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The Incidence of Severe Hypercalcaemia-Induced Mental Status Changes in Patients Treated with Antibiotic-Loaded Calcium Sulphate Depot for Orthopaedic Infections. J Clin Med 2022; 11:jcm11164900. [PMID: 36013138 PMCID: PMC9409894 DOI: 10.3390/jcm11164900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Local application of antibiotics with calcium-containing carrier materials (CCCM) might deliver large quantities of calcium, with some cases of hypercalcaemia reported. The incidence of symptomatic hypercalcaemia was estimated retrospectively in a consecutive, prospective series of patients treated between 10/2006 and 02/2019 with antibiotic-loaded CCCM for various orthopaedic infections. Risk factors were analysed. In the study period, 215 CCCM applications were performed. Two patients (0.9%) developed symptomatic hypercalcaemia. In one case, hypercalcaemia occurred 14 days after a second CCCM application during a staged septic hip revision. In the other case, hypercalcaemia became symptomatic six days after application of vancomycin-loaded CCCM in a component-retaining septic revision hip arthroplasty. In both cases, hypercalcemia was not imputable solely to the CCCM. Prolonged immobilization, renal impairment and other specific risk factors were present. Implantation of a CCCM for local application of antibiotics exposes the patient to large quantities of calcium during dissolution. This might induce symptomatic hypercalcaemia, a potentially life-threatening complication. The observed incidence of symptomatic hypercalcaemia remained rare (<1%). In some patients, compensatory mechanisms might be overwhelmed in the presence of other risk factors. Postoperative monitoring of calcaemia as well as elimination of risk factors is mandatory for all patients treated with CCCM.
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Levack AE, Turajane K, Yang X, Miller AO, Carli AV, Bostrom MP, Wellman DS. Thermal Stability and in Vitro Elution Kinetics of Alternative Antibiotics in Polymethylmethacrylate (PMMA) Bone Cement. J Bone Joint Surg Am 2021; 103:1694-1704. [PMID: 33857030 DOI: 10.2106/jbjs.20.00011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Amikacin, meropenem, minocycline, and fosfomycin have potential clinical utility for orthopaedic infections; however, their suitability for use in polymethylmethacrylate (PMMA) is poorly understood. The purpose of this study was (1) to quantify the thermal stability of these antibiotics at clinically relevant temperatures and (2) to determine the elution pharmacodynamics of these alternative antibiotics in vitro from PMMA beads of different sizes. METHODS Polymerization temperatures of 10-mm PMMA beads were measured over time to generate a simulated heating curve. Aqueous solutions of tobramycin, amikacin, meropenem, minocycline, and fosfomycin were subjected to the temperature curves, followed by incubation at 37°C. Minimum inhibitory concentrations of each antibiotic were evaluated against Staphylococcus aureus, Escherichia coli, and Acinetobacter baumannii. High-dose 4.5-mm, 6-mm, and 10-mm antibiotic-laden PMMA beads (10% antibiotic by weight) were submerged individually in a phosphate-buffered saline solution and incubated at 37°C. Antibiotic elution was determined with use of high-performance liquid chromatography with mass spectrometry. RESULTS Tobramycin, amikacin, and fosfomycin demonstrated thermal stability and maintained antimicrobial activity for 28 days. Minocycline and meropenem lost antimicrobial activity against all 3 organisms after 48 hours and 7 days, respectively. Elution concentrations, rates, and cumulative drug mass for tobramycin, amikacin, and meropenem were orders of magnitude higher than minocycline and fosfomycin at each time point. CONCLUSIONS This study identified notable differences in thermal stability and elution among antibiotics used to treat infections. Amikacin exhibited activity similarly to tobramycin. Meropenem demonstrated favorable elution kinetics and thermal stability in the initial 7-day period. CLINICAL RELEVANCE Amikacin and meropenem show pharmacologic promise as potential acceptable alternatives for local delivery in PMMA for treatment of orthopaedic infections. Further work to establish clinical relevance and utility is needed.
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Affiliation(s)
- Ashley E Levack
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY.,Loyola University Medical Center, Maywood, Illinois
| | - Kathleen Turajane
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - Xu Yang
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - Andy O Miller
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - Alberto V Carli
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - Mathias P Bostrom
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - David S Wellman
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY.,Westchester Medical Center, Valhalla, New York
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Jung SW, Oh SH, Lee IS, Byun JH, Lee JH. In Situ Gelling Hydrogel with Anti-Bacterial Activity and Bone Healing Property for Treatment of Osteomyelitis. Tissue Eng Regen Med 2019; 16:479-490. [PMID: 31624703 DOI: 10.1007/s13770-019-00206-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/27/2019] [Accepted: 07/16/2019] [Indexed: 01/07/2023] Open
Abstract
Background Despite the development of progressive surgical techniques and antibiotics, osteomyelitis is a big challenge for orthopedic surgeons. The main aim of this study is to fabricate an in situ gelling hydrogel that permits sustained release of antibiotic (for control of infection) and growth factor (for induction of new bone formation) for effective treatment of osteomyelitis. Methods An in situ gelling alginate (ALG)/hyaluronic acid (HA) hydrogel containing vancomycin (antibiotic) and bone morphogenetic protein-2 (BMP-2; growth factor) was prepared by simple mixing of ALG/HA/Na2HPO4 solution and CaSO4/vancomycin/BMP-2 solution. The release behaviors of vancomycin and BMP-2, anti-bacterial effect (in vitro); and therapeutic efficiency for osteomyelitis and bone regeneration (in vivo, osteomyelitis rat model) of the vancomycin and BMP-2-incorporated ALG/HA hydrogel were investigated. Results The gelation time of the ALG/HA hydrogel was controlled into approximately 4 min, which is sufficient time for handling and injection into osteomyelitis lesion. Both vancomycin and BMP-2 were continuously released from the hydrogel for 6 weeks. From the in vitro studies, the ALG/HA hydrogel showed an effective anti-bacterial activity without significant cytotoxicity for 6 weeks. From an in vivo animal study using Sprague-Dawley rats with osteomyelitis in femur as a model animal, it was demonstrated that the ALG/HA hydrogel was effective for suppressing bacteria (Staphylococcus aureus) proliferation at the osteomyelitis lesion and enhancing bone regeneration without additional bone grafts. Conclusions From the results, we suggest that the in situ gelling ALG/HA hydrogel containing vancomycin and BMP-2 can be a feasible therapeutic tool to treat osteomyelitis.
