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Humez M, Domann E, Thormann KM, Fölsch C, Strathausen R, Vogt S, Alt V, Kühn KD. Daptomycin-Impregnated PMMA Cement against Vancomycin-Resistant Germs: Dosage, Handling, Elution, Mechanical Stability, and Effectiveness. Antibiotics (Basel) 2023; 12:1567. [PMID: 37998769 PMCID: PMC10668807 DOI: 10.3390/antibiotics12111567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The number of periprosthetic joint infections caused by vancomycin-resistant pathogens is increasing. Currently, no PMMA cement is commercially available to cover VRE. Daptomycin shows promising results in treating infection, offering a good safety profile and a reduced risk of developing resistance. The purpose of this in vitro study was to investigate the mechanical stability, handling properties, elution behavior, and antimicrobial effectiveness of PMMA cement loaded with three different daptomycin concentrations in comparison to commercially available antibiotic-loaded bone cement (ALBC). METHODS Mechanical properties and handling characteristics (ISO 5833, DIN 53435), HPLC elution, antimicrobial effectiveness with proliferation assay (DIN 17025), and inhibition zone testing were investigated. RESULTS All tested daptomycin concentrations met the ISO and DIN standards for mechanical strength. Loading of 40 g of PMMA cement with 0.5 g of daptomycin did not show any antimicrobial effectiveness, in contrast to 1.0 g and 1.5 g. PMMA cement with 1.5 g of daptomycin was the best in terms of elution and effectiveness, and it showed good ISO mechanical strength; ISO doughing was sticky for a little longer and setting was faster compared to the vancomycin-containing reference cement. CONCLUSION PMMA cement containing 0.5 g of gentamicin and 1.5 g of daptomycin could be a good alternative to the already established COPAL® (Wehrheim, Germany) G+V for the treatment of PJIs caused by VRE.
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Affiliation(s)
- Martina Humez
- Institute of Hygiene and Environmental Medicine, Justus-Liebig-Universität Giessen, Schubertstrasse 81, 35392 Giessen, Germany; (E.D.); (K.M.T.)
- Heraeus Medical GmbH, Philipp-Reis-Str. 8-13, 61273 Wehrheim, Germany; (R.S.); (S.V.)
| | - Eugen Domann
- Institute of Hygiene and Environmental Medicine, Justus-Liebig-Universität Giessen, Schubertstrasse 81, 35392 Giessen, Germany; (E.D.); (K.M.T.)
| | - Kai M. Thormann
- Institute of Hygiene and Environmental Medicine, Justus-Liebig-Universität Giessen, Schubertstrasse 81, 35392 Giessen, Germany; (E.D.); (K.M.T.)
- Institute of Microbiology and Molecular Biology, Justus-Liebig-Universität Giessen, Heinrich-Buff-Ring 26, 35392 Giessen, Germany
| | - Christian Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany;
| | - Rainer Strathausen
- Heraeus Medical GmbH, Philipp-Reis-Str. 8-13, 61273 Wehrheim, Germany; (R.S.); (S.V.)
| | - Sebastian Vogt
- Heraeus Medical GmbH, Philipp-Reis-Str. 8-13, 61273 Wehrheim, Germany; (R.S.); (S.V.)
