Vancomycin Solution Research Articles

The Effect of Vancomycin and Gentamicin Antibiotics on Human Osteoblast Proliferation, Metabolic Function, and Bone Mineralization.

The present study investigates the effect of vancomycin and gentamicin antibiotics on primary human osteoblasts. Osteoblasts were incubated with vancomycin, gentamicin, or with povidone-iodine (PVI), at concentrations advocated for wound irrigation. Osteoblast proliferation, metabolic function, and bone mineralization were measured. The aim of the study was to model gentamicin and vancomycin wound irrigation in vitro and to examine the effect on osteoblast viability and cellular function in comparison to 0.35% PVI. Vancomycin, gentamicin, and dilute PVI are employed as wound irrigants in spinal surgery to reduce infection. We have, however, recently demonstrated that 0.35% PVI has a detrimental effect on osteoblast cellular function and bone mineralization. Studies to determine the effects of antibiotic wound irrigation solutions on osteoblasts and bone mineralization are therefore warranted. Primary human osteoblasts were exposed for 20 minutes to phosphate buffered saline (PBS) control, vancomycin (35 or 3.5 mmol/L), gentamicin (34 or 3.4 mmol/L), or 0.35% PVI for 3 minutes. Cellular proliferation was measured during 7 days by MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay. Osteoblast metabolic function was determined using a Seahorse XFe24 Bioanalyzer. Mineralized bone nodules were quantified using Alizarin red. At concentrations advocated for wound irrigation, both gentamicin (3.4 mmol/L) and vancomycin (3.5 mmol/L) induced a transient 15% to 20% reduction in osteoblast proliferation, which returned to control values within 72 hours. This was in marked contrast to the effect of 0.35% PVI, which resulted in a sustained reduction in osteoblast proliferation of between 40% and 50% during 7 days. Neither gentamicin nor vancomycin at concentrations up to 10× clinical dose had any effect on osteoblast oxygen consumption rate, or significantly affected mineralized bone nodule formation. Vancomycin and gentamicin solutions, at concentrations advocated for intrawound application in spinal surgery, have a small but transient effect on osteoblast proliferation, and no effect on either osteoblast metabolic function or bone nodule mineralization. N/A.

Use of allogenic bone graft in the treatment of benign osteolytic bone lesion

Introduction: Management of benign osteolytic lesions of bone involve intralesional excision and filling of the bone defect. Allograft used as a filler in these lesions confer advantages of being available in sufficient quantity without the risk of donor site morbidity. However use of allografts may carry a potential risk of infection and has debatable osteogenic potential. This study used Allogenic Bone Graft using antibiotic impregnated allografts and adjuvants like bone marrowso as to address these shortcomings. Materials and Methods: Eight cases of benign osteolytic lesions were treated by intralesional curettage and bone grafting using allogenic bone graft. Appropiate surgical procedure for fixation was done wherever necessary. Five cases had Allogenic Bone Graft impregnated with vancomycin solution. Three cases had autogenic bone graft while 1 case used bone marrow as adjuvant. Outcome was assessed in terms of fracture healing, infection and osteointegration. Results: In all the cases adequate osteointegration and complete healing of the lesion was observed in all the cases with time period of healing closely matching that of complete osteointegration. There was no statistically significant difference in the duration of osteointegration and bone healing between vancomycin impregnated group vis a vis allograft used alone. Only one case developed infection who responded to Intravenous antibiotics. No failure was observed in this study was probably due to use of adjuvants in half of the cases. Discussion and Conclusion: Use of allogenic bone graft alongwith adjuvants (bone marrow and autologous bone graft) appears to be effective in treatment of benign lytic lesions. Healing rates may be attributed to use of osteogenic potentiators. Vancomycin impregnation of allograft appears to be a beneficial step in controlling the graft related infection and does not affect graft osteointegration and bone healing.

