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Lewis G. Antibiotic-free antimicrobial poly (methyl methacrylate) bone cements: A state-of-the-art review. World J Orthop 2022; 13:339-353. [PMID: 35582158 PMCID: PMC9048499 DOI: 10.5312/wjo.v13.i4.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/30/2021] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
Prosthetic joint infection (PJI) is the most serious complication following total joint arthroplasty, this being because it is associated with, among other things, high morbidity and low quality of life, is difficult to prevent, and is very challenging to treat/manage. The many shortcomings of antibiotic-loaded poly (methyl methacrylate) (PMMA) bone cement (ALBC) as an agent for preventing and treating/managing PJI are well-known. One is that microorganisms responsible for most PJI cases, such as methicillin-resistant S. aureus, have developed or are developing resistance to gentamicin sulfate, which is the antibiotic in the vast majority of approved ALBC brands. This has led to many research efforts to develop cements that do not contain gentamicin (or, for that matter, any antibiotic) but demonstrate excellent antimicrobial efficacy. There is a sizeable body of literature on these so-called "antibiotic-free antimicrobial" PMMA bone cements (AFAMBCs). The present work is a comprehensive and critical review of this body. In addition to summaries of key trends in results of characterization studies of AFAMBCs, the attractive features and shortcomings of the literature are highlighted. Shortcomings provide motivation for future work, with some ideas being formulation of a new generation of AFAMBCs by, example, adding a nanostructured material and/or an extract from a natural product to the powder and/or liquid of the basis cement, respectively.
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Affiliation(s)
- Gladius Lewis
- Department of Mechanical Engineering, University of Memphis, Memphis, TN 38152, United States
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Muratlı SK, Karatosun V, Uzun B, Günal İ. Biomechanical comparison of tigecycline loaded bone cement with vancomycin and daptomycin loaded bone cements. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:535-540. [PMID: 33155566 DOI: 10.5152/j.aott.2020.19086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objectives of this study were "1" to analyze the compressive and tensile mechanical strength characteristics of tigecycline loaded bone cement and "2" to compare them with those of vancomycin and daptomycin loaded bone cements which are used in prosthetic joint infections complicated with resistant microorganisms. METHODS In this study, three experimental groups, which consisted of vancomycin (subgroups containing 1 g, 2 g, and 3 g vancomycin), daptomycin (subgroups containing 0.5 g, 1 g, and 1.5 g daptomycin), and tigecycline (subgroups containing 50 mg, 100 mg, and 150 mg tigecycline) and one control group without antibiotics were used. Using a standardized protocol, all antibiotic loaded bone cements were prepared. For each antibiotic group, including the control group, 10 samples were tested. All samples were biomechanically tested in terms of compressive strength and tensile strength. RESULTS Compression tests showed that all determined antibiotic concentrations resulted in a significant decrease when compared with the control group (p<0.0011). Vancomycin and daptomycin study groups demonstrated lower tensile strength than the control group (p<0.0011). However, comparison of tensile values of tigecycline study groups with the control group revealed no significant difference (p>0.0011). In addition, all statistically significant results from between groups comparisons revealed higher tensile and compressive mechanical strength values for the tigecycline groups (p<0.0011). CONCLUSION Evidence from this study has demonstrated that tigecycline loaded bone cement may have no mechanical disadvantage compared with vancomycin and daptomycin loaded bone cements in terms of mechanical strength when used at defined concentrations.