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Affiliation(s)
- Sun Woo Jung
- 1Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon, 34054 Republic of Korea
| | - Se Heang Oh
- 2Department of Nanobiomedical Science, Dankook University, Cheonan, 31116 Republic of Korea
- 3Department of Pharmaceutical Engineering, Dankook University, Cheonan, 31116 Republic of Korea
| | - In Soo Lee
- 4Department of Biological Science and Biotechnology, Hannam University, Daejeon, 34054 Republic of Korea
| | - June-Ho Byun
- 5Department of Oral and Maxillofacial Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, 52727 Republic of Korea
| | - Jin Ho Lee
- 1Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon, 34054 Republic of Korea
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Schmidt-Malan SM, Greenwood-Quaintance KE, Berglund LJ, Mandrekar J, Patel R. Oritavancin polymethylmethacrylate (PMMA)-compressive strength testing and in vitro elution. J Orthop Surg Res 2019; 14:43. [PMID: 30755223 PMCID: PMC6373086 DOI: 10.1186/s13018-019-1080-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Polymethylmethacrylate (PMMA) is used for local antimicrobial delivery in orthopedic infection. Oritavancin is a long half-life lipoglycopeptide with broad activity against Gram-positive bacteria. Herein, we addressed if 7.5% w/w oritavancin mixed into PMMA affects PMMA strength and whether it elutes from PMMA, compared to vancomycin. Methods Elution was assessed by placing an oritavancin- or vancomycin-loaded bead in a flow system with human plasma. Compressive strength of bland compared to oritavancin- or vancomycin-loaded PMMA was assessed after 0, 3, and 7 days of soaking in 1 ml of pooled normal human plasma at 37 °C, by testing to failure in axial compression using a servo-hydraulic testing machine. Results Median compressive strength on days 0, 3, and 7 for bland PMMA compared to oritavancin- or vancomycin-loaded PMMA was 80.1, 79.4, and 72.4 MPa, respectively; 93.3, 86.4, and 65.3 MPa, respectively; and 97.8, 82.7, and 65.9 MPa, respectively. Oritavancin reduced PMMA compressive strength after 3 and 7 days (P = 0.0250 and 0.0039, respectively), whereas vancomycin reduced the PMMA compressive strength after 0, 3, and 7 days (P = 0.0039, 0.0039, and 0.0062, respectively) as compared to bland PMMA. Oritavancin-loaded PMMA had higher compressive strength than vancomycin-loaded PMMA on days 3 and 7 (P = 0.0039 and 0.0062, respectively). Compressive elastic moduli were 1226, 1299, and 1394 MPa for bland PMMA; 1253, 1078, and 1245 MPa for oritavancin-loaded PMMA; and 986, 879, and 779 MPa for vancomycin-loaded PMMA on days 0, 3 and 7, respectively. Oritavancin-loaded PMMA had higher compressive elastic moduli than vancomycin-loaded PMMA on days 0 and 7 (P = 0.0250 and 0.0062, respectively). Following polymerization, 1.0% and 51.9% of the initial amount of oritavancin and vancomycin were detected, respectively. Cmax, Tmax, and AUC0–24 were 1.7 μg/ml, 2 h, and 11.4 μg/ml for oritavancin and 21.4 μg/ml, 2 h, and 163.9 μg/ml for vancomycin, respectively. Conclusions Oritavancin-loaded PMMA had higher compressive strength than vancomycin-loaded PMMA on days 3 and 7 and higher compressive elastic moduli than vancomycin-loaded PMMA on days 0 and 7. However, proportionally less oritavancin than vancomycin eluted out of PMMA.
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Affiliation(s)
- Suzannah M Schmidt-Malan
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kerryl E Greenwood-Quaintance
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lawrence J Berglund
- Materials Structural Testing Research Core, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jayawant Mandrekar
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
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Caraan NA, Windhager R, Webb J, Zentgraf N, Kuehn KD. Role of fast-setting cements in arthroplasty: A comparative analysis of characteristics. World J Orthop 2017; 8:881-890. [PMID: 29312846 PMCID: PMC5745430 DOI: 10.5312/wjo.v8.i12.881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 10/09/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the behaviour of two fast-setting polymethylmethacrylate (PMMA) cements CMW® 2G and Palacos® fast R + G, as reference: Standard-setting Palacos® R + G.