Antibiotic-releasing microspheres prevent mesh infection in vivo

BackgroundInfection remains a dreaded complication after implantation of surgical prosthetics, particularly after hernia repair with synthetic mesh. We previously demonstrated the ability of a newly developed polymer to provide controlled release of an antibiotic in a linear fashion over 45 d. We subsequently showed that coating mesh with the drug-releasing polymer prevented a Staphylococcus aureus (SA) infection in vivo. To broaden the applicability of this technology, the polymer was synthesized as isolated “microspheres” and loaded with vancomycin (VM) before conducting a noninferiority analysis. Materials and methodsSeventy-three mice underwent creation of a dorsal subcutaneous pocket that was inoculated with 104 colony forming units (CFU) of green fluorescent protein (GFP)-labeled SA (105 CFU/mL). Multifilament polyester mesh (7 × 7 mm) was placed into the pocket, and the skin was closed. Mesh was either placed alone (n = 16), coated with VM-loaded polymer (n = 20), placed next to VM-loaded microspheres (n = 20) or unloaded microspheres (n = 10), or flushed with VM solution (n = 7). Quantitative tissue/mesh cultures were performed at 2 and 4 week. Mice with open wounds and explanted mesh were excluded. ResultsTwenty-two of 23 (96%) tissue-mesh samples from mesh alone or empty miscrospheres were positive for GFP-labeled SA at 2 and 4 wk. Six of seven (86%) samples from the VM flush group were positive for GFP SA at 4 wk. Thirty-eight of 38 (100%) VM-loaded crosslinked cyclodextrin polymers–coated mesh or VM-loaded microspheres were negative for GFP SA at 2 and 4 wk. ConclusionsSlow affinity-based drug-releasing polymers in the form of microspheres are able to adequately clear a bacterial burden of SA and prevent mesh infection.

Development of functionalized nanostructured polymeric membranes for water purification

Pharmaceuticals specific molecularly imprinted polymers nanoparticles (MIPNPs) were synthesized and applied onto the polyvinylidene fluoride (PVDF) membranes previously subjected to the plasma treatment. Diclofenac-, metoprolol- and vancomycin-MIPs were applied onto the membranes and scanning electron microscopy was employed to visualize MIPNPs on the membrane. After functionalization of the membranes with target-specific MIPs the molecularly imprinted membranes (MIMs) affinity against their targets was evaluated using solid phase extraction (SPE) technique coupled with high performance liquid chromatography (HPLC). MIMs were used as filters to load the target solutions through employing a vacuum pump to evaluate the amount of pharmaceuticals in filtrate. Moreover, a comparative study was performed by comparing the efficiency of MIMs functionalized either by adsorption or covalent immobilization. The capacity analysis of MIPNPs by SPE–HPLC revealed 100%, 96.3%, and 50.1% uptake of loaded solution of metoprolol, diclofenac and vancomycin, respectively. MIMs showed 99.6% uptake with a capacity of 60.39ngcm2 for metoprolol; 94.7% uptake with a capacity of 45.09ngcm2 for diclofenac; and 42.6% uptake with a capacity of 16.9ngcm2 for vancomycin. HPLC detection limits of targets were found as 3.7, 7.5 and 15ngmL−1 for diclofenac, metoprolol and vancomycin respectively. A small scale pilot test was also conducted which indicates the promising future applications of the developed MIMs for high volume of filtrates especially in the case of the plasma-treated PVDF membranes prepared by covalent immobilization of the MIPs.

Comparison of telavancin and vancomycin lock solutions in eradication of biofilm-producing staphylococci and enterococci from central venous catheters

