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Al Thaher Y, Khalil R, Abdelghany S, Salem MS. Antimicrobial PMMA Bone Cement Containing Long Releasing Multi-Walled Carbon Nanotubes. NANOMATERIALS 2022; 12:nano12081381. [PMID: 35458089 PMCID: PMC9026701 DOI: 10.3390/nano12081381] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 02/07/2023]
Abstract
Prosthetic joint infections (PJIs) ensued from total joint replacement (TJR) pose a severe threat to patients that involve poor health outcomes, severe pain, death (in severe cases), and negative influence patients' quality of life. Antibiotic-loaded bone cement (ALBC) is frequently used for the prevention and treatment of PJI. This work aims to study gentamicin release from carbon nanotubes (CNTs) incorporated in polymethyl methacrylate (PMMA) bone cement to prolong release over several weeks to provide prophylaxis from PJIs after surgery. Different CNT concentrations were tested with the presence of gentamicin as a powder or preloaded onto carboxyl functionalized CNTs. The different types of bone cement were tested for drug release, mechanical properties, water uptake, antimicrobial properties, and cytocompatibility with human osteoblast cells (MTT, LDH, alizarin red, and morphology). Results showed prolonged release of gentamicin from CNT-loaded bone cements over several weeks compared to gentamicin-containing bone cement. Additionally, the presence of CNT enhanced the percentage of gentamicin released without adversely affecting the nanocomposite mechanical and antimicrobial properties needed for performance. Cytotoxicity testing showed non-inferior performance of the CNT-containing bone cement to the equivalent powder containing cement. Therefore, the developed nanocomposites may serve as a novel PMMA bone cement to prevent PJIs.
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Affiliation(s)
- Yazan Al Thaher
- Faculty of Pharmacy, Philadelphia University, Amman 19392, Jordan;
- Correspondence:
| | - Raida Khalil
- Department of Biotechnology and Genetic Engineering, Faculty of Science, Philadelphia University, Amman 19392, Jordan;
| | | | - Mutaz S. Salem
- Faculty of Pharmacy, Philadelphia University, Amman 19392, Jordan;
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
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Liu Q, Luo Y, Shi J. Reagent elution combined with positive pressure filtration: A zero-discharge method for cyanide tailings remediation. J Environ Sci (China) 2022; 113:376-384. [PMID: 34963545 DOI: 10.1016/j.jes.2021.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 06/14/2023]
Abstract
At present, the cyanide gold extraction process is still the main technology for gold production. Generated cyanide tailings containing highly toxic substances exhibit potential environmental risks. These tailings are in urgent need of purification treatment, especially after being classified as hazardous waste. In this study, the impacts of elution methods, operating time, tailings/water ratios, reagent types on the elution rates of cyanide were investigated. Furthermore, the composite elution method developed in this research was extended for engineering. Results showed that the optimum elution conditions were determined to be: stirring elution, tailings/water ratio (M/V; 1:1) and operating time (10-20 min). Besides, 4 reagents (sodium dodecyl benzene sulfonate, cyclodextrin, sodium silicate and calcium hydroxide) were selected from four categories of 21 reagents for further composite elution. The cyanide elution rate was the highest (90.7%±0.1%) while the molar ratio of these 4 reagents was 5:2:2:1. Moreover, the combination of reagent elution and positive pressure filtration improved the elution efficiency of cyanide (92.6%±0.8%). And the cyanide content in the toxic leaching solution was lower than the standard value (5.0 mg/L). Furthermore, the composite elution method developed in this study was also extended for engineering. The concentration of cyanide in the leachate was < 5.0 mg/L, and was stable during 189 days of detection. Notably, the effluent can be reused directly, or reused after further treatment. The zero discharge of effluents and solid wastes was realized in the processes. The above results provided supports for the engineering treatment of cyanide tailings.
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Affiliation(s)
- Qiang Liu
- Department of Environmental Engineering, College of Environmental and Resource Science, Zhejiang University, Hangzhou 310058, China; Changchun Gold Research Institute Co. Ltd, Changchun 130012, China
| | - Yating Luo
- Department of Environmental Engineering, College of Environmental and Resource Science, Zhejiang University, Hangzhou 310058, China
| | - Jiyan Shi
- Department of Environmental Engineering, College of Environmental and Resource Science, Zhejiang University, Hangzhou 310058, China.