METHODS The fast-setting cements CMW® 2G and Palacos® fast R + G were studied, using standard-setting high viscosity Palacos® R + G as a reference. Eleven units (of two batch numbers) of each cement were tested. All cements were mixed as specified by the manufacturer and analysed on the following parameters: Handling properties (mixing, waiting, working and hardening phase) according to Kuehn, Mechanical properties according to ISO 5833 and DIN 53435, Fatigue strength according to ISO 16402, Benzoyl Peroxide (BPO) - Content by titration, powder/liquid-ratio by weighing, antibiotic elution profile by High Performance Liquid Chromatography. All tests were done in an acclimatised laboratory with temperatures set at 23.5 °C ± 0.5 °C and a humidity of > 40%.
RESULTS Palacos® fast R + G showed slightly shorter handling properties (doughing, hardening phase, n = 12) than CMW® 2G, allowing to reduce operative time and to optimise cemented cup implantation. Data of the quasistatic properties of ISO 5833 and DIN 53435 of both cements tested was comparable. The ISO compressive strength (MPa) of Palacos® fast R + G was significantly higher than CMW® 2G, resulting in ANOVA (P < 0.01) and two sample t-test (P < 0.01) at 0.05 level of significance (n = 20). Palacos® fast R + G showed a higher fatigue strength of about 18% mean (ISO 16402) of 15.3 MPa instead of 13.0 MPa for CMW® 2G (n = 5 × 106 cycles). Palacos® fast R + G and CMW® 2G differed only by 0.11% (n = 6) with the former having the higher content. The BPO-content of both cements were therefore comparable. CMW® 2G had a powder/liquid ratio of 2:1, Palacos® fast R + G of 2.550:1 due to a higher powder content. Despite its higher gentamicin content, CMW® 2G showed a significantly lower antibiotic elution over time than Palacos® fast R + G (n = 3).
CONCLUSION Both cements are compliant with international standards and are highly suitable for their specified surgical indications, affording a time-saving measure without detriment to the mechanical properties.
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Affiliation(s)
- Neil Ayron Caraan
- Department of Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, Vienna 1090, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, Vienna 1090, Austria
| | - Jason Webb
- Avon Orthopaedic Centre, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom
| | - Nadine Zentgraf
- Heraeus Medical GmbH, Wehrheim 61273, Germany
- Medical University of Vienna, Vienna 1090, Austria
| | - Klaus-Dieter Kuehn
- Heraeus Medical GmbH, Wehrheim 61273, Germany
- Medical University of Vienna, Vienna 1090, Austria
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Karr JC. An Overview of the Percutaneous Antibiotic Delivery Technique for Osteomyelitis Treatment and a Case Study of Calcaneal Osteomyelitis. J Am Podiatr Med Assoc 2017; 107:511-515. [PMID: 29252017 DOI: 10.7547/13-047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND A percutaneous antibiotic delivery technique (PAD-T) used for the adjunctive management of osteomyelitis is presented. METHODS This surgical technique incorporates a calcium sulfate and hydroxyapatite (calcium phosphate) bone void filler acting as a carrier vehicle with either an antibiotic or an antifungal medicine, delivering this combination directly into the area of osteomyelitis. RESULTS The benefit of the PAD-T is reviewed with a case presentation of a successfully treated calcaneal osteomyelitis. CONCLUSIONS No previously reported PAD-T using a simple bone cortex incision in the adjunctive treatment of osteomyelitis has been reported. The PAD-T safely and effectively uses a calcium sulfate and hydroxyapatite bone void filler carrier vehicle to deliver either an antibiotic or an antifungal medicine directly into the area of osteomyelitis.
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Affiliation(s)
- Jeffrey C. Karr
- Karr Foot and Leg Center, 5421 S Florida Ave, Lakeland, FL 33813. (E-mail: )
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An In Vitro Comparison of PMMA and Calcium Sulfate as Carriers for the Local Delivery of Gallium(III) Nitrate to Staphylococcal Infected Surgical Sites. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7078989. [PMID: 26885514 PMCID: PMC4739006 DOI: 10.1155/2016/7078989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/24/2015] [Indexed: 11/17/2022]
Abstract
Antibiotic-loaded bone cements, including poly(methyl methacrylate) (PMMA) and calcium sulfate (CaSO4), are often used for treatment of orthopaedic infections involving Staphylococcus spp., although the effectiveness of this treatment modality may be limited due to the emergence of antimicrobial resistance and/or the development of biofilms within surgical sites. Gallium(III) is an iron analog capable of inhibiting essential iron-dependent pathways, exerting broad antimicrobial activity against multiple microorganisms, including Staphylococcus spp. Herein, we evaluated PMMA and CaSO4 as carriers for delivery of gallium(III) nitrate (Ga(NO3)3) to infected surgical sites by assessing the release kinetics subsequent to incorporation and antimicrobial activity against S. aureus and S. epidermidis. PMMA and to a lesser extent CaSO4 were observed to be compatible as carriers for Ga(NO3)3, eluting concentrations with antimicrobial activity against planktonic bacteria, inhibiting bacterial growth, and preventing bacterial colonization of beads, and effective against established bacterial biofilms of S. aureus and S. epidermidis. Collectively, our in vitro results indicate that PMMA is a more suitable carrier compared to CaSO4 for delivery of Ga(NO3)3; moreover they provide evidence for the potential use of Ga(NO3)3 with PMMA as a strategy for the prevention and/or treatment for orthopaedic infections.