Results of a study of the activity of antibiotic lock solutions of vancomycin and telavancin against biofilm-forming strains of Staphylococcus epidermidis, Enterococcus faecalis, and Staphylococcus aureus are reported. An established in vitro central venous catheter model was used to evaluate lock solutions containing vancomycin (5 mg/mL) or telavancin (5 mg/mL), with and without preservative-containing heparin sodium (with 0.45% benzyl alcohol) 2500 units/mL, heparin, and 0.9% sodium chloride solution. Lock solutions were introduced after 24-hour bacterial growth in catheters incubated at 35 °C. After 72 hours of exposure to the lock solutions, catheters were drained, flushed, and cut into segments for quantification of colony-forming units. Against S. epidermidis, vancomycin and telavancin (with or without heparin) had similar activity. Against E. faecalis, vancomycin alone was more active than telavancin alone (p < 0.01). Against S. aureus, vancomycin plus heparin had activity similar to that of vancomycin alone; both lock agents had greater activity than telavancin (p < 0.02). The addition of heparin was associated with reduced activity of the vancomycin lock solution against S. epidermidis and E. faecalis (p < 0.01). Telavancin activity was not significantly changed with the addition of heparin. In a central venous catheter model, vancomycin and telavancin activity was similar in reducing biofilm-producing S. epidermidis. However, vancomycin was more active than telavancin against E. faecalis and S. aureus. None of the tested agents eradicated biofilm-forming strains. The addition of preservative-containing heparin sodium 2500 units/mL to vancomycin was associated with reduced activity against S. epidermidis and E. faecalis.

An in vivo analysis of Miromesh—a novel porcine liver prosthetic created by perfusion decellularization

BackgroundBioprosthetics derived from human or porcine dermis and intestinal submucosa have dense, homogenous, aporous collagen structures that potentially limit cellular penetration, undermining the theoretical benefit of a “natural” collagen scaffold. We hypothesized that Miromesh—a novel prosthetic derived from porcine liver by perfusion decellularization—provides a more optimal matrix for tissue ingrowth. MethodsThirty rats underwent survival surgery that constituted the creation of a 4 × 1 cm abdominal defect and simultaneous bridged repair. Twenty rats were bridged with Miromesh, and 10 rats were bridged with non–cross-linked porcine dermis (Strattice). Ten Miromesh and all 10 Strattice were rinsed in vancomycin solution and inoculated with 104 colony-forming units of green fluorescent protein–labeled Staphylococcus aureus (GFP-SA) after implantation. Ten Miromesh controls were neither soaked nor inoculated. No animals received systemic antibiotics. All animals were euthanized at 90 d and underwent an examination of their gross appearance before being sectioned for quantitative bacterial culture and histologic grading. A pathologist scored specimens (0–4) for cellular infiltration, acute inflammation, chronic inflammation, granulation tissue, foreign body reaction, and fibrous capsule formation. ResultsAll but one rat repaired with Strattice survived until the 90-d euthanization. All quantitative bacterial cultures for inoculated specimens were negative for GFP-SA. Of nine Strattice explants, none received a cellular infiltration score >0, consistent with a poor tissue–mesh interface observed grossly. Of 10 Miromesh explants also inoculated with GFP-SA, seven of 10 demonstrated cellular infiltration with an average score of +2.7 ± 0.8, whereas sterile Miromesh implants received an average score of 0.8 ± 1.0. Two inoculated Miromesh implants demonstrated acute inflammation and infection on histology. ConclusionsA prosthetic generated from porcine liver by perfusion decellularization provides a matrix for superior cellular infiltration compared with non–cross-linked porcine dermis.

Fecal Microbiota Transplant for Severe Complicated Clostridium difficile Infection via a Loop Ileostomy: A Novel Administration Route