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Affiliation(s)
- Sedit Kıvanç Muratlı
- Department of Orthopedics and Traumatology, Çanakkale Onsekiz Mart University, Research and Training Hospital, Çanakkale, Turkey
| | - Vasfi Karatosun
- Department of Orthopedics and Traumatology, Dokuz Eylül University, School of Medicine Hospital, İzmir, Turkey
| | - Bora Uzun
- Department of Biomechanics, Dokuz Eylül University, School of Medicine Hospital, İzmir, Turkey
| | - İzge Günal
- Department of Orthopedics and Traumatology, Dokuz Eylül University, School of Medicine Hospital, İzmir, Turkey
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Oliver RA, Lovric V, Christou C, Walsh WR. Evaluation of comparative soft tissue response to bone void fillers with antibiotics in a rabbit intramuscular model. J Biomater Appl 2019; 34:117-129. [PMID: 30987506 PMCID: PMC6587362 DOI: 10.1177/0885328219838382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management of osseous and soft tissue dead space can be a significant challenge in the clinical setting. Calcium sulphate and calcium phosphate-based biomaterials are increasingly being used as alternatives to PMMA for local release of antibiotics, in particular to fill dead space following surgical debridement. This study aims to observe the in-vivo absorption characteristics and tissue response of three commercially available calcium sulphate-based materials combined with gentamicin in an established soft tissue rabbit model. The implant materials (1cc) were placed into four intramuscular sites in 18 New Zealand White rabbits (n = 6). In-life blood samples and radiographs were taken from each animal following implantation. Animals were sacrificed at 0, 1, 7, 21, 42 and 63 days post-operatively (n = 3) and implant sites analysed by micro-computed tomography and histology. Radiographically and histologically, recrystallized calcium sulphate (RCS) absorbed the fastest with complete absorption by day 21. Calcium sulphate/HA composite (CSHA) and Calcium sulphate/calcium carbonate (CSCC) absorbed slower and were detectable at day 63. Residual bead analysis revealed the presence of detectable gentamicin at 24 h and 7 days for CSHA and RCS but none in CSCC. Systemic levels of gentamicin were only detected between 1 h and 24 h. Serological inflammatory cytokine expression for IL-6, TNF-α and IL-1β indicated no unusual inflammatory response to the implanted materials. Calcium sulphate materials loaded with gentamicin are effective in resolving a surgically created dead space without eliciting any adverse host response.
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Affiliation(s)
- Rema A Oliver
- Surgical & Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - Vedran Lovric
- Surgical & Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - Chris Christou
- Surgical & Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - William R Walsh
- Surgical & Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Hospital, Randwick, Australia
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Hip and Knee Section, Prevention, Local Antimicrobials: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S289-S292. [PMID: 30343975 DOI: 10.1016/j.arth.2018.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Abstract
Antibiotic-laden bone cement (ALBC) has a number of different uses in primary and revision total joint arthroplasty. However, considerable controversy remains regarding how and when it is best used. The prophylactic use of low-dose ALBC in primary cemented total hip arthroplasty is well supported by the literature, conferring both clinical and economic benefits. In contrast, conclusive evidence on the clinical efficacy or economic benefit of the routine use of ALBC in primary total knee arthroplasty remains elusive. Given the currently available evidence, we cannot determine definitively whether the routine use of ALBC in primary total knee arthroplasty is justified, although selective use in patients with a high risk of infection seems warranted. The routine use of ALBC in revision total joint arthroplasty is well accepted, with good supporting evidence in studies of both aseptic and first-stage revision procedures. Although limited clinical evidence exists on the use of ALBC at the time of definitive component reimplantation after septic revision, the rationale for its use is strong.
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Kuo FC, Yen SH, Peng KT, Wang JW, Lee MS. Methicillin-resistant Staphylococcal periprosthetic joint infections can be effectively controlled by systemic and local daptomycin. BMC Infect Dis 2016; 16:48. [PMID: 26830838 PMCID: PMC4735949 DOI: 10.1186/s12879-016-1366-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/22/2016] [Indexed: 01/25/2023] Open
Abstract
Background Methicillin-resistant Staphylococcus remains a serious problem in the treatment of periprosthetic joint infection (PJI). Higher failure rates were reported when vancomycin was used in 2-stage exchange arthroplasty. Therefore a better therapeutic drug is needed to treat PJI caused by methicillin-resistant organisms. The purpose of the study was to evaluate the safety and efficacy of daptomycin when administered in bone cement combined with systemic use for methicillin-resistant Staphylococci PJI. Methods We conducted a retrospective study from January 2010 to December 2012. Twenty-two patients (10 knees and 12 hips) with PJI caused by methicillin-resistant Staphylococcus species underwent 2-stage revision arthroplasty. In the first stage, 10 % daptomycin (weight daptomycin per weight bone cement) was incorporated into polymethylmethacrylate bone cement, and systemic daptomycin (6 mg/kg) was administered postoperatively for 14 days. In the second stage, 2.5 % w/w daptomycin was used in the bone cement. The minimum follow-up was 2 years or until recurrence of infection. Results The infecting organisms included methicillin-resistant Staphylococcus aureus in 10 patients, methicillin-resistant Staphylococcus epidermidis in 8 patients and methicillin-resistant coagulase-negative Staphylococci in 4 patients. The mean follow-up duration was 33.7 months (range, 24–51 months). The treatment success rate was 100 %. Only one patient developed asymptomatic transient elevation of the creatine phosphokinase level. No patient experienced any adverse effects related to daptomycin such as myositis, rhabdomyolysis, peripheral neuropathy, derangement of liver function, or eosinophilic pneumonia. Conclusions In this series, no serious adverse events occurred. Our protocol, using daptomycin-impregnated cement combined with short duration of systemic daptomycin, appears to be an effective and safe treatment for methicillin-resistant Staphylococcus PJI.
