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Evaluation of Antibiotic-Releasing Triphasic Bone Void Filler In-Vitro. J Funct Biomater 2018; 9:jfb9040055. [PMID: 30248929 PMCID: PMC6306754 DOI: 10.3390/jfb9040055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/31/2018] [Accepted: 09/17/2018] [Indexed: 11/16/2022] Open
Abstract
Bone void fillers (BVFs) containing calcium sulfate, tricalcium phosphate (TCP), and hydroxyapatite can be loaded with antibiotics for infection treatment or prevention under surgeon-directed use. The aim of this study was to characterize the handling and elution properties of a triphasic BVF loaded with common antibiotics. BVF was mixed with vancomycin and/or tobramycin to form pellets, and the set time was recorded. A partial refreshment elution study was conducted with time points at 4, 8, and 24 h, as well as 2, 7, 14, 28, and 42 days. Effects on dissolution were evaluated in a 14-day dissolution study. Set time increased to over 1 h for groups containing tobramycin, although vancomycin had a minimal effect. Pellets continued to elute antibiotics throughout the 42-day elution study, suggesting efficacy for the treatment or prevention of orthopedic infections. BVF containing vancomycin or tobramycin showed similar dissolution at 14 days compared to BVF without antibiotics; however, BVF containing both antibiotics showed significantly more dissolution.
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Casadidio C, Butini ME, Trampuz A, Di Luca M, Censi R, Di Martino P. Daptomycin-loaded biodegradable thermosensitive hydrogels enhance drug stability and foster bactericidal activity against Staphylococcus aureus. Eur J Pharm Biopharm 2018; 130:260-271. [PMID: 30064700 DOI: 10.1016/j.ejpb.2018.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
A drug delivery system based on fully biodegradable thermosensitive hydrogels enabling controlled antibiotic release may support the management of implant-associated infections. In this work, the lipopeptide antibiotic daptomycin was encapsulated in hydrogel networks consisting of vinyl sulfonated triblock copolymers of PEG-p(HPMAm-lac1,2) and thiolated hyaluronic acid. High concentrations of active daptomycin exceeding the minimum biofilm eradicating concentration were sustainably eluted from the biodegradable carrier. The drug release profiles were tailored by varying the degree of substitution (DS) of thiol groups of hyaluronic acid, reaching a plateau level after 200 and 330 h for DS values of 53% and 31%, respectively. The hydrogel polymeric network preserved the structural stability of the loaded antibiotic and retained the calcium-dependent daptomycin activity, showing a noticeable biofilm bactericidal effect against a 24 h-old Staphylococcus aureus biofilm in vitro. The two-component thermosensitive hydrogels demonstrated to be an excellent antibiotic releasing scaffold with potential clinical applications in the management of implant-associated infections.
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Affiliation(s)
- Cristina Casadidio
- School of Pharmacy, University of Camerino, Via S. Agostino 1, 62032 Camerino, MC, Italy
| | - Maria Eugenia Butini
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Charitéplatz 1, 10117 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Charitéplatz 1, 10117 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Mariagrazia Di Luca
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Charitéplatz 1, 10117 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; NEST, Istituto Nanoscienze - Consiglio Nazionale delle Ricerche, Piazza San Silvestro 12, 10027 Pisa, Italy
| | - Roberta Censi
- School of Pharmacy, University of Camerino, Via S. Agostino 1, 62032 Camerino, MC, Italy.