Introduction: Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in healthcare settings. High cure rates of CDI with fecal microbiota transplantation (FMT) have been reported (88 to 100%). Successful delivery of donor fecal material has been described via nasogastric duodenal tube, colonoscopy, physician administered retention enemas and self-administered enemas. To our knowledge there has been no reported case of successful FMT for CDI via a loop ileostomy. Case Report: A 57-year-old women with past medical history of hypertension and type II diabetes mellitus developed diarrhea related to CDI after a hospitalization for pneumonia that had required antibiotics. She was successfully treated with oral vancomycin and intravenous flagyl. Two months later she re-developed diarrhea and was diagnosed with severe complicated CDI. On this second presentation her WBC count was 87 k/uL and a CT abdomen showed pan-colitis. She developed septic shock with multi-organ system failure. She required pressor support, mechanical ventilation and intermittent hemodialysis. She was treated with oral and rectal vancomycin, intravenous flagyl and oral pro-biotics. When she failed to respond, a laparoscopy was done to create a loop ileostomy. She was given vancomycin solution through the ileostomy for about 10 days. She showed some clinical response to this aggressive antibiotic therapy with declining leukocytosis and pressor requirement but remained critically ill and continued to have diarrhea. At this point it was decided to perform a FMT. All her antibiotics were stopped for a 24-hour period prior to instillation of 250 mL of open biome donor feces into her ileostomy. All antibiotics were held for another week after the FMT. Her diarrhea completely resolved. Her subsequent hospital course was complicated by candidal fungemia, multiple drug resistant Pseudomonas aeruginosa empyema and bilateral femoral deep venous thrombosis but she remained free from recurrence of CDI. Two repeat PCR's for C. difficile approximately one and two month after FMT via loop ileostomy remained negative. She has now been discharged from the hospital and is doing well. Conclusion: This is the first ever reported case of successful cure of recurrent severe complicated CDI with FMT through a loop ileostomy. This report demonstrates the versatility of routes through which a successful FMT can be performed.

Compounded vancomycin solution for Clostridium difficile infection

Compounded vancomycin solution for Clostridium difficile infection

No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts.

To investigate the pre-soaking of hamstring grafts in topical vancomycin, in addition to IV prophylaxis, during anterior cruciate ligament (ACL) reconstruction to reduce the incidence of post-operative infection, and to describe an evidence-based diagnostic and treatment algorithm to facilitate early diagnosis and appropriate management of possible knee sepsis post-operatively after ACL reconstruction. This study is a controlled observational series comprising of 1585 individuals who underwent ACL reconstruction over a 13-year period. All surgeries were performed by a single surgeon at the same hospital. Group 1 consisted of 285 patients who received pre-operative IV antibiotics without topical graft pre-soaking. Group 2 consisted of 1300 individuals who received IV antibiotics and graft pre-soaking in a vancomycin solution of 5mg/mL. In group 1, a total of four patients suffered a post-operative joint infection (1.4%). Three out of the four were culture positive for Staphylococcus species. The fourth was culture negative but was managed as an acute infection. Group 2 suffered no post-operative infections (0%). Statistical analysis of the vancomycin pre-soak with IV antibiotics group, compared with IV antibiotics-alone group, revealed a significantly reduced post-operative infection rate using a Fisher's exact test (P=0.0011) and Chi-square test with Yates' correction (P=0.0003). Pre-soaking of hamstrings grafts with topical vancomycin reduced the rate of post-operative infection when compared to IV antibiotics alone. This technique should be utilised by surgeons to reduce the overall incidence of knee sepsis post-ACL reconstruction. III.

Incorporation of Hands-On Sterile Technique Instruction in an Introductory Pharmacy Practice Experience

To examine sterile technique and basic sterile compounding procedures among third-year pharmacy students. Third year pharmacy students participating in an introductory pharmacy practice experience (IPPE) in 2012 (n=126) and 2013 (n=119) performed a modified low-risk compounded sterile product (CSP) media fill challenge test, then prepared a 5 mg/mL vancomycin solution that was subsequently analyzed for accuracy. To identify deficiencies in sterile procedures, students were observed while performing a modified low-risk CSP media fill challenge test. In the first year of conducting the challenge test (2012), 3 deficiencies were identified: hand washing before compounding, cleaning items with alcohol prior to start, and cleaning work area upon completion. In 2013, significant improvements were observed in these 3 areas after students watched a demonstration video. Examination of CSPs revealed less than 1% contamination in both years. Analysis of compounded vancomycin solutions showed that 84% and 71% of students prepared solutions in 2012 and 2013, respectively, were within 10% of the targeted final concentration. Hands-on sterile compounding exercises are typically delivered early in the pharmacy professional curriculum with minimal reinforcement in subsequent years. Providing opportunities for advanced pharmacy students to refresh and practice sterile compounding procedures allows students to refine their skills before entering pharmacy practice.