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Cyphert EL, Zhang N, Marques DW, Learn GD, Zhang F, von Recum HA. Poly(methyl methacrylate) Bone Cement Composite Can Be Refilled with Antibiotics after Implantation in Femur or Soft Tissue. J Funct Biomater 2021; 12:jfb12010008. [PMID: 33530542 PMCID: PMC7838923 DOI: 10.3390/jfb12010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/21/2022] Open
Abstract
While periprosthetic joint infections (PJIs) result in a small percentage of patients following arthroplasties, they are challenging to treat if they spread into bone and soft tissue. Treatment involves delivering antibiotics using poly(methyl methacrylate) (PMMA) bone cement. However, antibiotic release is insufficient for prolonged infections. Previous work demonstrated efficacy of incorporating insoluble cyclodextrin (CD) microparticles into PMMA to improve antibiotic release and allow for post-implantation drug refilling to occur in a tissue-mimicking model. To simulate how antibiotic refilling may be possible in more physiologically relevant models, this work investigated development of bone and muscle refilling models. The bone refilling model involved embedding PMMA-CD into rabbit femur and administering antibiotic via intraosseous infusion. Muscle tissue refilling model involved implanting PMMA-CD beads in bovine muscle tissue and administering antibiotic via tissue injection. Duration of antimicrobial activity of refilled PMMA-CD was evaluated. PMMA-CD composite in bone and muscle tissue models was capable of being refilled with antibiotics and resulted in prolonged antimicrobial activity. PMMA-CD provided sustained and on-demand antimicrobial activity without removal of implant if infection develops. Intraosseous infusion appeared to be a viable technique to enable refilling of PMMA-CD after implantation in bone, reporting for the first time the ability to refill PMMA in bone.
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Cyphert EL, Learn GD, Marques DW, Lu CY, von Recum HA. Antibiotic Refilling, Antimicrobial Activity, and Mechanical Strength of PMMA Bone Cement Composites Critically Depend on the Processing Technique. ACS Biomater Sci Eng 2020; 6:4024-4035. [PMID: 33463344 DOI: 10.1021/acsbiomaterials.0c00305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Antibiotic-laden poly(methyl methacrylate) (PMMA) bone cement is used in a variety of applications including temporary spacers for load-bearing arthroplasties and non-load bearing orthopedic revision procedures and antibiotic beads to treat infections. Depending upon the surgical preparation technique, properties of PMMA can widely vary. The primary objective of this work was to perform an in-depth structure-function analysis regarding how processing of PMMA impacted material and structural properties (i.e., porosity) and downstream functional properties (i.e., drug refilling and strength). PMMA with cyclodextrin (CD) microparticles was generated via hand- or vacuum-mixing and characterized for material and structural properties including porosity and internal morphology and functional properties of drug refilling, compressive strength, and antimicrobial activity. CD microparticles were incorporated into PMMA to enable functional refilling properties and to determine new information on drug distribution and distance or depth of PMMA which the refilled drug was able to penetrate. Vacuum-mixing of PMMA resulted in improved mechanical strength and allowed for incorporation of greater amounts of CD microparticles but less homogeneity relative to hand-mixing. Refilling studies showed shallow penetration of the drug into PMMA samples without CD. However, PMMA with CD microparticles showed increased depth of drug penetration, indicating that the drug could be delivered deeper within the device, resulting in more drug being available for delivery and more opportunity for later antibiotic refilling on a patient-specific basis. Knowledge of structure-function relationships can assist and provide valuable information in design and optimization of PMMA-CD for specific load-bearing or non-load-bearing applications.
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Affiliation(s)
- Erika L Cyphert
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Greg D Learn
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Dylan W Marques
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Chao-Yi Lu
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Horst A von Recum
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
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Affiliation(s)
- S-T Jerry Tsang
- Department of Orthopaedic Surgery, University of Edinburgh, and Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - A Hamish R W Simpson
- Department of Orthopaedic Surgery, University of Edinburgh, and Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Dall GF, Tsang STJ, Gwynne PJ, MacKenzie SP, Simpson AHRW, Breusch SJ, Gallagher MP. Unexpected synergistic and antagonistic antibiotic activity against Staphylococcus biofilms. J Antimicrob Chemother 2019; 73:1830-1840. [PMID: 29554250 DOI: 10.1093/jac/dky087] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/15/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate putative anti-staphylococcal biofilm antibiotic combinations used in the management of periprosthetic joint infections (PJIs). Methods Using the dissolvable bead biofilm assay, the minimum biofilm eradication concentration (MBEC) was determined for the most commonly used antimicrobial agents and combination regimens against staphylococcal PJIs. The established fractional inhibitory concentration (FIC) index was modified to create the fractional biofilm eradication concentration (FBEC) index to evaluate synergism or antagonism between antibiotics. Results Only gentamicin (MBEC 64 mg/L) and daptomycin (MBEC 64 mg/L) were observed to be effective antistaphylococcal agents at clinically achievable concentrations. Supplementation of gentamicin with daptomycin, vancomycin or ciprofloxacin resulted in a similar or lower MBEC than gentamicin alone (FBEC index 0.25-2). Conversely, when rifampicin, clindamycin or linezolid was added to gentamicin, there was an increase in the MBEC of gentamicin relative to its use as a monotherapy (FBEC index 8-32). Conclusions This study found that gentamicin and daptomycin were the only effective single-agent antibiotics against established Staphylococcus biofilms. Interestingly the addition of a bacteriostatic antibiotic was found to antagonize the ability of gentamicin to eradicate Staphylococcus biofilms.