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Oh SH, Nam BR, Lee IS, Lee JH. Prolonged anti-bacterial activity of ion-complexed doxycycline for the treatment of osteomyelitis. Eur J Pharm Biopharm 2016; 98:67-75. [DOI: 10.1016/j.ejpb.2015.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 11/26/2022]
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Houdek MT, Greenwood-Quaintance KE, Morrey ME, Patel R, Hanssen AD. Elution of High Dose Amphotericin B Deoxycholate From Polymethylmethacrylate. J Arthroplasty 2015; 30:2308-10. [PMID: 26162513 DOI: 10.1016/j.arth.2015.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 02/01/2023] Open
Abstract
Fungal periprosthetic joint infections are rare, devastating complications of arthroplasty. There is conflicting evidence as to the efficacy of amphotericin B elution from cement spacers. The purpose of this study was to determine whether concentrations of amphotericin B released from bone cement over time would be efficacious in treating a periprosthetic infection. A continuous flow chamber was used to evaluate the in vitro release of amphotericin from cement beads containing 7.5% amphotericin. Following polymerization, 3.3% of the initially loaded amphotericin B was detected. The peak mean concentration eluted from the bone cement was 0.33 μg/mL at 8 hours. The AUC0-24 was 2.79 μg/mL/h; 0.20% of the amphotericin B was released. In conclusion, amphotericin B is released from bone cement at a clinically useful concentration.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kerryl E Greenwood-Quaintance
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robin Patel
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Aiken SS, Cooper JJ, Florance H, Robinson MT, Michell S. Local release of antibiotics for surgical site infection management using high-purity calcium sulfate: an in vitro elution study. Surg Infect (Larchmt) 2015; 16:54-61. [PMID: 25148101 PMCID: PMC4363816 DOI: 10.1089/sur.2013.162] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to characterize the elution of four antibiotics from pharmaceutical-grade calcium sulfate beads and show that the eluted antibiotics retained efficacy. METHODS Calcium sulfate was combined with gentamicin, tobramycin, vancomycin, or rifampicin (ratio: 20 g of calcium sulfate, to 240 mg, 500 mg, 900 mg, and 600 mg of antibiotic, respectively). Three grams of beads were immersed in 4 mL of sterile phosphate-buffered saline (PBS) at 37°C. At each time point (4, 8, 24 h; 2, 7, 14, 28, 42 d), eluates were removed for analysis by liquid chromatography-mass spectrometry. The antimicrobial efficacy of antibiotics combined with calcium sulfate beads after 42 d was tested by a modified Kirby-Bauer disc diffusion assay. RESULTS All samples showed a generally exponential decay in the eluted antibiotic concentration. At the first time point, both gentamicin and tobramycin had eluted to a peak concentration of approximately 10,000 mcg/mL. For rifampicin, the peak concentration occurred at 24 h, whereas for vancomycin, it occurred at 48 h. The eluted concentrations exceeded the minimum inhibitory concentration for common periprosthetic joint infection pathogens for the entire span of the 42 study days. Mass spectrometry confirmed all antibiotics were unchanged when eluted from the calcium sulfate carrier. Antimicrobial efficacy was unaltered after 42 d in combination with calcium sulfate at 37°C. CONCLUSIONS Pharmaceutical-grade calcium sulfate has the potential for targeted local release of tobramycin, gentamicin, vancomycin, and rifampicin over a clinically meaningful time period.
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Affiliation(s)
- Sean S. Aiken
- Biocomposites Ltd., Keele Science Park, Staffordshire, United Kingdom
| | - John J. Cooper
- Biocomposites Ltd., Keele Science Park, Staffordshire, United Kingdom
| | - Hannah Florance
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Matthew T. Robinson
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Stephen Michell
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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Uskoković V. Nanostructured platforms for the sustained and local delivery of antibiotics in the treatment of osteomyelitis. Crit Rev Ther Drug Carrier Syst 2015; 32:1-59. [PMID: 25746204 PMCID: PMC4406243 DOI: 10.1615/critrevtherdrugcarriersyst.2014010920] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This article provides a critical view of the current state of the development of nanoparticulate and other solid-state carriers for the local delivery of antibiotics in the treatment of osteomyelitis. Mentioned are the downsides of traditional means for treating bone infection, which involve systemic administration of antibiotics and surgical debridement, along with the rather imperfect local delivery options currently available in the clinic. Envisaged are more sophisticated carriers for the local and sustained delivery of antimicrobials, including bioresorbable polymeric, collagenous, liquid crystalline, and bioglass- and nanotube-based carriers, as well as those composed of calcium phosphate, the mineral component of bone and teeth. A special emphasis is placed on composite multifunctional antibiotic carriers of a nanoparticulate nature and on their ability to induce osteogenesis of hard tissues demineralized due to disease. An ideal carrier of this type would prevent the long-term, repetitive, and systemic administration of antibiotics and either minimize or completely eliminate the need for surgical debridement of necrotic tissue. Potential problems faced by even hypothetically "perfect" antibiotic delivery vehicles are mentioned too, including (i) intracellular bacterial colonies involved in recurrent, chronic osteomyelitis; (ii) the need for mechanical and release properties to be adjusted to the area of surgical placement; (iii) different environments in which in vitro and in vivo testings are carried out; (iv) unpredictable synergies between drug delivery system components; and (v) experimental sensitivity issues entailing the increasing subtlety of the design of nanoplatforms for the controlled delivery of therapeutics.
