities of some antimicrobial agents requires accurately defined standard conditions (20).…”

mentioning

confidence: 99%

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In Vitro Testing of Antimicrobial Activity of Bone Cement

Alt¹,

Bechert²,

Steinrücke³

et al. 2004

Antimicrob Agents Chemother

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The purpose of this study was to establish a reliable and cost-effective microplate proliferation assay for in vitro antimicrobial testing of bone cement samples. Cement samples devoid of antimicrobial agents, loaded with 2% gentamicin or with different concentrations of high-porosity silver, were incubated in a 96-well microplate with several staphylococcal, Pseudomonas aeruginosa, and Enterococcus faecium isolates exhibiting different susceptibilities to gentamicin. After being rinsed, the samples were brought into a soy medium in which adherent cells on the cement surface either were killed by the antimicrobial surface or started to release clonal counterparts. The medium was monitored in real time by recording a time proliferation curve for each well. Microplate testing revealed no antibacterial effect of plain bone cement. The antibacterial activity of gentamicin-loaded bone cement was shown by the microplate test to depend on the gentamicin susceptibilities of the strains. The effect of high-porosity silver was dose dependent. Bactericidal activity against all tested strains was found for bone cement loaded with 1% high-porosity silver. The accuracy of this new proliferation assay was shown by the high correlation between the types of proliferation curves and antibiotic susceptibility. In contrast to routine agar diffusion testing, it assesses the dynamic response of microorganisms to antimicrobial agents in biomaterials and allows high-throughput screening and detection of antimicrobial properties of poorly water-soluble compounds like silver.Infections in total joint arthroplasty are devastating situations (19), and many strategies have been undertaken to reduce infection rates, including the use of helmet aspirator suits (22), laminar airflow (5, 10, 18), and prophylactic intravenous antibiotics (9, 13, 15). Loading polymethylmethacrylate (PMMA) bone cement with antibiotics to reduce infection rates has also been postulated in the literature (6,16,24,26).As in all other fields of medicine, new ideas in orthopedics should be evaluated stepwise, with in vitro and subsequent in vivo investigations of antimicrobial properties occurring before clinical trials. Therefore, testing the antimicrobial activity of bone cement with new antibiotics or other antimicrobial agents should begin with in vitro studies. Agar diffusion testing has been the standard method for many years for in vitro assessment of antibiotic-loaded bone cements (17,23,27,28). However, the assessment by agar diffusion testing of the anti-infective activities of some antimicrobial agents requires accurately defined standard conditions (20). For example, large molecules, such as vancomycin and teicoplanin, harbor a reduced diffusion capacity and their susceptibilities are difficult to determine exactly. Other anti-infective agents, e.g., fosfomycin, are able to interact with components of the culture medium in agar plates, resulting in reduced activity. Therefore, adequate culture media are required (20). New anti-infective agents like microdis...

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Section: Figsupporting

confidence: 61%

mentioning

confidence: 99%

In Vitro Testing of Antimicrobial Activity of Bone Cement

Alt¹,

Bechert²,

Steinrücke³

et al. 2004

Antimicrob Agents Chemother

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“…The greater the antibiotic concentration the bigger the antibiotic domains from which rupture initiates. [32][33][34][35] In general, the compression strength is not affected by small additions of antibiotics. 31,32,35,36 However, at higher percentages, this parameter can decrease below the minimum required by the ISO standard (70 MPa).…”

Section: Discussionmentioning

confidence: 99%

“…35,36 The effect is more noticeable in flexural tests 34,36 and, above all, in fatigue tests, since in these assays there is a significant decrease of the fatigue life with the addition of small quantities of antibiotics to the cement formulation. 32,33,37 With the aim of minimizing the detrimental effects of the addition of antibiotics, some authors recommend the use of commercial formulations with antibiotics included. These formulations are more consistent and homogeneous than hand-mixed ones, which can show lower strengths.…”

