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A comparison of low-dose teicoplanin-loaded spacer application vs. high-dose vancomycin-and-gentamicin-loaded spacer application in the treatment of periprosthetic knee infection. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221082312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background/purpose In the current study, our aim was to compare the efficacy and biocompatibility of teicoplanin-loaded and vancomycin-and-gentamicin-loaded articulating spacers used in two-stage revision arthroplasty for eradication of periprosthetic knee joint infection. Methods In the current retrospective cohort study, there were 24 patients who were given 2 g or less antibiotics per 40 g of cement in the low-dose teicoplanin group, and 20 patients who were given a total of 3.6 g or more antibiotics per 40 g of cement in the high-dose vancomycin and gentamicin group. Two groups were compared statistically. Results There was no statistically significant difference in the treatment failure between the two groups (p = 0.488). No statistically significant differences were found in spacer fracture rates between the two groups (p = 0.802). Conclusion The current study has demonstrated that low-dose teicoplanin protocol is as effective and safe as high-dose vancomycin and gentamycin protocol.
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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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Research into biocompatibility and cytotoxicity of daptomycin, gentamicin, vancomycin and teicoplanin antibiotics at common doses added to bone cement. Jt Dis Relat Surg 2020; 31:328-334. [PMID: 32584733 PMCID: PMC7489165 DOI: 10.5606/ehc.2020.74943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/23/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aims to investigate the biocompatibility and cytotoxicity of daptomycin, gentamicin, vancomycin and teicoplanin at commonly-used dose intervals added to polymethylmethacrylate (PMMA) in vitro. MATERIALS AND METHODS This prospective study was conducted between February 2016 and June 2016. Antibiotics were added to PMMA at doses frequently used in clinical practice. The antibiotic doses added were teicoplanin (2 g, 3 g, 4 g), gentamicin (0.5 g, 0.75 g, 1 g), daptomycin (0.5 g.) and vancomycin (2 g, 3 g, 4 g). Standard cement balls (10 mm) were created. Activated L929 mouse fibroblast cell culture was used for incubation. Agar diffusion, Cell Proliferation Kit II (XTT) test and electron microscope investigations were performed to examine biocompatibility and cytotoxicity. RESULTS In the cytotoxicity test, teicoplanin at 4 g and daptomycin at 0.5 g doses were observed to cause reductions in viability percentages. The same doses caused 20% and 20-40% cell lysis indices during the agar diffusion test. On electron microscope images, cytotoxic effects in fibroblast cells and involvement with the surface of cement balls were observed. CONCLUSION Gentamicin, vancomycin and teicoplanin were observed to be non-toxic and biocompatible at commonly-used dose intervals. Teicoplanin at 4 g and daptomycin at 0.5 g doses were identified to be cytotoxic and not biocompatible. When selecting antibiotics to be added to bone cement, care should be taken that the antibiotic is non-toxic and biocompatible.
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Liao CH, Chen CS, Chen YC, Jiang NE, Farn CJ, Shen YS, Hsu ML, Chang CH. Vancomycin-loaded oxidized hyaluronic acid and adipic acid dihydrazide hydrogel: Bio-compatibility, drug release, antimicrobial activity, and biofilm model. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 53:525-531. [PMID: 31607570 DOI: 10.1016/j.jmii.2019.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prosthesis infection is a difficult-to-treat situation. Hydrogel is a novel biomaterial, which can be applied by simply spraying or by coating on implants before surgery and can be easily mixed with antibiotics. METHODS In order to evaluate the potential use of antibiotic-loaded hydrogel, we incorporated vancomycin into oxidized hyaluronic acid (HA) and adipic acid dihydrazide and evaluated the drug release and antimicrobial activity against methicillin-resistant Staphylococcus aureus (ATCC 29213). RESULTS The average release percentage of vancomycin on day 3 was about 86%. The antibiotic-loaded gel was biocompatible with mesenchymal stem cell, MC3T3, and L929 cell lines. The in vitro inhibition zones of vancomycin-loaded hydrogel [500X minimal inhibition concentration (MIC), 50X MIC, 10X MIC, and blank hydrogel] were 21, 13, 9, and 5 mm, respectively. In the Ti6Al4V implant biofilm model, 0.01-1% vancomycin-loaded gel exhibited significant anti-biofilm activity, measured by the MTT assay. CONCLUSIONS Vancomycin could be loaded onto oxidized HA and adipic acid dihydrazide, which exhibited excellent drug release and in vitro antimicrobial activity with minimal cell toxicity.