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre, Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany;
| | - Klaus-Dieter Kühn
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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García-García J, Azuara G, Fraile-Martinez O, García-Montero C, Álvarez-Mon MA, Ruíz-Díez S, Álvarez-Mon M, Buján J, García-Honduvilla N, Ortega MA, De la Torre B. Modification of the Polymer of a Bone Cement with Biodegradable Microspheres of PLGA and Loading with Daptomycin and Vancomycin Improve the Response to Bone Tissue Infection. Polymers (Basel) 2022; 14:polym14050888. [PMID: 35267711 PMCID: PMC8912454 DOI: 10.3390/polym14050888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 12/13/2022] Open
Abstract
Chronic infections are one of the most serious adverse outcomes of prosthetic surgery. Prosthetic revision surgery using a bone cement loaded with antibiotics between the two stages of the surgery is commonly performed. However, this method often fails to reach the minimum inhibitory concentration and promotes antibiotic resistance, thus emphasizing the need for improving the current available therapies. MATERIALS AND METHODS In this study, we performed a study of the in vivo response of a polymer-based construct of poly (lactic-co-glycolic acid) (PLGA) in the solid phase of Palacos R® in combination with vancomycin, daptomycin, and/or linezolid. To test its effectiveness, we applied an in vivo model, using both histological and immunohistochemical analyses to study the bone tissue. RESULTS The presence of PLGA in the combination of vancomycin with daptomycin showed the most promising results regarding the preservation of bone cytoarchitecture and S. aureus elimination. Conversely, the combination of vancomycin plus linezolid was associated with a loss of bone cytoarchitecture, probably related to an increased macrophage response and inefficient antimicrobial activity. CONCLUSIONS The modification of Palacos R® bone cement with PLGA microspheres and its doping with the antibiotic daptomycin in combination with vancomycin improve the tissue response to bone infection.
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Affiliation(s)
- Joaquin García-García
- Service of Orthopedic Surgery of University Hospital Principe de Asturias, 28805 Alcalá de Henares, Madrid, Spain;
| | - Galo Azuara
- Service of Traumatology of University Hospital of Guadalajara, 19002 Guadalajara, Spain;
| | - Oscar Fraile-Martinez
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Cielo García-Montero
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Miguel Angel Álvarez-Mon
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Sara Ruíz-Díez
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
| | - Melchor Álvarez-Mon
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcala de Henares, Spain
| | - Julia Buján
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Natalio García-Honduvilla
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Miguel A. Ortega
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Correspondence:
| | - Basilio De la Torre
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
- Service of Traumatology of University Hospital Ramón y Cajal, 28034 Madrid, Spain
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Xu YM, Peng HM, Feng B, Weng XS. Progress of antibiotic-loaded bone cement in joint arthroplasty. Chin Med J (Engl) 2020; 133:2486-2494. [PMID: 32960839 PMCID: PMC7575178 DOI: 10.1097/cm9.0000000000001093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 11/26/2022] Open
Abstract
Bone cement, consisting of polymethyl methacrylate, is a bioinert material used for prothesis fixation in joint arthroplasty. To treat orthopedic infections, such as periprosthetic joint infection, antibiotic-loaded bone cement (ALBC) was introduced into clinical practice. Recent studies have revealed the limitations of the antibacterial effect of ALBC. Moreover, with the increase in high infection risk patients and highly resistant microbes, more researches and modification of ALBC are required. This paper reviewed latest findings about ALBC for most popular and destructive pathogens, summarized the influence of antibiotic kind, drug dosage, application method, and environment towards characteristic of ALBC. Subsequently, new cement additives and clinical applications of ALBC in joint arthroplasty were also discussed.
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Affiliation(s)
- Yi-Ming Xu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Sweeney E, Lovering A, Bowker K, MacGowan A, Nelson S. Anin vitrobiofilm model ofStaphylococcus aureusinfection of bone. Lett Appl Microbiol 2019; 68:294-302. [PMID: 30770577 DOI: 10.1111/lam.13131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/15/2019] [Accepted: 02/07/2019] [Indexed: 12/18/2022]
Affiliation(s)
- E. Sweeney
- School of Life Sciences University of Warwick Coventry UK
| | - A.M. Lovering
- Bristol Centre for Antimicrobial Research & Evaluation North Bristol NHS Trust Department of Infection Sciences Southmead Hospital Westbury‐on‐Trym Bristol UK
| | - K.E. Bowker
- Bristol Centre for Antimicrobial Research & Evaluation North Bristol NHS Trust Department of Infection Sciences Southmead Hospital Westbury‐on‐Trym Bristol UK
| | - A.P. MacGowan
- Bristol Centre for Antimicrobial Research & Evaluation North Bristol NHS Trust Department of Infection Sciences Southmead Hospital Westbury‐on‐Trym Bristol UK
| | - S.M. Nelson
- Department of Applied Sciences University of the West of England Bristol UK
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