| | - Piera Di Martino
- School of Pharmacy, University of Camerino, Via S. Agostino 1, 62032 Camerino, MC, Italy
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Menon A, Soman R, Rodrigues C, Phadke S, Agashe VM. Careful interpretation of the wound status is needed with use of antibiotic impregnated biodegradable synthetic pure calcium sulfate beads: Series of 39 cases. J Bone Jt Infect 2018; 3:87-93. [PMID: 29922571 PMCID: PMC6004684 DOI: 10.7150/jbji.22684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 02/04/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction: The use of antibiotic impregnated biodegradable synthetic high purity calcium sulfate (SHPCS) beads is frequently reported as they offer increased concentration of antibiotics locally, without need for removal. However some wound discharge following their use has been noted. The purpose of this study was to determine any correlation between wound discharge and infection remission. Methodology: Retrospective study of 39 cases of Osteoarticular infections from April 2013 to November 2016 in whom SHPCS beads were used. All patients underwent the standard staged protocol of aggressive debridement, deep tissue biopsy, implant removal where indicated and early soft tissue cover. SHPCS beads were used locally in the second stage combined with appropriate antibiotics based on tissue culture. All patients received systemic antibiotics for a period of 6 weeks and followed up for a minimum period of six months. The study analysed the patient demographics, etiology, surgical procedures, culture patterns, local antibiotics used, radiological status of beads, incidence and characteristics of wound discharge and outcome. Results: There were 25 cases of chronic osteomyelitis, eight infected non unions, three peri prosthetic joint infections, two soft tissue infections and one case of acute osteomyelitis. 17 of these infections were following osteosynthesis. The cultures were negative on eight occasions in seven patients. A total of 40 organisms were isolated in the other patients; commonest being Staphylococcus aureus (n=16) and E coli (n=7). SHPCS beads were mixed with vancomycin in 17 cases, colistin in 11, vancomycin with colistin in eight and vancomycin with gentamicin in four. Voriconazole was used in one case with fungal infection. Eight cases (20.51 %) developed discharge from the wound at an average of 6 days after inserting the beads. The discharge was serous with no foul smell in six and purulent in two inflamed wounds. Four cases underwent re-debridement; two cases with purulent discharge and subsequent positive cultures; two with serous discharge early in the series and no evidence of infection on re-exploration with negative cultures. The remaining four patients with serous wound discharge were observed without any further surgical intervention, with the discharge stopping spontaneously between 15 to 36 days post operatively. There was no correlation between antibiotic used and wound discharge. Radiographic analysis showed dissolution of all the beads at an average of 36 days in the 39 cases. Heterotrophic ossification was not observed. Clinical and radiological remission of infection was observed in 37 cases (94.9%). Two patients died during the course of hospitalization, secondary to septicaemia and multi organ failure. Three patients had an infection recurrence within six months, managed successfully by re-debridement and appropriate antibiotics. Radiological union was achieved in seven of the eight infected non unions. Conclusions: With the encouraging rates of infection remission we have observed, we continue to use antibiotic loaded SHPCS as an alternative for local antibiotic delivery in the treatment of osteoarticular infections. However, wound discharge is a known potential observation following implantation of calcium sulfate beads, subsiding typically within four to six weeks. The appearance of wound discharge can vary, ranging from purulent discharges to non-purulent, serous/ sero sanguineous fluid wound discharges. The presence of a wound discharge alone does not necessarily imply a failure to treat the infection. It is important to be aware of this side effect and guard against unnecessary re- operations, by careful consideration and monitoring all of the available clinical signs of infection, in addition to blood test results and radiographic evidence. Further research is needed to determine the relationship between the implantation of antibiotic loaded calcium sulfates and the incidence and duration of drainage.
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Affiliation(s)
| | | | - Camilla Rodrigues
- Department of Microbiology, P D Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Sanjay Phadke
- Agashe Maternity and Surgical Nursing Home, Mumbai, Maharashtra, India
| | - Vikas M Agashe
- Department of Orthopaedics
- Agashe Maternity and Surgical Nursing Home, Mumbai, Maharashtra, India
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54
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Lum ZC, Pereira GC. Local bio-absorbable antibiotic delivery in calcium sulfate beads in hip and knee arthroplasty. J Orthop 2018; 15:676-678. [PMID: 29881219 DOI: 10.1016/j.jor.2018.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/06/2018] [Indexed: 11/24/2022] Open
Abstract
Antibiotic-impregnated calcium sulfate (AICS) beads have been used for prevention and treatment of periprosthetic joint infections. We evaluated post-operative complications following the use of AICS beads. 56 patients undergoing complex primary or revision hip or knee arthroplasty received antibiotic calcium sulfate beads. Primary outcomes were wound complication rates. Secondary outcomes included reoperation and reinfection rates. One case (1.7%) of persistent wound drainage occurred requiring surgical irrigation and a poly-exchange. No post-operative infections were seen. Use of 100% pure calcium sulfate AICS beads may help reduce post-operative wound complications. AICS appears to be a safe adjunct tool in local antibiotic delivery.
