Efficacy of Vancomycin-Impregnated Cement Beads for the Treatment of MRSA Infection of Failed Graft Tissue at the Mandible

Abstract

The oral and nasal cavities are regions likely to harbor methicillin-resistant Staphylococcus aureus (MRSA). Therefore, when performing a surgical procedure in these areas, standard precautions are observed and the use of third-generation cephalosporins is restricted to prevent the onset of MRSA infection. However, after extensive surgery such as mandibular resection and reconstruction, MRSA infection is likely to occur as a result of reduced host immunity and impaired tissue healing because of preoperative chemoradiotherapy. Antibiotic-impregnated cement beads gradually release the antibiotic to maintain regional concentrations above the minimum inhibitory concentration (MIC), to continuously suppress bacterial growth. In the field of orthopedics, cement beads impregnated with antibiotics have been effectively used to treat bone and joint infections. 1 In particular, cement beads impregnated with gentamicin were used successfully in 77% of cases in which infection developed following hip joint surgery. 1 Moreover, several studies have reported the usefulness of cement beads impregnated with gentamicin or tobramycin for the treatment of osteomyelitis of the jaw. 2-4 Many reports have documented the effectiveness of bone cement impregnated with vancomycin hydrochloride (VCM) in the treatment of MRSA infection of the hip joint or