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Affiliation(s)
- Vuk Uskoković
- Advanced Materials and Nanobiotechnology Laboratory, Richard and Loan Hill Department of Bioengineering, College of Medicine, University of Illinois at Chicago, 851 South Morgan St, #205 Chicago, Illinois, 60607-7052
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Kumeria T, Gulati K, Santos A, Losic D. Real-time and in situ drug release monitoring from nanoporous implants under dynamic flow conditions by reflectometric interference spectroscopy. ACS APPLIED MATERIALS & INTERFACES 2013; 5:5436-5442. [PMID: 23731441 DOI: 10.1021/am4013984] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Herein, we present an innovative approach to monitoring in situ drug release under dynamic flow conditions from aluminum implants featuring nanoporous anodic alumina (NAA) covers used as a model of drug-releasing implants. In this method, reflectometric interference spectroscopy (RIfS) is used to monitor in real-time the diffusion of drug from these nanoporous implants. The release process is carried out in a microfluidic device, which makes it possible to analyze drug release under dynamic flow conditions with constant refreshing of eluting medium. This setup mimics the physiological conditions of biological milieu at the implant site inside the host body. The release of a model drug, indomethacin, is established by measuring the optical thickness change with time under four different flow rates (i.e. 0, 10, 30, and 50 μL min(-1)). The obtained data are fitted by a modified Higuchi model, confirming the diffusion-controlled release mechanism. The obtained release rate constants demonstrate that the drug release depends on the flow rate and the faster the flow rate the higher the drug release from the nanoporous covers. In particular, the rate constants increase from 2.23 ± 0.02 to 12.47 ± 0.04 μg min(-1/2) when the flow rate is increased from 10 to 50 μL min(-1), respectively. Therefore, this method provides more reliable and relevant information than conventional in vitro drug release methods performed under static conditions.
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Affiliation(s)
- Tushar Kumeria
- School of Chemical Engineering, The University of Adelaide, Adelaide, SA 5005, Australia
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Rosslenbroich SB, Raschke MJ, Kreis C, Tholema-Hans N, Uekoetter A, Reichelt R, Fuchs TF. Daptomycin: local application in implant-associated infection and complicated osteomyelitis. ScientificWorldJournal 2012; 2012:578251. [PMID: 22792046 PMCID: PMC3385625 DOI: 10.1100/2012/578251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/02/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The rise of highly resistant bacteria creates a persistent urge to develop new antimicrobial agents. This paper investigates the application of the lipopeptide antibiotic daptomycin in infections involving the human bone. METHODS Compressive and tensile strength testing of daptomycin-laden PMMA was performed referring to the ISO 5833. The microstructure of the antibiotic-laden PMMA was evaluated by scanning electron microscopy. Intracellular activity of daptomycin was determined by a human osteoblast infection model. Elution kinetics of the antibiotic-laden bone cement was measured by using a continuous flow chamber setup. RESULTS There was no significant negative effect of adding 1.225% and 7.5% per weight of daptomycin to the PMMA. There was no significant difference in intracellular activity comparing gentamicin to daptomycin. Elution of daptomycin from PMMA showed within the first-hour initial peak values of 15-20 μg/mL. CONCLUSION Daptomycin has a certain degree of activity in the intracellular environment of osteoblasts. Daptomycin admixed to PMMA remains bactericidal and does not significantly impair structural characteristics of the PMMA. The results of this paper suggest that daptomycin might be a potent alternative for treating osteomyelitis and implant-associated infection in trauma and orthopedic surgery caused by multiresistant strains.
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Affiliation(s)
- Steffen B Rosslenbroich
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelm's-University Muenster, 48149 Muenster, Germany.
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Are anidulafungin or voriconazole released from polymethylmethacrylate in vitro? Clin Orthop Relat Res 2011; 469:1466-9. [PMID: 20963525 PMCID: PMC3069256 DOI: 10.1007/s11999-010-1643-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 10/08/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depot delivery of antimicrobial agents is used for treatment and prevention of bacterial orthopaedic infections; there is little information regarding newer antifungal agents and their potential use in polymethylmethacrylate (PMMA) depot delivery. QUESTIONS/PURPOSES We determined the percent of anidulafungin or voriconazole present after polymerization in PMMA beads loaded with anidulafungin or voriconazole, and we assessed elution of anidulafungin or voriconazole from beads loaded with anidulafungin or voriconazole. MATERIALS AND METHODS Beads containing 7.5% anidulafungin or voriconazole were pulverized and incubated in Kreb's ringer buffer for 48 hours; the buffer was assayed for anidulafungin or voriconazole concentration. The in vitro release of anidulafungin and voriconazole from PMMA beads loaded with 7.5% anidulafungin or voriconazole was determined in triplicate in a continuous flow chamber. RESULTS 0.7% of anidulafungin and 5.6% of voriconazole loaded in the beads were detected after polymerization. No anidulafungin was detected in the elution studies. The mean peak voriconazole concentration in the elution studies was 0.9 μg/mL. CONCLUSIONS Anidulafungin may not be suitable for depot delivery in PMMA.