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Affiliation(s)
- Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. .,Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Shih-Hsiang Yen
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. .,Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Kuo-Ti Peng
- Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Jun-Wen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. .,Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. .,Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Jennings JA, Beenken KE, Parker AC, Smith JK, Courtney HS, Smeltzer MS, Haggard WO. Polymicrobial Biofilm Inhibition Effects of Acetate-Buffered Chitosan Sponge Delivery Device. Macromol Biosci 2016; 16:591-8. [DOI: 10.1002/mabi.201500347] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/04/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Jessica Amber Jennings
- Department of Biomedical Engineering; University of Memphis; 330 Engineering Technology Building Memphis TN 38152 USA
| | - Karen E. Beenken
- Department of Orthopaedics; University of Arkansas for Medical Sciences; 4301 W. Markham St. Little Rock AR 72205 USA
| | - Ashley C. Parker
- Department of Biomedical Engineering; University of Memphis; 330 Engineering Technology Building Memphis TN 38152 USA
| | - James Keaton Smith
- Department of Biomedical Engineering; University of Memphis; 330 Engineering Technology Building Memphis TN 38152 USA
| | - Harry S. Courtney
- Department of Medicine; University of Tennessee Health Science Center; Coleman Building Suite D334, 956 Court Avenue Memphis TN 38163 USA
| | - Mark S. Smeltzer
- Department of Orthopaedics; University of Arkansas for Medical Sciences; 4301 W. Markham St. Little Rock AR 72205 USA
| | - Warren O. Haggard
- Department of Biomedical Engineering; University of Memphis; 330 Engineering Technology Building Memphis TN 38152 USA
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Abstract
BACKGROUND Orthopaedic biomaterials are susceptible to biofilm formation. A novel lipid-based material has been developed that may be loaded with antibiotics and applied as an implant coating at point of care. However, this material has not been evaluated for antibiotic elution, biofilm inhibition, or in vivo efficacy. QUESTIONS/PURPOSES (1) Do antibiotic-loaded coatings inhibit biofilm formation? (2) Is the coating effective in preventing biofilm in vivo? METHODS Purified phosphatidylcholine was mixed with 25% amikacin or vancomycin or a combination of 12.5% of both. A 7-day elution study for coated titanium and stainless steel coupons was followed by turbidity and zone of inhibition assays against Staphylococcus aureus and Pseudomonas aeruginosa. Coupons were inoculated with bacteria and incubated 24 hours (N = 4 for each test group). Microscopic images of biofilm were obtained. After washing and vortexing, attached bacteria were counted. A mouse biofilm model was modified to include coated and uncoated stainless steel wires inserted into the lumens of catheters inoculated with a mixture of S aureus or P aeruginosa. Colony-forming unit counts (N = 10) and scanning electron microscopy imaging of implants were used to determine antimicrobial activity. RESULTS Active antibiotics with colony inhibition effects were eluted for up to 6 days. Antibiotic-loaded coatings inhibited biofilm formation on in vitro coupons (log-fold reductions of 4.3 ± 0.4 in S aureus and 3.1 ± 0 for P aeruginosa in phosphatidylcholine-only coatings, 5.6 ± 0 for S aureus and 3.1 ± 0 for P aeruginosa for combination-loaded coatings, 5.5 ± 0.3 for S aureus in vancomycin-loaded coatings, and 3.1 ± 0 for P aeruginosa for amikacin-loaded coatings (p < 0.001 for all comparisons of antibiotic-loaded coatings against uncoated controls for both bacterial strains, p < 0.001 for comparison of antibiotic-loaded coatings against phosphatidylcholine only for S aureus, p = 0.54 for comparison of vancomycin versus combination coating in S aureus, P = 0.99 for comparison of antibiotic- and unloaded phosphatidylcholine coatings in P aeruginosa). Similarly, antibiotic-loaded coatings reduced attachment of bacteria to wires in vivo (log-fold reduction of 2.54 ± 0; p < 0.001 for S aureus and 0.83 ± 0.3; p = 0.112 for P aeruginosa). CONCLUSIONS Coatings deliver active antibiotics locally to inhibit biofilm formation and bacterial growth in vivo. Future evaluations will include orthopaedic preclinical models to confirm therapeutic efficacy. CLINICAL RELEVANCE Clinical applications of local drug delivery coating could reduce the rate of implant-associated infections.