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Affiliation(s)
- Chun-Hsing Liao
- Department of Medicine, Yang-Ming University, Taiwan; Division of Infectious Disease, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chiang Sang Chen
- Department of Material and Fiber, Oriental Institute of Technology, New Taipei City, Taiwan; Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Chun Chen
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; College of General Studies, Yuan Ze University, Taoyuan City, Taiwan
| | - Ni-En Jiang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chui Jia Farn
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taiwan
| | - Yi-Shan Shen
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Ming-Lun Hsu
- School of Dentistry, National Yang-Ming University, Taipei, Taiwan.
| | - Chih-Hung Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan.
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Martínez-Moreno J, Merino V, Nácher A, Rodrigo JL, Climente M, Merino-Sanjuán M. Antibiotic-loaded Bone Cement as Prophylaxis in Total Joint Replacement. Orthop Surg 2018; 9:331-341. [PMID: 29178309 DOI: 10.1111/os.12351] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/10/2017] [Indexed: 12/14/2022] Open
Abstract
One of its most serious complications associated with arthroplasty is the development of infections. Although its prevalence is only between 0.5% and 3%, in some cases it can lead to death. Therefore, an important challenge in joint surgery is the prevention of infections when an arthroplasty is performed. The use of antibiotic-loaded cements could be a suitable tool due to numerous advantages. The main advantage of the use of antibiotic loading into bone cement derives directly from antibiotic release in the effect site, allowing achievement of high concentrations at the site of action, and minimal or no systemic toxicity. This route of administration was first described by Buchholz and Engelbrecht. In the case of infection treatment, this is an established method and its good results have been confirmed. However, its role in infection prevention, and, therefore, the use of these systems in clinical practice, has proved controversial because of the uncertainty about the development of possible antibiotic resistance after prolonged exposure time, their effectiveness, the cost of the systems, toxicity and loosening of mechanical properties. This review discusses all these topics, focusing on effectiveness and safety, antibiotic decisions, cement type, mixing method, release kinetics and future perspectives. The final objective is to provide the orthopaedic surgeons the right information in their clinical practice based on current evidence.
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Affiliation(s)
- Javier Martínez-Moreno
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Institute of Molecular Recognition and Technological Development, Mixed Center Polytechnic University of Valencia, University of Valencia, Valencia, Spain.,Pharmacy Service, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Virginia Merino
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Institute of Molecular Recognition and Technological Development, Mixed Center Polytechnic University of Valencia, University of Valencia, Valencia, Spain
| | - Amparo Nácher
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Institute of Molecular Recognition and Technological Development, Mixed Center Polytechnic University of Valencia, University of Valencia, Valencia, Spain
| | - José Luis Rodrigo
- Traumatology Service, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Mónica Climente
- Pharmacy Service, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Matilde Merino-Sanjuán
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Institute of Molecular Recognition and Technological Development, Mixed Center Polytechnic University of Valencia, University of Valencia, Valencia, Spain
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Ferreira M, Rzhepishevska O, Grenho L, Malheiros D, Gonçalves L, Almeida AJ, Jordão L, Ribeiro IA, Ramstedt M, Gomes P, Bettencourt A. Levofloxacin-loaded bone cement delivery system: Highly effective against intracellular bacteria and Staphylococcus aureus biofilms. Int J Pharm 2017; 532:241-248. [PMID: 28851574 DOI: 10.1016/j.ijpharm.2017.08.089] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 12/31/2022]