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Affiliation(s)
- Zachary C Lum
- University of California, Davis Medical Center, Sacramento, CA, United States
| | - Gavin C Pereira
- University of California, Davis Medical Center, Sacramento, CA, United States
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55
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Rubin HN, Neufeld BH, Reynolds MM. Surface-Anchored Metal-Organic Framework-Cotton Material for Tunable Antibacterial Copper Delivery. ACS APPLIED MATERIALS & INTERFACES 2018; 10:15189-15199. [PMID: 29637764 PMCID: PMC6351152 DOI: 10.1021/acsami.7b19455] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In the present study, a new copper metal-organic framework (MOF)-cotton material was strategically fabricated to exploit its antibacterial properties for postsynthetic modification (PSM) to introduce a free amine to tune the physicochemical properties of the material. A modified methodology for carboxymethylation of natural cotton was utilized to enhance the number of nucleation sites for the MOF growth. Subsequently, MOF Cu3(NH2BTC)2 was synthesized into a homogenous surface-supported film via a layer-by-layer dip-coating process. The resultant materials contained uniformly distributed 1 μm × 1 μm octahedral MOF crystals around each carboxymethylated fiber. Importantly, the accessible free amine of the MOF ligand allowed for the PSM of the MOF-cotton surface with valeric anhydride, yielding 23.5 ± 2.2% modified. The Cu2+ ion-releasing performance of the materials was probed under biological conditions per submersion in complex media at 37 °C. Indeed, PSM induces a change in the copper flux of the material over the first 6 h. The materials continue to slowly release Cu2+ ions beyond 24 h tested at a flux of 0.22 ± 0.003 μmol·cm-2·h-1 with the unmodified MOF-cotton and at 0.25 ± 0.004 μmol·cm-2·h-1 with the modified MOF-cotton. The antibacterial activity of the material was explored using Escherichia coli by testing the planktonic and attached bacteria under a variety of conditions. MOF-cotton materials elicit antibacterial effects, yielding a 4-log reduction or greater, after 24 h of exposure. Additionally, the MOF-cotton materials inhibit the attachment of bacteria, under both dry and wet conditions. A material of this type would be ideal for clothing, bandages, and other textile applications. As such, this work serves as a precedence toward developing uniform, tunable MOF-composite textile materials that can kill bacteria and prevent the attachment of bacteria to the surface.
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Affiliation(s)
- Heather N. Rubin
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523, United States
| | - Bella H. Neufeld
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523, United States
| | - Melissa M. Reynolds
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523, United States
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado 80523, United States
- Department of Chemical & Biological Engineering, Colorado State University, Fort Collins, Colorado 80523, United States
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Levack AE, Cyphert EL, Bostrom MP, Hernandez CJ, von Recum HA, Carli AV. Current Options and Emerging Biomaterials for Periprosthetic Joint Infection. Curr Rheumatol Rep 2018; 20:33. [PMID: 29713837 DOI: 10.1007/s11926-018-0742-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Infection in the setting of total joint arthroplasty, referred to as periprosthetic joint infection (PJI), is a devastating complication requiring prolonged and costly treatment. The unique environment around an artificial joint and ability of surrounding tissues to sequester bacteria collectively make prevention, diagnosis, and treatment of this condition challenging. In light of the unique pathogenesis of PJI, this review explores the limitations of contemporary treatments and discusses novel treatment options. RECENT FINDINGS Recent advancements in local antibiotic delivery platforms for preventing and treating PJI include titanium nanotube arrays, synthetic polymers, resorbable hydrogels, and cyclodextrin-based drug delivery options. In particular, cyclodextrins have facilitated great advancements in other clinical disorders and have demonstrated early promise as a future option in the arena of PJI. Novel treatment modalities for PJI optimize the implant surfaces to prevent bacterial biofilm formation or provide prolonged intra-articular antibiotic dosing to eradicate bacteria.