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Local antibiotic delivery with demineralized bone matrix. Cell Tissue Bank 2011; 13:119-27. [DOI: 10.1007/s10561-010-9236-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 12/11/2010] [Indexed: 10/18/2022]
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Lewis CS, Katz J, Baker MI, Supronowicz PR, Gill E, Cobb RR. Local antibiotic delivery with bovine cancellous chips. J Biomater Appl 2010; 26:491-506. [PMID: 20819915 DOI: 10.1177/0885328210375729] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infected bone defects and osteomyelitis are encountered frequently in trauma cases. Currently, the standard of care for osteomyelitis cases is prolonged systemic antibiotic therapy and implantation of antibiotic carrier beads. However, this method requires a secondary surgery to remove the beads after the infection has cleared. In the present study a common bone void filler was investigated for its ability to be infused with an antibiotic. This study demonstrates that the xenograft material tested can be loaded with gentamicin and release clinically relevant levels of the drug for at least 14 days in vitro allowing for the inhibition of bacterial growth on the graft. This study also demonstrates that the levels of gentamicin released did not have an adverse effect on primary osteoblast cell proliferation or ability to generate alkaline phosphatase. This bone void filler may represent a viable alternative to current methods of local antibiotic delivery in orthopedic applications.
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Affiliation(s)
- Christine S Lewis
- Biotechnology Research Group, RTI Biologics, Inc., 11621 Research Circle, Alachua, FL, USA.
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Abstract
BACKGROUND Open orthopaedic wounds are ideal sites for infection. Preventing infection in these wounds is critical for reducing patient morbidity and mortality, controlling antimicrobial resistance and lowering the cost of treatment. Localized drug delivery has the potential to overcome the challenges associated with traditional systemic dosing. A degradable, biocompatible polymer sponge (chitosan) that can be loaded with clinician-selected antibiotics at the point of care would provide the patient and clinician with a desirable, adjunctive preventive modality. QUESTIONS/PURPOSES We asked (1) if an adaptable, porous chitosan matrix could absorb and elute antibiotics for 72 hours for potential use as an adjunctive therapy to débridement and lavage; and (2) if the sponges could elute levels of antibiotic that would inhibit growth of Staphylococcus aureus and Pseudomonas aeruginosa? METHODS We fabricated a degradable chitosan sponge that can be loaded with antibiotics during a 60-second hydration in drug-containing solution. In vitro evaluation determined amikacin and vancomycin release from chitosan sponges at six time points. Activity tests were used to assess the release of inhibitory levels of amikacin and vancomycin. RESULTS Amikacin concentration was 881.5 microg/mL after 1 hour with a gradual decline to 13.9 microg/mL after 72 hours. Vancomycin concentration was 1007.4 microg/mL after 1 hour with a decrease to 48.1 microg/mL after 72 hours. Zone of inhibition tests were used to verify inhibitory levels of drug release from chitosan sponges. A turbidity assay testing activity of released amikacin and vancomycin indicated inhibitory levels of elution from the chitosan sponge. CLINICAL RELEVANCE Chitosan sponges may provide a potential local drug delivery device for preventing musculoskeletal infections.
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Abstract
INTRODUCTION To review the pharmacology, pharmacokinetics, efficacy, and safety of daptomycin, a novel antibiotic for the treatment of bone and joint infections, a literature search of relevant articles was conducted. MATERIALS AND METHODS A PubMed/MEDLINE search (1990-April 2008) to identify relevant English-language literature was conducted. Search terms included bone and joint infection, osteomyelitis, daptomycin, and methicillin-resistant Staphylococcus aureus (MRSA). Additional articles were identified by reviewing the bibliographies of articles cited. Programs and abstracts from infectious disease meetings were searched, and prescribing information of antibiotics indicated for bone and joint infections consulted. All articles identified from data sources published in English were evaluated. RESULTS Caused primarily by Gram-positive pathogens such as S. aureus and, to a lesser extent, Enterococcus faecalis, bone and joint infections are difficult to treat successfully. Surgical intervention and prolonged courses of antibiotics are frequently required, and failure of first-line antibiotic therapy is common. The emergence of S. aureus strains with reduced susceptibility to vancomycin, the longstanding gold standard for bone and joint infections, has complicated the clinical scenario. Few randomized trials comparing the efficacy of different antibiotics for bone and joint infections exist. Daptomycin, a novel intravenous lipopeptide antibiotic, has shown potent in vitro activity against a broad spectrum of Gram-positive bacteria, including many resistant pathogens commonly associated with bone and joint infections such as MRSA and vancomycin-resistant E. faecalis. Early clinical investigation of daptomycin in bone and joint infections unresponsive to antibiotics, such as vancomycin, has found a cure rate of approximately 80%, with a low incidence of adverse events and drug resistance. CONCLUSION Further studies are warranted to determine if limited clinical evidence, described in individual case reports and a daptomycin-specific retrospective registry, suggests daptomycin is a promising option for patients with bone and joint infections such as MRSA osteomyelitis.
