Abstract
Antibiotic-impregnated bone cement beads have been popularized for the treatment of chronic osteomyelitis. Many surgeons have used aminoglycoside-impregnated beads, because aminoglycosides are heat-stable during polymerization of PMMA and have a broad antibacterial spectrum. Unfortunately, aminoglycosides are not very effective against methicillin-resistant staphylococcus aureus (MRSA) infections. Cement beads have not been impregnated with vancomycin because of its heat-liability. With vancomycin-impregnated beads (VCM-beads), we were successful in treating a 58 year-old man, who had an MRSA infection after THR. The local concentration of vancomycin was 85.23μg/ml at 24 hours after surgery, 9.34μg/ml at 7 days, 3.69μg/ml at 14 days. These values were well above the minimum inhibitory concentration (MIC, 1.56μg/ml). The serum concentration of vancomycin reached the peak (2.96μg/ml) 4 hours after surgery. This peak value was under the safety limit, and the serum concentration of vancomycin was undetectable after 4 days. From this study, VCM-beads were proved to be effective for deep MRSA infection and local concentration of vancomycin beads was well above the MIC at least 2 weeks after insertion.
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