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Affiliation(s)
| | - Erika L Cyphert
- Department of Biomedical Engineering, Case Western Reserve University, Room 220 Wickenden Building, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | | | - Christopher J Hernandez
- Hospital for Special Surgery, New York, NY, USA
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Horst A von Recum
- Department of Biomedical Engineering, Case Western Reserve University, Room 220 Wickenden Building, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Alberto V Carli
- Hospital for Special Surgery, New York, NY, USA
- Surgery, The Ottawa Hospital, Ottawa, ON, Canada
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57
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Absorbable Antibiotic Beads Prophylaxis in Immediate Breast Reconstruction. Plast Reconstr Surg 2018; 141:486e-492e. [DOI: 10.1097/prs.0000000000004203] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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58
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Sanz-Ruiz P, Carbó-Laso E, Del Real-Romero JC, Arán-Ais F, Ballesteros-Iglesias Y, Paz-Jiménez E, Sánchez-Navarro M, Pérez-Limiñana MÁ, Vaquero-Martín J. Microencapsulation of rifampicin: A technique to preserve the mechanical properties of bone cement. J Orthop Res 2018; 36:459-466. [PMID: 28543702 DOI: 10.1002/jor.23614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/19/2017] [Indexed: 02/04/2023]
Abstract
Two-stage exchange with antibiotic-loaded bone cement spacers remains the gold standard for chronic periprosthetic joint infection (PJI). Rifampicin is highly efficient on stationary-phase staphylococci in biofilm; however, its addition to PMMA to manufacture spacers prevents polymerization and reduces mechanical properties. Isolation of rifampicin during polymerization by microencapsulation could allow manufacturing rifampicin-loaded bone cement maintaining elution and mechanical properties. Microcapsules of rifampicin with alginate, polyhydroxybutyratehydroxyvalerate (PHBV), ethylcellulose and stearic acid (SA) were synthesized. Alginate and PHBV microcapsules were added to bone cement and elution, compression, bending, hardness, setting time and microbiological tests were performed. Repeated measures ANOVA and Bonferroni post-hoc test were performed, considering a p < 0.05 as statistical significance. Bone cement specimens containing alginate microcapsules eluted more rifampicin than PHBV microcapsules or non-encapsulated rifampicin over time (p < 0.012). Microencapsulation of rifampicin allowed PMMA to preserve mechanical properties in compression and bending tests. Cement with alginate microcapsules showed similar behavior in hardness tests to control cement over the study period (73 ± 1.68HD ). PMMA with alginate microcapsules exhibited the largest zones of inhibition in microbiological tests. Statistically significant differences in mean diameters of zones of inhibition between PMMA loaded with alginate-rifampicin (p = 0.0001) and alginate-PHBV microcapsules (p = 0.0001) were detected. Rifampicin microencapsulation with alginate is the best choice to introduce rifampicin in PMMA preserving mechanical properties, setting time, elution, and antimicrobial properties. The main applicability of this study is the opportunity for obtaining rifampicin-loaded PMMA by microencapsulation of rifampicin in alginate microparticles, achieving high doses of rifampicin in infected tissues, increasing the successful of PJI treatment. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:459-466, 2018.
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Affiliation(s)
- Pablo Sanz-Ruiz
- Department of Traumatology and Orthopaedic Surgery, University General Hospital Gregorio Marañon, Doctor Esquerdo 46, 28007, Madrid, Spain.,Complutense University of Madrid, Ciudad Universitaria, 28040, Madrid, Spain
| | - Esther Carbó-Laso
- Department of Traumatology and Orthopaedic Surgery, University General Hospital Gregorio Marañon, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Juan Carlos Del Real-Romero
- Institute for Research in Technology/Mechanical Engineering Department, Universidad Pontificia Comillas, Alberto Aguilera 23, 28015, Madrid, Spain
| | - Francisca Arán-Ais
- INESCOP Footwear Technological Institute Microencapsulation and Nanotechnology Elda, Políg. Ind. Campo Alto, Alemania 102, 03600, Elda, Alicante, Spain
| | - Yolanda Ballesteros-Iglesias
- Institute for Research in Technology/Mechanical Engineering Department, Universidad Pontificia Comillas, Alberto Aguilera 23, 28015, Madrid, Spain
| | - Eva Paz-Jiménez
- Institute for Research in Technology/Mechanical Engineering Department, Universidad Pontificia Comillas, Alberto Aguilera 23, 28015, Madrid, Spain
| | - Magdalena Sánchez-Navarro
- INESCOP Footwear Technological Institute Microencapsulation and Nanotechnology Elda, Políg. Ind. Campo Alto, Alemania 102, 03600, Elda, Alicante, Spain
| | - María Ángeles Pérez-Limiñana
- INESCOP Footwear Technological Institute Microencapsulation and Nanotechnology Elda, Políg. Ind. Campo Alto, Alemania 102, 03600, Elda, Alicante, Spain
| | - Javier Vaquero-Martín
- Department of Traumatology and Orthopaedic Surgery, University General Hospital Gregorio Marañon, Doctor Esquerdo 46, 28007, Madrid, Spain.,Complutense University of Madrid, Ciudad Universitaria, 28040, Madrid, Spain
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59