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Lewis G. Not all approved antibiotic-loaded PMMA bone cement brands are the same: ranking using the utility materials selection concept. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:5388. [PMID: 25595722 DOI: 10.1007/s10856-015-5388-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/16/2014] [Indexed: 06/04/2023]
Abstract
In the literature on in vitro characterization of approved antibiotic-loaded poly(methyl methacrylate) bone cement brands, there is no information on the basis for selection of a given brand for use in cemented arthroplasties. This shortcoming is addressed in the present study. It involved determining four key properties (fatigue limit, fracture toughness, polymerization rate, and phosphate buffered saline diffusion coefficient) for six brands and then using the mean property values, in conjunction with a materials selection methodology, called the utility concept, to rank the brands. It is emphasized that the present work is an illustration of a rational approach to selection of a cement brand and, as such, the study findings are not intended to be recommendations regarding clinical use or otherwise of a brand.
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Affiliation(s)
- Gladius Lewis
- Department of Mechanical Engineering, The University of Memphis, Memphis, TN, 38152, USA,
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Barker S, Nichol T, Harrison PL, Stockley I, Townsend R, Smith TJ. Temocillin: a new candidate antibiotic for local antimicrobial delivery in orthopaedic surgery? J Antimicrob Chemother 2014; 70:780-3. [DOI: 10.1093/jac/dku425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Two-stage exchange remains the gold standard for treatment of peri-prosthetic joint infection after total hip replacement (THR). In the first stage, all components and associated cement if present are removed, an aggressive debridement is undertaken including a complete synovectomy, and an antibiotic-loaded cement spacer is put in place. Patients are then treated with six weeks of parenteral antibiotics, followed by an ‘antibiotic free period’ to help ensure the infection has been eradicated. If the clinical evaluation and serum inflammatory markers suggest the infection has resolved, then the second stage can be completed, which involves removal of the cement spacer, repeat debridement, and placement of a new THR. Cite this article: Bone Joint J 2013;95-B, Supple A:84–7.
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Affiliation(s)
- H. J. Cooper
- Department of Orthopaedic Surgery, Lenox
Hill Hospital, 130 East 77th Street, 11th
Floor, New York, New York
10075, USA
| | - C. J. Della Valle
- Department of Orthopaedic Surgery, Rush
University Medical Center, 1611 West Harrison
Street, Suite 300 Chicago, Illinois
60612, USA
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A daptomycin-xylitol-loaded polymethylmethacrylate bone cement: how much xylitol should be used? Clin Orthop Relat Res 2013; 471:3149-57. [PMID: 23529635 PMCID: PMC3773153 DOI: 10.1007/s11999-013-2939-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The rate of release of an antibiotic from an antibiotic-loaded polymethylmethacrylate (PMMA) bone cement is low. This may be increased by adding a particulate poragen (eg, xylitol) to the cement powder. However, the appropriate poragen amount is unclear. QUESTIONS/PURPOSES We explored the appropriate amount of xylitol to use in a PMMA bone cement loaded with daptomycin and xylitol. METHODS We prepared four groups of cement, each comprising the same amount of daptomycin in the powder (1.36 g/40 g dry powder) but different amounts of xylitol (0, 0.7, 1.4, and 2.7 g); the xylitol mass ratio (X) (mass divided by mass of the final dry cement-daptomycin-xylitol mixture) ranged from 0 to 6.13 wt/wt%. Eight mechanical, antibiotic release, and bacterial inhibitory properties were determined using three to 22 specimens or replicates per test. We then used an optimization method to determine an appropriate value of X by (1) identifying the best-fit relationship between the value of each property and X, (2) defining a master objective function incorporating all of the best fits; and (3) determining the value of X at the maximum master objective function. RESULTS We found an appropriate xylitol amount to be 4.46 wt/wt% (equivalent to 1.93 g xylitol mixed with 1.36 g daptomycin and 40 g dry cement powder). CONCLUSIONS We demonstrated a method that may be used to determine an appropriate xylitol amount for a daptomycin-xylitol-loaded PMMA bone cement. These findings will require in vivo confirmation. CLINICAL RELEVANCE While we identified an appropriate amount of xylitol in a daptomycin-xylitol-loaded PMMA bone cement as a prophylactic agent in total joint arthroplasties, clinical evaluations are needed to confirm the effectiveness of this cement.
