Abstract
Introduction: Locally implanted antibiotic-eluting carriers may be a valuable adjuvant to the management of prosthetic joint infections. Aim: to assess local and plasma antibiotic concentrations as well as cumulative antibiotic urine excretion associated with clinical use of a gentamicin - or vancomycin-loaded mineral composite antibiotic carrier.Methods: 32 patients (male/female=19/13, mean age=56; 21-82 years) were prospectively followed after implantation of gentamicin (n=11), vancomycin (n=15), or a combination (n=7), using an antibiotic carrier (CERAMENT™|G or CERAMENT™|V, mean amount 11 (3-20) mL) during resection arthroplasty of the hip/knee. We measured antibiotic concentrations in plasma (1h, 3h, 24h, 48h and 72h post-implantation), urine (24h, 48h and 72h post-implantation) and in drain (n=15).Results: We observed low antibiotic concentrations in plasma (Gentamicin: 0.33 mg/L (95%-CI: 0.25-0.44) and vancomycin: 1.33 mg/L (95%-CI: 1.02-1.66)) and high concentrations in drain (Gentamicin: mean 57.8 mg/L (95%-CI: 45.8-69.7) and vancomycin: mean 234.4 mg/L (95%-CI: 198.9-269.7)). Use of a drain was associated with a statistically significant reduction in vancomycin urine excretion (55.6% (95% CI: 36.45-74.92) to 28.71% (95% CI: 13.07-44.35), p=0.042). A similar trend was observed for gentamicin (34.17% (95% CI: 24.62-43.72) to 16.22% (95% CI: 0-33.86), p=0.078).Conclusions: CERAMENT™G/V was associated with safe plasma concentrations and high local concentrations above minimum inhibitory concentration. Installation of a surgical drain results in removal of a substantial amount of antibiotics and reduces antibiotic urine excretion.
Highlights
Implanted antibiotic-eluting carriers may be a valuable adjuvant to the management of prosthetic joint infections
A similar trend was observed for gentamicin (34.17% to 16.22%, p=0.078)
We obtained an average cumulative drain output of 698mL, which was collected over a mean of 90h post-antibiotic implantation (Table 2), with mean drain-fluid concentrations of 57.8 mg/L for gentamicin and 234.4 mg/L for vancomycin, respectively
Summary
Implanted antibiotic-eluting carriers may be a valuable adjuvant to the management of prosthetic joint infections. The purpose of this study was to investigate clinical in-vivo antibiotic elution characteristics and pharmacokinetic properties of a commercially available antibiotic eluting BGS: Bone graft substitute that has shown promising in-vitro and in-vivo results in the treatment or prevention of bone and joint-infections [8, 11, 14]. An aminoglycoside (gentamicin) and/or a glycopeptide (vancomycin) were applied in a commercially available antibiotic-eluting BGS (bone graft substitute), for prevention or treatment of PJI. Vancomycin attacks gram-positive cell walls, thereby working bactericidically [15] This is the first clinical study that investigates the in-vivo elution profile of this antibiotic carrier in plasma, drain-fluid and urine in a cohort of patients
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