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Butini ME, Cabric S, Trampuz A, Di Luca M. In vitro anti-biofilm activity of a biphasic gentamicin-loaded calcium sulfate/hydroxyapatite bone graft substitute. Colloids Surf B Biointerfaces 2018; 161:252-260. [DOI: 10.1016/j.colsurfb.2017.10.050] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/07/2017] [Accepted: 10/17/2017] [Indexed: 02/03/2023]
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60
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Carver DC, Kuehn SB, Weinlein JC. Role of Systemic and Local Antibiotics in the Treatment of Open Fractures. Orthop Clin North Am 2017; 48:137-153. [PMID: 28336038 DOI: 10.1016/j.ocl.2016.12.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The orthopedic community has learned much about the treatment of open fractures from the tremendous work of Ramon Gustilo, Michael Patzakis, and others; however, open fractures continue to be very difficult challenges. Type III open fractures continue to be associated with high infection rates. Some combination of systemic and local antibiotics may be most appropriate in these high-grade open fractures. Further research is still necessary in determining optimal systemic antibiotic regimens as well as the role of local antibiotics. Any new discoveries related to novel systemic antibiotics or local antibiotic carriers will need to be evaluated related to cost.
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Affiliation(s)
- David C Carver
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Sean B Kuehn
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - John C Weinlein
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
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61
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Meza-López LR, Cigarroa-López JA, Hernández-Meneses S, Castán-Flores DA, Mendoza-Zavala GH, Barragán-Zamora JA, Carrillo-Muñoz A, Munguía-Canales DA. [Dissolvable and extended release antibiotic beads in mediastinoscopic management of mediastinitis after heart transplantation]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:182-186. [PMID: 28259393 DOI: 10.1016/j.acmx.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 10/05/2016] [Accepted: 01/17/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Luis Raúl Meza-López
- Departamento de Cirugía Cardiotorácica, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| | - José Angel Cigarroa-López
- Clínica de Insuficiencia Cardiaca y Trasplante, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Silvia Hernández-Meneses
- Departamento de Cirugía Cardiotorácica, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - David Arturo Castán-Flores
- Clínica de Insuficiencia Cardiaca y Trasplante, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Genaro Hiram Mendoza-Zavala
- Clínica de Insuficiencia Cardiaca y Trasplante, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Antonio Barragán-Zamora
- Departamento de Cirugía Cardiotorácica, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Arturo Carrillo-Muñoz
- Clínica de Insuficiencia Cardiaca y Trasplante, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Daniel Alejandro Munguía-Canales
- Departamento de Cirugía Cardiotorácica, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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62
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Dusane DH, Diamond SM, Knecht CS, Farrar NR, Peters CW, Howlin RP, Swearingen MC, Calhoun JH, Plaut RD, Nocera TM, Granger JF, Stoodley P. Effects of loading concentration, blood and synovial fluid on antibiotic release and anti-biofilm activity of bone cement beads. J Control Release 2017; 248:24-32. [PMID: 28087408 DOI: 10.1016/j.jconrel.2017.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/21/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
Antibiotic loaded cement beads are commonly used for the treatment of biofilm related orthopaedic periprosthetic infections; however the effects of antibiotic loading and exposure of beads to body fluids on release kinetics are unclear. The purpose of this study was to determine the effects of (i) antibiotic loading density (ii) loading amount (iii) material type and (iv) exposure to body fluids (blood or synovial fluid) on release kinetics and efficacy of antibiotics against planktonic and lawn biofilm bacteria. Short-term release into an agar gel was evaluated using a fluorescent tracer (fluorescein) incorporated in the carrier materials calcium sulfate (CaSO4) and poly methyl methacrylate (PMMA). Different fluorescein concentrations in CaSO4 beads were evaluated. Mechanical properties of fluorescein-incorporated beads were analyzed. Efficacy of the antibiotics vancomycin (VAN) or tobramycin (TOB) alone and in combination was evaluated against lawn biofilms of bioluminescent strains of Staphylococcus aureus and Pseudomonas aeruginosa. Zones of inhibition of cultures (ZOI) were measured visually and using an in-vivo imaging system (IVIS). The influence of body fluids on release was assessed using CaSO4 beads that contained fluorescein or antibiotics and were pre-coated with human blood or synovial fluid. The spread from the beads followed a square root of time relationship in all cases. The loading concentration had no influence on short-term fluorescein release and pre-coating of beads with body fluids did not affect short-term release or antibacterial activity. Compared to PMMA, CaSO4 had a more rapid short term rate of elution and activity against planktonic and lawn biofilms. This study highlights the importance of considering antibiotic loading and packing density when investigating the clinical application of bone cements for infection management.