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Affiliation(s)
- Dennis A. K. Rice
- St. Joseph’s/Candler Health System, Savannah, GA USA
- Ortho-McNeil Janssen, LLC, Fayetteville, GA USA
| | - Luke Mendez-Vigo
- Cubist Pharmaceuticals, Inc., 65 Hayden Avenue, Lexington, MA 02421 USA
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Mouriño V, Boccaccini AR. Bone tissue engineering therapeutics: controlled drug delivery in three-dimensional scaffolds. J R Soc Interface 2009; 7:209-27. [PMID: 19864265 DOI: 10.1098/rsif.2009.0379] [Citation(s) in RCA: 398] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This paper provides an extensive overview of published studies on the development and applications of three-dimensional bone tissue engineering (TE) scaffolds with potential capability for the controlled delivery of therapeutic drugs. Typical drugs considered include gentamicin and other antibiotics generally used to combat osteomyelitis, as well as anti-inflammatory drugs and bisphosphonates, but delivery of growth factors is not covered in this review. In each case reviewed, special attention has been given to the technology used for controlling the release of the loaded drugs. The possibility of designing multifunctional three-dimensional bone TE scaffolds for the emerging field of bone TE therapeutics is discussed. A detailed summary of drugs included in three-dimensional scaffolds and the several approaches developed to combine bioceramics with various polymeric biomaterials in composites for drug-delivery systems is included. The main results presented in the literature are discussed and the remaining challenges in the field are summarized with suggestions for future research directions.
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Affiliation(s)
- Viviana Mouriño
- Department of Materials, Imperial College London, Prince Consort Road, London SW7 2BP, UK
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Gbureck U, Vorndran E, Barralet JE. Modeling vancomycin release kinetics from microporous calcium phosphate ceramics comparing static and dynamic immersion conditions. Acta Biomater 2008; 4:1480-6. [PMID: 18485844 DOI: 10.1016/j.actbio.2008.02.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 02/14/2008] [Accepted: 02/19/2008] [Indexed: 11/30/2022]
Abstract
The release kinetics of vancomycin from calcium phosphate dihydrate (brushite) matrices and polymer/brushite composites were compared using different fluid replacement regimes, a regular replacement (static conditions) and a continuous flow technique (dynamic conditions). The use of a constantly refreshed flowing resulted in a faster drug release due to a constantly high diffusion gradient between drug loaded matrix and the eluting medium. Drug release was modeled using the Weibull, Peppas and Higuchi equations. The results showed that drug liberation was diffusion controlled for the ceramics matrices, whereas ceramics/polymer composites led to a mixed diffusion and degradation controlled release mechanism. The continuous flow technique was for these materials responsible for a faster release due to an accelerated polymer degradation rate compared with the regular fluid replacement technique.
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Affiliation(s)
- Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany.
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Anguita-Alonso P, Giacometti A, Cirioni O, Ghiselli R, Orlando F, Saba V, Scalise G, Sevo M, Tuzova M, Patel R, Balaban N. RNAIII-inhibiting-peptide-loaded polymethylmethacrylate prevents in vivo Staphylococcus aureus biofilm formation. Antimicrob Agents Chemother 2006; 51:2594-6. [PMID: 17116671 PMCID: PMC1913233 DOI: 10.1128/aac.00580-06] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococci, common orthopedic pathogens, form antibiotic-resistant biofilms. Polymethylmethacrylate (PMMA) beads loaded with the quorum-sensing inhibitor RNAIII-inhibiting peptide (RIP) were implanted in rats and shown to prevent methicillin-resistant Staphylococcus aureus infection. RIP release was bimodal, typical of previously-tested antibiotics. These results suggest that RIP-PMMA warrants further evaluation for management of orthopedic infections caused by staphylococci.
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Affiliation(s)
- Paloma Anguita-Alonso
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Heijink A, Yaszemski MJ, Patel R, Rouse MS, Lewallen DG, Hanssen AD. Local antibiotic delivery with OsteoSet, DBX, and Collagraft. Clin Orthop Relat Res 2006; 451:29-33. [PMID: 16906070 DOI: 10.1097/01.blo.0000229319.45416.81] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Biodegradable local antibiotic delivery systems have gained interest for prophylaxis and treatment of musculoskeletal infections. We studied the biodegradable materials Osteo- Set, DBX and Collagraft for local delivery of vancomycin and gentamicin in vitro. We determined the antimicrobial activity of vancomycin and gentamicin after mixing with each biodegradable material and determined the release of each antimicrobial from each material in an intermittent flow chamber. Antimicrobial activity was expressed as percent of antimicrobial loaded into each sample that was detected; antimicrobial release was expressed as concentration (microg/mL) after timed intervals of chamber flow, peak concentration, area under the curve and percent antimicrobial recovered. Activity of vancomycin after mixing with Osteo- Set, DBX and Collagraft was > 73%. Activity of gentamicin after mixing with DBX was 100%; after mixing with OsteoSet and Collagraft it was reduced to < 61%. AUC0-48hrs of vancomycin was 469, 426 and 432 microg x hr/mL, and the AUC0-48hrs of gentamicin was 368, 306 and 301 microg x hr/mL after release from OsteoSet, DBX, and Collagraft, respectively. Recovered percentages of vancomycin were 39%, 11% and 25%, and recovered percentages of gentamicin were 39%, 9% and 23% after release from OsteoSet, DBX, and Collagraft, respectively. OsteoSet, DBX and Collagraft may be suitable for local delivery of vancomycin and gentamicin.
