Abstract
BackgroundIn the fields of traumatology and orthopaedics staphylococci are the most frequently isolated pathogens. Staphylococcus aureus and Staphylococcus epidermidis are known to be the major causative agents of osteomyelitis. The increasing number of multiresistant Staphylococcus aureus and resistant coagulase-negative staphylococci as a trigger of complicated osteomyelitis and implant-associated infections is a major problem. Antibiotic therapy fails in 20% of cases. Therefore the development of novel antibiotics becomes necessary.MethodsThis study analyses tigecyclin, the first antibiotic of the glycylines, as a potential therapy for osteomyelitis caused by multiresistant Staphylococcus aureus. Therefore its intracellular activity and the potential use in polymethylmetacrylate-bone cement are examined. The intracellular activity of tigecyclin is determined by a human osteoblast infection model. The investigation of the biomechanical characteristics is conducted concerning the ISO 5833-guidelines.ResultsTigecyclin shows in vitro an intracellular activity that ranges between the antimicrobial activity of gentamicin and rifampicin. A significant negative effect on the biomechanical characteristics with an impaired stability is detected after adding tigecyclin to polymethylmetacrylate-bone cement with a percentage of 1.225% per weight.ConclusionsThis study shows that tigecyclin might be a potent alternative for the systemic therapy of osteomyelitis and implant-associated infections whereas the local application has to be reconsidered individually.
Highlights
In the fields of traumatology and orthopaedics staphylococci are the most frequently isolated pathogens
This study investigates tigecyclin as a potential therapy for osteomyelitis caused by multiresistant S. aureus
In order to assure a multiplicity of infection (MOI) of 100 with an optical density (OD) of 1, bacteria are added with the following amounts: S. carnosus TM 300: 38 μl, S. aureus Cowan I ATCC 12598: 19 μl, S. aureus Subspezies Rosenbach ATCC 49230: 16 μl
Summary
In the fields of traumatology and orthopaedics staphylococci are the most frequently isolated pathogens. Staphylococcus aureus and Staphylococcus epidermidis are known to be the major causative agents of osteomyelitis. The increasing number of multiresistant Staphylococcus aureus and resistant coagulase-negative staphylococci as a trigger of complicated osteomyelitis and implant-associated infections is a major problem. Implant-associated infections are often caused by S. epidermidis (Staphylococcus epidermidis) [3,4] and occur with a rate from 333% [5]. The combination of rifampicin plus another antibiotic agent shows efficient therapeutic results for the implant-associated infection caused by S. aureus [1]. Antibiotic therapy fails in 20% of cases This might be explained by the ability of S. aureus to invade human osteoblast cells [1,2,3] and to survive intracellularly [1,2]. In general SCVs have a reduced metabolism and have an increased resistance against antibiotics, especially against aminoglycosides [3,8,9]
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