Abstract
Gentamicin (G) and vancomycin (V) concentrations in drainage fluids obtained from patients during the first 24 hours after implantation of antibiotic-loaded polymethylmethacrylate (PMMA) spacers in two-stage revision of infected total hip arthroplasty were studied. The inhibitory activity of drainage fluids against different multiresistant clinical isolates was investigated as well. Seven hips were treated by implantation of industrial G-loaded spacers. Vancomycin was added by manually mixing with PMMA bone cement. Serum and drainage fluid samples were collected 1, 4, and 24 hours after spacer implantation. Antibiotics concentrations and drains bactericidal titer of combination were determined against multiresistant staphylococcal strains. The release of G and V from PMMA cement at the site of infection was prompt and effective. Serum levels were below the limit of detection. The local release kinetics of G and V from PMMA cement was similar, exerting a pronounced, combined inhibitory effect in the implant site. The inhibitory activity of drainage fluids showed substantial intersubject variability related to antibiotic concentrations and differed according to the pathogens tested. Gentamicin and vancomycin were released from temporary hip spacers at bactericidal concentrations, and their use in combination exerted strong inhibition against methicillin-resistant S. aureus and Coagulase Negative Staphylococci strains.
Highlights
Polymethylmethacrylate (PMMA) cements preloaded with antibiotics, mainly gentamicin (G), are used in some cases for prophylaxis but especially for the surgical revision of prosthetic infections [1]
Frequent microorganisms isolated from joint fluid or periprosthetic tissue are the Coagulase Negative Staphylococci (CoNS), S. aureus and most commonly S. epidermidis, and Streptococcus haemolyticus [2]
A two-stage revision of an infected arthroplasty with antibiotic-loaded spacer implantation is considered an effective procedure for these infections [2, 5]
Summary
Polymethylmethacrylate (PMMA) cements preloaded with antibiotics, mainly gentamicin (G), are used in some cases for prophylaxis but especially for the surgical revision of prosthetic infections [1]. Frequent microorganisms isolated from joint fluid or periprosthetic tissue are the Coagulase Negative Staphylococci (CoNS), S. aureus and most commonly S. epidermidis, and Streptococcus haemolyticus [2]. Some difficult-totreat bacteria, such as methicillin-resistant S. aureus (MRSA), methicillin-resistant CoNS, enterococci, and Pseudomonas aeruginosa present much greater failure risks. In a number of cases S. aureus infection is the significant factor associated with treatment failure, along with retained prosthesis and treatment with inappropriate antibiotics [4]. A two-stage revision of an infected arthroplasty with antibiotic-loaded spacer implantation is considered an effective procedure for these infections [2, 5]
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