The Effect of the Use of Synthetic Mesh Soaked in Antibiotic Solution on the Rate of Graft Infection in Ventral Hernias: A Prospective Randomized Study.

Wound infections and seroma formations are important problems in ventral hernia repair operations using synthetic mesh grafts. The aim of this study was to investigate the effect of the use of synthetic mesh soaked in vancomycin solution on the rate of graft infection. The total number of subjects was 52. The subjects were randomized into 2 groups using a software program. Group 1 (n = 26) was the control group. In group 2 (n = 26), synthetic mesh was soaked in a Vancomycin solution before it was implanted. The patients were compared with respect to demographic characteristics and preoperative, intraoperative, and postoperative variables. There were no significant differences between the groups with respect to the available variables. Seroma development was significantly more common in group 2 (P < 0.041). Three patients (5.7%) developed superficial wound infection, and 9 (17%) developed surgical site infection 2-type wound-site infection. No significant difference was found between the groups in terms of infection. The use of synthetic mesh soaked in vancomycin solution had no beneficial effects on the rate of wound-site infection. Future randomized, controlled, large-scale studies using the same mesh and suture types, and meshes soaked in larger spectrum antibiotics are needed.

1652Retrospective Comparision of Oral Vancomycin Capsules vs Oral Vancomycin Solution for the Treatment of Severe Clostridium Defficile Infection

1652Retrospective Comparision of Oral Vancomycin Capsules vs Oral Vancomycin Solution for the Treatment of Severe Clostridium Defficile Infection

Autograft soaking in vancomycin reduces the risk of infection after anterior cruciate ligament reconstruction.

To determine whether the bathing of an anterior cruciate ligament (ACL) autograft in vancomycin reduces the rate of infection following an ACL reconstruction. Retrospective analysis of all ACL reconstructions over an 8-year period in two University Hospitals. In the initial 4-year period, all patients were operated on under classical antibiotic intravenous prophylaxis (group 1). Over the last 4-year period, this prophylaxis was supplemented with presoaking of the autograft (group 2). Presoaking was performed with sterile gauze previously saturated with a vancomycin solution (5mg/ml). There were 810 and 734 patients in group 1 and 2, respectively. Fifteen cases of knee joint infections were identified in the series (0.97%). All of these infections occurred in group 1, representing a rate of infection of 1.85% in comparison with 0% in group 2 (p<0.001). Autograft presoaking with vancomycin in combination with classical intravenous antibiotic prophylaxis reduced the rate of knee joint infection following an ACLR in comparison with antibiotic prophylaxis alone. This technique could be of relevance in daily clinical practice to prevent infection after ACLR. Case control study, retrospective comparative study, Level III.

Surface properties of Vancomycin after interaction with laser beams

Abstract This study presents results about UV laser beam interaction with Vancomycin (VCM) solutions in ultrapure water performed on bulk samples (5 mL). Photoproducts and molecular fragments resulting from the parent VCM and generated by exposure to 266 nm are evidenced by UV–vis absorption and FTIR spectroscopy and liquid chromatography electro spray ionization time-of-flight mass spectrometry (LC/ESI-TOF-MS) measurements. A novel method is reported to characterize surface active compounds produced in VCM solutions during exposure to UV laser radiation, by measuring in real time the dynamic interfacial tension of the irradiated solutions in emerging, constant volume bubble configuration. This shows that amphiphilic photoproducts are generated after the interaction of VCM molecules with laser beam that migrate at the interface air bubble/VCM solution. They accumulate at the interface leading at transition surface effects. In the paper four such amphiphilic photoproducts were identified and their chemical structures were proposed.

Vancomycin iontophoresis of allograft bone.