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Wolf-Brandstetter C, Roessler S, Storch S, Hempel U, Gbureck U, Nies B, Bierbaum S, Scharnweber D. Physicochemical and cell biological characterization of PMMA bone cements modified with additives to increase bioactivity. J Biomed Mater Res B Appl Biomater 2012; 101:599-609. [PMID: 23281256 DOI: 10.1002/jbm.b.32862] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 09/11/2012] [Accepted: 10/16/2012] [Indexed: 11/08/2022]
Abstract
Polymethylmethacrylate (PMMA) bone cement is the most widely used material in surgery to fix joint replacements in the bone. In this study, we propose a new approach to generate bioactive PMMA surfaces directly at the site of implantation by adding the amphiphilic molecule phosphorylated 2-hydroxyethylmethacrylate (HEMA-P) to commercial PMMA bone cement, both with or without addition of 1-5% soluble calcium and carbonate salts. The setting behavior as well as the mechanical properties, the bonding quality at the metal/cement interface, mineral deposition, and cellular response for different cement modifications were investigated in vitro. The addition of HEMA-P resulted in entirely positive effects with respect to proliferation and differentiation of osteoblast-like cells (SaOs-2) and a very tight contact at the metal/cement interface. No detrimental changes of other properties were detected. The additional incorporation of salts provoked an increased deposition of calcium phosphate minerals but no further improvement in SaOs-2 cell differentiation. A significant decrease in polarization resistance for cements with high salt content (5%) was attributed to debonding between metal and cement. The results suggest an improved clinical performance of PMMA/HEMA-P composites, which might be further enhanced by small amounts of the soluble salts.
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Brown ME, Zou Y, Dziubla TD, Puleo DA. Effects of composition and setting environment on mechanical properties of a composite bone filler. J Biomed Mater Res A 2012; 101:973-80. [DOI: 10.1002/jbm.a.34399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 07/30/2012] [Accepted: 07/31/2012] [Indexed: 11/12/2022]
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Novel Therapeutic Combinations for Methicillin-Resistant Staphylococcus aureus Bacteremia and Prosthetic Joint Infection With Evolving Multidrug Resistance. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e31822e9bcd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Parker AC, Smith JK, Courtney HS, Haggard WO. Evaluation of two sources of calcium sulfate for a local drug delivery system: a pilot study. Clin Orthop Relat Res 2011; 469:3008-15. [PMID: 21553170 PMCID: PMC3183187 DOI: 10.1007/s11999-011-1911-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Local drug delivery has substantial potential to prevent infections compared with systemic delivery. Although calcium sulfate (CaSO(4)) has been studied for local drug delivery and two types are commercially available, it is unknown whether they differentially release antibiotics. QUESTIONS/PURPOSES We determined the differences between two sources of CaSO(4) and the K(2)SO(4) catalyst's presence on the degradation, daptomycin elution, and activity against Staphylococcus aureus. METHODS We formed pellets from synthetic and naturally sourced (from gypsum) CaSO(4) and loaded with 5% daptomycin and 3% or 0% K(2)SO(4). We used in vitro experiments to determine the daptomycin concentration and degradation profiles over 10 days. Turbidity assays were used to evaluate the activity of the daptomycin eluates against S. aureus. RESULTS All pellets exhibited a bolus release with the highest daptomycin concentration on Day 1 with the sourced CaSO(4) pellets. The synthetic CaSO(4) pellets with 3% K(2)SO(4) exhibited a slower drug release compared with the synthetic CaSO(4) pellets with 0% K(2)SO(4), which degraded and eluted daptomycin too quickly to inhibit S. aureus. Turbidity assays demonstrated that all CaSO(4) pellets inhibit S. aureus for expected lengths of time. CONCLUSIONS Our preliminary in vitro data suggest differences in the degradation, elution, and activity properties between sourced and synthetic CaSO(4) pellets. The addition of K(2)SO(4) appeared beneficial when using synthetic CaSO(4). Synthetic CaSO(4) may be effective when slow degradation and longer elution times are needed. CLINICAL RELEVANCE Local delivery of eluted daptomycin can be tailored through material selection and K(2)SO(4) addition.
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Affiliation(s)
- Ashley C Parker
- Department of Biomedical Engineering, University of Memphis, 321H Engineering Technology Building, Memphis, TN 38152, USA.
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Lewis G. Viscoelastic properties of injectable bone cements for orthopaedic applications: State-of-the-art review. J Biomed Mater Res B Appl Biomater 2011; 98:171-91. [DOI: 10.1002/jbm.b.31835] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/08/2010] [Accepted: 02/10/2011] [Indexed: 02/05/2023]
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