Abstract
Staphylococcus aureus is a major pathogen in bone associated infections due to its ability to adhere and form biofilms on bone and/or implants. Moreover, recrudescent and chronic infections have been associated with S. aureus capacity to invade and persist within osteoblast cells. With the growing need of novel therapeutic tools, this research aimed to evaluate some important key biological properties of a novel carrier system composed of acrylic bone cement (polymethylmethacrylate - PMMA), loaded with a release modulator (lactose) and an antibiotic (levofloxacin). Levofloxacin-loaded bone cement (BC) exhibited antimicrobial effects against planktonic and biofilm forms of S. aureus (evaluated by a flow chamber system). Moreover, novel BC formulation showed high anti-bacterial intraosteoblast activity. This fact led to the conclusion that levofloxacin released from BC matrices could penetrate the cell membrane of osteoblasts and be active against S. aureus strains in the intracellular environment. Furthermore, levofloxacin-BC formulations showed no significant in vitro cytotoxicity and no allergic potential (measured by the in vivo chorioallantoic membrane assay). Our results indicate that levofloxacin-loaded BC has potential as a local antibiotic delivery system for treating S. aureus associated bone infections.
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Affiliation(s)
- Magda Ferreira
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal; Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Liliana Grenho
- Laboratory for Bone Metabolism and Regeneration - Faculty of Dental Medicine, U. Porto, Porto, Portugal
| | | | - Lídia Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - António J Almeida
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Luisa Jordão
- National Institute of Health Dr Ricardo Jorge, Department of Environmental Health, Lisbon, Portugal
| | - Isabel A Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | | | - Pedro Gomes
- Laboratory for Bone Metabolism and Regeneration - Faculty of Dental Medicine, U. Porto, Porto, Portugal; REQUIMTE/LAQV - Universidade do Porto, Porto, Portugal
| | - Ana Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal.
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Activity of Fosfomycin- and Daptomycin-Containing Bone Cement on Selected Bacterial Species Being Associated with Orthopedic Infections. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2318174. [PMID: 28484708 PMCID: PMC5397628 DOI: 10.1155/2017/2318174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/24/2017] [Accepted: 03/09/2017] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to determine activity of fosfomycin/gentamicin and daptomycin/gentamicin-containing PMMA bone-cement against Staphylococcus aureus (MRSA, MSSA), Staphylococcus epidermidis, Enterococcus faecium (VRE), and E. coli (ESBL; only fosfomycin). Test specimens of the bone cement were formed and bacteria in two concentrations were added one time or repeatedly up to 96 h. All fosfomycin-containing cement killed ultimately all MSSA, Staphylococcus epidermidis, and E. coli within 24 h; growth of MRSA was suppressed up to 48 h. Activity of daptomycin-containing cement depended on the concentration; the highest concentrated bone cement used (1.5 g daptomycin/40 g of powder) was active against all one-time added bacteria. When bacteria were added repeatedly to fosfomycin-containing cement, growth was suppressed up to 96 h and that of MRSA and VRE only up to 24 h. The highest concentration of daptomycin suppressed the growth of repeated added bacteria up to 48 h (VRE) until 96 h (MSSA, MRSA). In conclusion, PMMA bone cement with 1.5 g of daptomycin and 0.5 g of gentamicin may be an alternative in treatment of periprosthetic infections caused by Gram-positive bacteria.
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Nandi SK, Bandyopadhyay S, Das P, Samanta I, Mukherjee P, Roy S, Kundu B. Understanding osteomyelitis and its treatment through local drug delivery system. Biotechnol Adv 2016; 34:1305-1317. [DOI: 10.1016/j.biotechadv.2016.09.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/12/2016] [Accepted: 09/27/2016] [Indexed: 02/08/2023]
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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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