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Affiliation(s)
- Devendra H Dusane
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus 43210, USA.
| | - Scott M Diamond
- Department of Medicine, The Ohio State University, Columbus 43210, USA
| | - Cory S Knecht
- Department of Medicine, The Ohio State University, Columbus 43210, USA
| | - Nicholas R Farrar
- Department of Biomedical Engineering, The Ohio State University, Columbus 43210, USA
| | - Casey W Peters
- Department of Biochemistry, The Ohio State University, Columbus 43210, USA
| | - Robert P Howlin
- Centre for Biological Sciences, Faculty of Natural & Environmental Sciences & Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Matthew C Swearingen
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus 43210, USA
| | - Jason H Calhoun
- Department of Muscoskeletal Sciences, Spectrum Health Medical Group, Grand Rapids, USA
| | - Roger D Plaut
- Division of Bacterial, Parasitic, and Allergenic Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring 20993, USA
| | - Tanya M Nocera
- Department of Biomedical Engineering, The Ohio State University, Columbus 43210, USA
| | - Jeffrey F Granger
- Department of Orthopaedics, The Ohio State University, Columbus 43210, USA
| | - Paul Stoodley
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus 43210, USA; Department of Orthopaedics, The Ohio State University, Columbus 43210, USA; National Center for Advanced Tribology at Southampton (nCATS), Engineering and the Environment, University of Southampton SO17 1BJ, UK
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63
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Howlin RP, Winnard C, Frapwell CJ, Webb JS, Cooper JJ, Aiken SS, Stoodley P. Biofilm prevention of gram-negative bacterial pathogens involved in periprosthetic infection by antibiotic-loaded calcium sulfate beads in vitro. ACTA ACUST UNITED AC 2016; 12:015002. [PMID: 27910828 DOI: 10.1088/1748-605x/12/1/015002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biofilm formation represents a key stage in the pathogenesis of prosthetic infections (PIs). More tolerant to antibiotics than their planktonic counterparts, biofilm bacteria are difficult to eradicate using conventional therapeutic regimes. A common approach in PI management is the adjunctive use of localised antibiotics in addition to systemic administration in an attempt to protect the implant from colonisation by infiltrating bacteria. This study evaluates the antibacterial and antibiofilm efficacy of antibiotic-loaded dissolvable calcium sulphate, previously shown to be effective against key gram-positive pathogens, against gram-negative species important in the establishment of chronic infection in PIs. Synthetic calcium sulfate beads loaded with tobramycin, vancomycin and both antibiotics in combination were assessed for their ability to eradicate planktonic Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae strains. The efficacy of the beads in preventing biofilm formation and eliminating established biofilms over multiple days was evaluated using confocal laser scanning microscopy (CSLM) imaging combined with image analysis and viable cell counts. Beads loaded with antibiotics demonstrated effective eluting concentrations for up to 37 d depending on the bacterial strain. In the presence of repeated bacterial challenges, antibiotic-loaded beads prevented bacterial colonisation and significantly reduce biofilm formation for the duration of the assay (7 d). Complete eradication of established biofilms was more difficult with evidence of biofilm regrowth after 1 week of contact with antibiotic-loaded beads, despite data suggesting a complete kill was achieved at earlier timepoints of 24 h and 72 h in the case of K. pneumoniae and P. aeruginosa. This study provides further evidence that calcium sulfate beads loaded with vancomycin and tobramycin may be a useful adjunctive component to the successful management of PIs.