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Affiliation(s)
- Andras Heijink
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
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Stallmann HP, Faber C, Bronckers ALJJ, Nieuw Amerongen AV, Wuisman PIJM. In vitro gentamicin release from commercially available calcium-phosphate bone substitutes influence of carrier type on duration of the release profile. BMC Musculoskelet Disord 2006; 7:18. [PMID: 16504140 PMCID: PMC1459860 DOI: 10.1186/1471-2474-7-18] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 02/26/2006] [Indexed: 11/21/2022] Open
Abstract
Background Polymethyl-methacrylate (PMMA) beads releasing antibiotics are used extensively to treat osteomyelitis, but require surgical removal afterwards because they do not degrade. Methods As an alternative option, this report compares the in vitro gentamicin release profile from clinically used, biodegradable carrier-materials: six injectable cements and six granule-types. Cement cylinders and coated granules containing 3% gentamicin were submerged in dH2O and placed in a 48-sample parallel drug-release system. At regular intervals (30, 90, 180 min. and then every 24 h, for 21 days), the release fluid was exchanged and the gentamicin concentration was measured. The activity of released gentamicin was tested on Staphylococcus aureus. Results All combinations showed initial burst-release of active gentamicin, two cements had continuous-release (17 days). The relative release of all cements (36–85%) and granules (30–62%) was higher than previously reported for injectable PMMA-cements (up to 17%) and comparable to other biodegradable carriers. From the cements residual gentamicin could be extracted, whereas the granules released all gentamicin that had adhered to the surface. Conclusion The high release achieved shows great promise for clinical application of these biodegradable drug-carriers. Using the appropriate combination, the required release profile (burst or sustained) may be achieved.
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Affiliation(s)
- Hein P Stallmann
- Orthopaedic Surgery, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
- Oral Cell Biology / ACTA. vd Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Chris Faber
- Orthopaedic Surgery, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
- Oral Cell Biology / ACTA. vd Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | | | | | - Paul IJM Wuisman
- Orthopaedic Surgery, VU Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Rouse MS, Piper KE, Jacobson M, Jacofsky DJ, Steckelberg JM, Patel R. Daptomycin treatment of Staphylococcus aureus experimental chronic osteomyelitis. J Antimicrob Chemother 2005; 57:301-5. [PMID: 16361330 DOI: 10.1093/jac/dki435] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Infection due to methicillin-resistant Staphylococcus aureus (MRSA) is increasingly common in nosocomial and community settings. Daptomycin is a cyclic lipopeptide anti-infective with activity against MRSA, approved for treatment of complicated skin and skin structure infections. Daptomycin may be useful in systemic or local treatment of chronic osteomyelitis. METHODS We measured mechanical strength of daptomycin- and vancomycin-loaded polymethylmethacrylate (PMMA), assayed in vivo release of daptomycin and vancomycin from daptomycin- and vancomycin-loaded PMMA, respectively, and compared the efficacy of two systemic doses of daptomycin with that of vancomycin, each with or without the respective anti-infective loaded into PMMA, using a rat model of MRSA chronic osteomyelitis. RESULTS Neither tensile nor compressive strength of PMMA was impacted by impregnation with these antimicrobials at a concentration of 7.5% by weight. The peak concentrations of daptomycin and vancomycin in rat tibial bone surrounding a 7.5% daptomycin- and vancomycin-loaded 3 mm PMMA bead were 178 and 49 mg/L, respectively. In the treatment of experimental osteomyelitis, rats assigned to no treatment, daptomycin 50 mg/kg subcutaneously twice daily, daptomycin 60 mg/kg subcutaneously twice daily, and vancomycin 50 mg/kg intraperitoneally twice daily had 6.4, 4.1, 4.0 and 4.5 median log10 cfu/g of bone at the end of 21 days of therapy. All systemic anti-infectives studied were more active than was no treatment. Daptomycin- or vancomycin-loaded PMMA did not, however, exhibit microbiological efficacy alone or adjunctively, as assessed 21 days after implantation. CONCLUSIONS Daptomycin is released from PMMA in vivo at a rate similar to that of vancomycin. Systemic daptomycin is as active as vancomycin in a rat model of chronic MRSA experimental osteomyelitis.
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Affiliation(s)
- Mark S Rouse
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Hall EW, Rouse MS, Jacofsky DJ, Osmon DR, Hanssen AD, Steckelberg JM, Patel R. Release of daptomycin from polymethylmethacrylate beads in a continuous flow chamber. Diagn Microbiol Infect Dis 2005; 50:261-5. [PMID: 15582299 DOI: 10.1016/j.diagmicrobio.2004.03.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 03/20/2004] [Indexed: 11/29/2022]
Abstract
Because daptomycin is active against Gram-positive cocci, it may be useful in the treatment and prevention of bone and joint infections when incorporated into polymethylmethacrylate (PMMA). The release kinetics of daptomycin from PMMA were studied in a continuous flow chamber designed to simulate in vivo conditions. Three-millimeter beads containing 2.5%, 7.5%, and 15.0% daptomycin (weight daptomycin per weight PMMA) were individually placed in a chamber with 1 mL Krebs Ringer buffer flowing at 1 mL/hour. The majority of daptomycin was released in the first 24 hours. The mean peak concentrations were 13.4, 62.3, and 146.7 microg/mL; the mean AUC0-infinity were 30, 272, and 1204 h x microg/mL; and the mean percentages of daptomycin released were 6%, 18%, and 42% for the beads containing 2.5%, 7.5%, and 15.0% daptomycin, respectively. Daptomycin is released from PMMA in a continuous flow chamber at a rate similar to that previously determined by our laboratory for vancomycin.
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