In Vitro Testing of Gentamicin-Vancomycin Loaded Bone Cement to Prevent Prosthetic Joint Infection

Abstract

Sepsis is a greatly feared complication of total joint arthroplasty. One key question is how to prevent perioperative bacterial adherence, and therefore the potential for infectious complications. The objective of our study was to appraise the emerging capacity of staphylococcal survival on prosthetic materials and to analyze the in vitro effects of gentamicin and vancomycin loaded polymethylmethacrylate (PMMA) cement on bacterial adherence and growth. Hospital acquired staphylococcal strains were systematically inoculated on four orthopedic materials (ultrahigh molecular weight polyethylene, PMMA without antibiotic, commercially produced PMMA loaded with gentamicin, and manually mixed PMMA loaded with gentamicin and vancomycin). Staphylococci were identified using culture and biochemical tests. The inoculated material was allowed to incubate in a liquid broth growth media and subsequently prepared for scanning electron microscopy and bacterial growth quantification. Materials without antibiotics showed evidence of staphylococcal growth. PMMA loaded with only gentamicin grew methicillin-resistant Staphylococcus aureus. Gentamicin-vancomycin loaded PMMA completely inhibited any bacterial growth. Low-dose gentamicin-vancomycin loaded PMMA prevents staphylococcal colonization better than commercially manufactured PMMA loaded with gentamicin. We recommend this combination in high-risk procedures and revision surgeries requiring bone cement.

Chitosan Sponges to Locally Deliver Amikacin and Vancomycin: A Pilot In Vitro Evaluation

“…PMMA is used in many orthopaedic applications, including arthroplasty and antibiotic-loaded spacers. PMMA provides a consistent, predictable rate of antibiotic elution; however, potential drawbacks to this particular therapy include the need for surgical removal of bead implants and bacterial colonization and subsequent biofilm formation on the implant surface [10,23,25]. Like with systemic antibiotics, subtherapeutic release of antibiotic from PMMA can lead to resistance [15,21].…”

In vitro susceptibility of Staphylococcus aureus and Staphylococcus epidermidis isolated from prosthetic joint infections

“…8,9 For this reason, other antibiotics have recently been considered as alternatives to vancomycin. [10][11][12][13][14][15] Despite these facts, antimicrobial susceptibility remains extremely variable among these microorganisms, making it necessary to perform individual susceptibility studies for each strain to select the best antibiotic combination for treatment. 16 The aim of this study was to evaluate the in vitro susceptibility pattern of S. aureus and S. epidermidis strains isolated from retrieved prosthetic joint implants against antibiotics commonly used in the treatment of PJI.…”

Antibiotic Intramedullary Nail in the Management of Infected Ununited Tibial Fractures - Case Report, Technique and Review of Literature

“…In regards to selection of antibiotic, vancomycin and gentamicin are by far the most commonly used agents with minimal reports of systemic toxicity [20][21][22]. Gentamicin and vancomycin are broad spectrum antibiotics, stable for the exothermic reaction present in PMMA, work synergistically, and have been reported to increase elution rates when used simultaneously [21][22][23][24]. The optimal solution to antibiotic selection would be isolation of the offending organism and subsequent use of a targeted antibiotic mixed into the PMMA.…”