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Affiliation(s)
- Robert P Howlin
- Southampton NIHR Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. Centre for Biological Sciences, Faculty of Natural and Environmental Sciences and Institute for Life Sciences, Building 85, University of Southampton, Highfield, Southampton, SO17 1BJ, UK. Author to whom any correspondence should be addressed. Microbial Ecology Group, Centre for Biological Sciences, University of Southampton, Life Sciences Building 85, Highfield, Southampton, SO17 1BJ, UK
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Development of a Novel Collagen Wound Model To Simulate the Activity and Distribution of Antimicrobials in Soft Tissue during Diabetic Foot Infection. Antimicrob Agents Chemother 2016; 60:6880-6889. [PMID: 27620475 PMCID: PMC5075099 DOI: 10.1128/aac.01064-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/20/2016] [Indexed: 01/13/2023] Open
Abstract
Diabetes has major implications for public health, with diabetic foot ulcers (DFUs) being responsible for significant morbidity and mortality. A key factor in the development of nonhealing ulcers is infection, which often leads to the development of biofilm, gangrene, and amputation. A novel approach to treating DFUs is the local release of antibiotics from calcium sulfate beads. We have developed a novel model system to study and compare the release and efficacy of antibiotics released locally, using collagen as a substrate for biofilm growth and incorporating serum to mimic the biochemical complexity of the wound environment. We found that our soft-tissue model supports the growth of a robust Pseudomonas aeruginosa biofilm, and that this was completely eradicated by the introduction of calcium sulfate beads loaded with tobramycin or gentamicin. The model also enabled us to measure the concentration of these antibiotics at different distances from the beads and in simulated wound fluid bathing the collagen matrix. We additionally found that a multidrug-resistant Staphylococcus aureus biofilm, nonsusceptible to antibiotics, nonetheless showed an almost 1-log drop in viable counts when exposed to calcium sulfate beads combined with antibiotics. Together, these data suggest that locally applied antibiotics combined with calcium sulfate provide surprising efficacy in diabetic foot infections and offer an effective alternative approach to infection management. Our study additionally establishes our new system as a biochemically and histologically relevant model that may be used to study the effectiveness of a range of therapies locally or systemically for infected DFUs.
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Cooper JJ, Florance H, McKinnon JL, Laycock PA, Aiken SS. Elution profiles of tobramycin and vancomycin from high-purity calcium sulphate beads incubated in a range of simulated body fluids. J Biomater Appl 2016; 31:357-65. [PMID: 27511982 DOI: 10.1177/0885328216663392] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to characterise the elution profiles of antibiotics in combination with pharmaceutical grade calcium sulphate beads in phosphate buffered saline and other physiological solutions which more closely mimic the in vivo environment. Synthetic recrystallised calcium sulphate was combined with vancomycin hydrochloride powder and tobramycin sulphate solution and the paste was formed into 3 mm diameter hemispherical beads. Then 2 g of beads were immersed in 2 ml of either phosphate buffered saline, Dulbecco's Modified Eagle Medium or Hartmann's solution and incubated at 37℃ for up to 21 days. At a range of time points, eluent was removed for analysis by liquid chromatography-mass spectrometry (LC-MS). Tobramycin sulphate and vancomycin hydrochloride release was successfully quantified against standard curves from solutions eluted in all three physiological media (phosphate buffered saline, Dulbecco's Modified Eagle Medium and Hartmann's solution) during incubation with calcium sulphate beads. One hour eluate concentrations were high, up to 2602 µg/ml for tobramycin in phosphate buffered saline and 7417 µg/ml for vancomycin, whereas in DMEM, the levels of tobramycin were 2458 µg/ml and 4401 µg/ml for vancomycin. The levels in HRT were 2354 µg/ml for tobramycin and 5948 µg/ml for vancomycin. The results show highest levels of antibiotic elution over the first 24 h, which gradually diminish over the following 21 days.