ObjectivesThe most concerning infection of allografts and operative procedures is methicillin resistant Staphylococcus aureus (MRSA) and no current iontophoresed antibiotics effectively combat this microbe. It was initially hypothesised that iontophoresis of vancomycin through bone would not be effective due to its large molecular size and lack of charge. The aim of this study was to determine whether this was a viable procedure and to find the optimum conditions for its use. MethodsAn iontophoresis cell was set up with varying concentrations of Vancomycin within the medulla of a section of sheep tibia, sealed from an external saline solution. The cell was run for varying times, Vancomycin concentrations and voltages, to gain information on optimisation of conditions for impregnating the graft. Each graft was then sectioned and dust ground from the exposed surface. The dust was serially washed to extract the Vancomycin and concentrations measured and plotted for all variables tested.ResultsVancomycin was successfully delivered and impregnated to the graft using the iontophoresis technique. The first order fit to the whole data set gave a significant result (p = 0.0233), with a significant concentration (p = 0.02774) component. The time component was the next most significant (p = 0.0597), but did not exceed the 95% confidence level.ConclusionsIontophoresis is an effective method for delivering Vancomycin to allograft bone. The concentrations of the vancomycin solution affected the bone concentration, but results were highly variable. Further study should be done on the effectiveness of delivering different antibiotics using this method.

Liquid Chromatography–Tandem Mass Spectrometry for Simultaneous Determination of Ticarcillin and Vancomycin in Presence of Degradation Products. Application to the Chemical Stability Monitoring of Ticarcillin- Vancomycin Solutions

Acute bacterial conjunctivitis and their complications are commonly treated by 6 mg/mL ticarcillin and 50 mg/mL vancomycin eyes drops, formulated separately in hospitals. A rapid, selective and specific LC-tandem MS method has been developed and validated for simultaneous quantification of ticarcillin and vancomycinin solution and in presence of degradation products. Atlantis® C18 Column T3 (250×4.6 mm I.D., 5 μm) and gradient mobile phase composed of 44 mM trifluoracetic acid/methanol allowed for good separation. Degradation products were separated on LC and detected with mass spectrometry in full scan mode. The method was suitable forthe stability study of ticarcillin-vancomycin pH 5.2 solutionsover an 8-day period storage at 5 ± 3°C and at room temperature (25 ± 2°C). The solutions remained stable up to 5 days at 5 ± 3°C. At room temperature, degradation of ticarcillin was accelerated in presence of vancomycin, while vancomycin stability was not further affected by ticarcillin. High-resolution mass spectrometry was used for the characterization of the degradation products.

Comparison of Oral Vancomycin Capsule and Solution for Treatment of Initial Episode of Severe Clostridium difficile Infection

Objective: Vancomycin is recommended as a first-line therapy for severe Clostridium difficile infection (CDI). Due to the high cost of commercially available vancomycin capsules, hospitals frequently compound oral solution despite a lack of data comparing outcomes. This study was conducted to determine treatment outcome differences based on oral vancomycin formulation. Methods: Medical charts of 76 patients with an initial episode of severe CDI receiving oral vancomycin as a commercially available capsule or a compounded oral solution for at least 72 hours were retrospectively reviewed. The primary objective was to compare the time to clinical cure of CDI. Results: Baseline characteristics between groups were similar except for the median lactate, which was higher in compounded oral solution group (1.5 vs 0.6 mmol/L, P < .001). There was no difference in clinical cure at day 10 (64% solution vs 59% capsules, P = .664). Median time to clinical cure was 8 days for solution and 7 for capsules (P = .597). After adjustment, the hazard ratio of time to clinical cure for solution compared to capsules was 1.15 (P = .69). No significant differences in mortality, recurrence, or complications were noted. Conclusion: Formulation of oral vancomycin did not impact treatment outcomes in this retrospective study.