Section: Discussionmentioning

confidence: 99%

New injectable and radiopaque antibiotic loaded acrylic bone cements

et al. 2008

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The use of antibiotic loaded bone cements (ALBCs) has become a common clinical practice in the prevention and treatment of prosthesis-related infections. However, due to antibiotic resistance, there is a general interest in broadening the antibacterial spectrum of currently used drugs. The aim of this work is to formulate ALBCs for specific use in vertebroplasty and kyphoplasty, and to study the effect of the addition of ciprofloxacin alone and in combination with vancomycin on some properties of the cement. The cements were formulated using bismuth salicylate as the radiopacifier. The setting properties, residual monomer content, release of antibiotics, rheological behavior, injectability, and mechanical properties of these formulations were studied. They showed long setting times and low curing temperatures. From the release studies, antibacterial properties are assumed because the concentration of released antibiotic was higher than the minimum effective. Although the experimental cements had slightly reduced mechanical properties, the other alterations shown were negligible.

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“…8 A study by Weisman et al evaluating the mechanical strength of antibiotic free cement and antibiotic impregnated cement using compression and elongation revealed a 32% decrease in compressive and tensile strength when the antibiotic powder was added to the liquid monomer compared to a 7% decrease in both when the antibiotic powder was added to the powdered polymer. 13 The mechanical strength of the PMMA is of outmost importance when used for arthroplasties, but not for AIPMMA bead production.…”

mentioning

confidence: 99%

Evaluation of in vitro serial antibiotic elution from meropenem-impregnated polymethylmethacrylate beads after ethylene oxide gas and autoclave sterilization

Baez

Langston²,

Givaruangsawat³

et al. 2011

Vet Comp Orthop Traumatol

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Summary Objectives: To determine the elution properties of meropenem and to compare the elutions of meropenem-impregnated polymethylmethacrylate (PMMA) beads without sterilization (P-M-C) to those sterilized with steam (P-M-A) and ethylene oxide gas (P-M-EO). Methods: A commercial bead mould was used to produce four groups of beads: one group without antibiotic (negative control), and three groups of meropenem-impregnated beads: P-M-C, P-M-A, and P-M-EO. The beads were placed in a phosphate buffered solution and eluent samples were collected. Concentrations of the antibiotic in eluent samples from the two sterilized groups and the control beads were determined using a microbiological assay at 1, 3, 6 and 12 hours and at 1, 2, 3, 6, 9, 12, 15, 18, 22, 26, and 30 days. Results: The microbiological assay resulted in no zone of inhibition at all time periods for the P-M-A samples and the samples of PMMA without antimicrobial. The meropenem concentration on the eluent remained above 4 mcg/ml for 15 days in the P-M-C group and until day 18 for P-M-EO group. There was no statistical difference in AUC0-∞ (p <0.318), however significance did occur for MRT (p <0.005) when comparing P-M-C and P-M-EO with the later being higher. Discussion: The meropenem incorporated in the PMMA beads eluted effectively and gradually decreased after the 24 hour peak, but remained above the concentration level of 4 mcg/ml for 15 days in the P-M-C group and until day 18 for P-M-EO group. Ethylene oxide does not adversely affect meropenem’s elution from PMMA beads.

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In Vitro Evaluation of Antibiotic Elution from Polymethylmethacrylate (PMMA) and Mechanical Assessment of Antibiotic‐PMMA Composites

Abstract: Bacteria introduced during a surgical procedure may be inhibited by elution of antibiotic from PMMA at the time of contamination.

Cited by 52 publications

References 32 publications

In Vitro Testing of Antimicrobial Activity of Bone Cement

In Vitro Testing of Antimicrobial Activity of Bone Cement

New injectable and radiopaque antibiotic loaded acrylic bone cements

Evaluation of in vitro serial antibiotic elution from meropenem-impregnated polymethylmethacrylate beads after ethylene oxide gas and autoclave sterilization

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