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Affiliation(s)
- J J Cooper
- Biocomposites Ltd., Keele Science Park, Staffordshire, UK
| | - H Florance
- Centre for Synthetic and Systems Biology, University of Edinburgh, Edinburgh, UK Exeter Mass Spectrometry Facility, Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - J L McKinnon
- Biocomposites Ltd., Keele Science Park, Staffordshire, UK
| | - P A Laycock
- Biocomposites Ltd., Keele Science Park, Staffordshire, UK
| | - S S Aiken
- Biocomposites Ltd., Keele Science Park, Staffordshire, UK
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Gu J, Wang T, Fan G, Ma J, Hu W, Cai X. Biocompatibility of artificial bone based on vancomycin loaded mesoporous silica nanoparticles and calcium sulfate composites. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:64. [PMID: 26883948 PMCID: PMC4756035 DOI: 10.1007/s10856-016-5671-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the in vitro and in vivo biocompatibility of artificial bone based on vancomycin loaded mesoporous silica nanoparticles and calcium sulfate composites. In vitro cytotoxicity tests by cholecystokinin octapeptide (CCK-8) assay showed that the 5%Van-MSN-CaSO4 and Van-CaSO4 bone cements were cytocompatible for mouse osteoblastic cell line MC3T3-E1. The microscopic observation confirmed that MC3T3-E1cells incubated with Van-CaSO4 group and 5%Van-MSN-CaSO4 group exhibited clear spindle-shaped changes, volume increase and maturation, showing that these cements supported adhesion of osteoblastic cells on their surfaces. In addition, the measurement of alkaline phosphatase activity revealed the osteoconductive property of these biomaterials. In order to assess in vivo biocompatibility, synthesized cements were implanted into the distal femur of twelve adult male and female New Zealand rabbits. After implantation in artificial defects of the distal femur, 5%Van-MSN-CaSO4 and Van-CaSO4 bone cements did not damage the function of main organs of rabbits. In addition, the Van-MSN-CaSO4 composite allowed complete repair of bone defects with new bone formation 3 months after implantation. These results show potential application of Van-MSN-CaSO4 composites as bone graft materials for the treatment of open fracture in human due to its mechanical, osteoconductive and potential sustained drug release characteristics and the absence of adverse effects on the body.
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Affiliation(s)
- Jisheng Gu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Teng Wang
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Guoxin Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Junhua Ma
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Wei Hu
- Department of General Surgery, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai, 200433, China.
| | - Xiaobing Cai
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China.
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Genovese EA, Avgerinos ED, Baril DT, Makaroun MS, Chaer RA. Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections. Vascular 2016; 24:590-597. [PMID: 26896286 DOI: 10.1177/1708538116630859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is limited investigation into the use of bio-absorbable antibiotic beads for the treatment of prosthetic vascular graft infections. Our goal was to investigate the rates of infection eradication, graft preservation, and limb salvage in patients who are not candidates for graft explant or extensive reconstruction. METHODS A retrospective review of patients implanted with antibiotic impregnated bio-absorbable calcium sulfate beads at a major university center was conducted. RESULTS Six patients with prosthetic graft infections were treated with bio-absorbable antibiotics beads from 2012-2014. Grafts included an aortobifemoral, an aorto-hepatic/superior mesenteric artery, and four extra-anatomic bypasses. Pathogens included Gram-positive and Gram-negative bacteria. Half of the patients underwent graft explant with reconstruction and half debridement of the original graft, all with antibiotic bead placement around the graft. Mean follow-up was 7.3 ± 8.3 months; all patients had infection resolution, healed wounds, and 100% graft patency, limb salvage, and survival. CONCLUSION This report details the successful use of bio-absorbable antibiotic beads for the treatment prosthetic vascular graft infections in patients at high risk for graft explant or major vascular reconstruction. At early follow-up, we demonstrate successful infection suppression, graft preservation, and limb salvage with the use of these beads in a subset of vascular patients.
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Affiliation(s)
- Elizabeth A Genovese
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Donald T Baril
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michel S Makaroun
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rabih A Chaer
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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