Fatal Clostridium difficile Infection of the Small Bowel after Total Colectomy: A Case Report and Review

Introduction:Clostridium difficile infection occurring in the small bowel is exceedingly rare, especially following total colectomy. We describe a case of C. difficile small-bowel enteritis occurring in a patient 27 years after total colectomy and review cases of C. difficile enteritis in patients following complete colectomy. Case: A 74-year-old male nursing home resident with a past medical history of ulcerative colitis with subsequent colectomy and Kock pouch ileostomy, DM and dementia was evaluated for stomal obstruction and infection following increased difficulty with stoma self-care and mild epigastric pain. He received a seven-day course of antibiotics and pouch care while the surgical team contemplated a revision of the ileostomy. On the 12th day of admission, he developed nausea, vomiting, cramping abdominal pain and increased ileostomy output. On abdominal examination, he had marked diffuse tenderness, hyperactive bowel sounds and voluminous output from the stoma. Laboratory investigation revealed a WBC count of 31,000 cells/mm3 and a sudden worsening of renal function with a serum creatinine of 3.8mg/dl. On the 14th day of admission, ileostomy stool cultures tested positive for C. difficile toxin A and B; he previously tested negative for this on the 3rd day of admission. He subsequently developed septic shock and despite aggressive resuscitation and treatment with oral vancomycin, flagyl and vancomycin solution via ileostomy, he died on the 20th day of admission. Discussion: Isolated small bowel C. difficile infection in the absence of colonic involvement, especially post-colectomy, is exceedingly rare. A review of cases of C. difficile enteritis post-colectomy revealed a high mortality rate that is likely due to missed diagnosis and delayed institution of treatment because of low clinical suspicion. Advanced age and prior or ongoing antibiotic therapy are associated with increased mortality. The high mortality rate of almost 60% seen in C. difficile enteritis is worse than is seen in colitis and has been attributed to the increased permeability of the small bowel predisposing to septicemia and multi-organ involvement. The pathogenesis of C. difficile in the small bowel following colectomy is thought to be due to phenotypic changes that occur in the small bowel mucosa leading to colonic-type metaplasia and partial villous atrophy. These changes facilitate fecal floral establishment in the small bowel and explain the development of C. diff enteritis in this group of patients. Small bowel C. difficile infection should be strongly considered in the differential diagnosis of high risk patients even in the absence of a colon as early diagnosis and treatment could be life saving.

Patient Preferences and Compliance with Oral Vancomycin Solution for the Management of Clostridium difficile Infection

Patient Preferences and Compliance with Oral Vancomycin Solution for the Management of Clostridium difficile Infection

The Use of Natural Biopolymer of Chitosan as Biodegradable Beads for Local Antibiotic Delivery: Release Studies

Chitosan is a naturally occurring biopolymer which has been widely used in a variety of biomedical applications including local antibiotic delivery due to its excellent mechanical properties, biodegradability and biocompatibility. Beads are spherical, porous carriers which are prepared from various materials including chitosan. The current study aimed to fabricate a new controlled delivery system for local anti-infective treatment and to study its release behavior. Twenty beads were prepared from 1% or 2% chitosan solutions and immersed in vancomycin (VM) or teicoplanin (TN) solutions. The antibiotic release kinetics was determined by linear regression analysis supposing first order kinetics. Immersion for 3 h resulted in significant increase in the total TN release that differed from 0.5 h of immersion, except for the 1% beads immersed in VM. Increasing the chitosan concentration significantly increased the total release and antibiotic load of beads. The release of TN was more delayed compared to that of VM, which allowed a gradual release beyond 3 days. The half-life (mean ± SEM) of both types of TN-containing beads was significantly extended for 3 h immersion in comparison to 0.5 h immersion (26.1 ± 5.9 vs 10.9 ± 1.0 and 17.0 ± 2.1 vs 5.1 ± 1.9; P < 0.001). However, neither increasing the chitosan concentration, nor immersion time did result in any significant increase in the release of VM. The current study demonstrated an improved control of TN release impregnated in beads. It can be concluded that chitosan beads might be considered as a novel carrier for TN delivery to infected bone for local anti-infective therapy.