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Affiliation(s)
- G F Dall
- Department of Orthopaedic Surgery, Borders General Hospital, Huntlyburn, Melrose TD6 9BS, UK.,School of Biological Sciences, University of Edinburgh, Darwin Building, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK.,Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK
| | - S-T J Tsang
- School of Biological Sciences, University of Edinburgh, Darwin Building, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK.,Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK.,Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - P J Gwynne
- School of Biological Sciences, University of Edinburgh, Darwin Building, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK
| | - S P MacKenzie
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - A H R W Simpson
- Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK
| | - S J Breusch
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - M P Gallagher
- School of Biological Sciences, University of Edinburgh, Darwin Building, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK
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Wendling AC, Mar DE, Burkes JC, McIff TE. Effect of Ultrasound Frequency and Treatment Duration on Antibiotic Elution from Polymethylmethacrylate Bone Cement. Kans J Med 2019; 12:45-49. [PMID: 31191809 PMCID: PMC6527193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/16/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The objective of this study was to evaluate the effect of ultrasound frequency and treatment duration on antibiotic-impregnated polymethylmethacrylate (PMMA) antibiotic elution rates and mechanical strength. METHODS Two batches of PMMA were prepared: one with five grams of vancomycin powder and one without. Each batch was divided into two frequency groups: kHz and MHz. Each frequency group was divided into two duration groups: two minutes and ten minutes. Elution samples were measured daily using flow injection analysis. After one week of elution, ultrasound treatments were done daily until each group's average concentration fell below those of non-ultrasound control groups. After elution testing, compression testing determined mechanical properties. Paired t-tests were used to compare daily elution amounts to baseline values. Univariate ANOVAs were used to test for effects of both frequency and treatment duration on antibiotic elution amounts and on mechanical properties. RESULTS All ultrasound treatments resulted in significant increases in antibiotic elution. Frequency and duration had significant effects of increasing antibiotic elution (p < 0.001). The kHz group produced significantly greater antibiotic elution than the MHz group (p < 0.001). The 10-minute duration produced significantly greater antibiotic elution than the two-minute duration (both p < 0.001). Frequency and duration did not have significant effects on yield stress (p = 0.841 and p = 0.179, respectively). Frequency had a significant effect (p = 0.024) on modulus, but duration did not (p = 0.136). CONCLUSIONS Ultrasound frequency and treatment duration significantly affect antibiotic elution from PMMA which may be helpful for treatment of periprosthetic joint infections during revision arthroplasty.
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Affiliation(s)
- Alexander C. Wendling
- University of Kansas Medical Center, Department of Orthopedic Surgery, Kansas City, KS,University of Kansas School of Medicine-Wichita, Department of Orthopedic Surgery, Wichita, KS
| | - Damon E. Mar
- University of Kansas Medical Center, Department of Orthopedic Surgery, Kansas City, KS
| | - Jonathan C. Burkes
- University of Kansas Medical Center, Department of Orthopedic Surgery, Kansas City, KS
| | - Terence E. McIff
- University of Kansas Medical Center, Department of Orthopedic Surgery, Kansas City, KS
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Effect of High Mixing Intensity on Rheological Properties of Cemented Paste Backfill. MINERALS 2019. [DOI: 10.3390/min9040240] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cemented paste backfill (CPB) consists of a mixture of fine particles, mainly consisting of tailings and cement dispersed in water. Therefore, it is necessary to introduce an intensive shearing force into the paste during mixing in order to maintain an equilibrium between agglomeration and dispersion. It is influential for the macroscopical fluidity and rheological properties when changes occur in the microstructure of CPB under shear. However, the research on how mixing affects the properties of CPB is still in its infancy. This paper puts an insight into the relation between the mixing intensity and the rheological behavior of the CPB. It can be demonstrated that two threshold mixing intensities exist in this process. After passing the first or lower threshold, the rheological parameters (yield stress and viscosity) of the paste decrease. After passing the second threshold, a continued increase is observed. The changes in rheological properties are connected with physical and chemical changes in the microstructure of the CPB. The results are discussed in light of the three concepts “structural breakdown”, “thixotropic breakdown”, and “thixotropic behavior” of rheological properties of CPB.
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Perni S, Caserta S, Pasquino R, Jones SA, Prokopovich P. Prolonged Antimicrobial Activity of PMMA Bone Cement with Embedded Gentamicin-Releasing Silica Nanocarriers. ACS APPLIED BIO MATERIALS 2019; 2:1850-1861. [DOI: 10.1021/acsabm.8b00752] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Stefano Perni
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, United Kingdom
| | - Sergio Caserta
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, Napoli 80125, Italy
| | - Rossana Pasquino
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, Napoli 80125, Italy
| | - Steve A. Jones
- University Hospital Llandough, Cardiff & Vale University Health Board, Penlan Road, Penarth, Vale of Glamorgan, Wales CF64 2XX, United Kingdom
| | - Polina Prokopovich
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, United Kingdom
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Al Thaher Y, Yang L, Jones SA, Perni S, Prokopovich P. LbL-assembled gentamicin delivery system for PMMA bone cements to prolong antimicrobial activity. PLoS One 2018; 13:e0207753. [PMID: 30543660 PMCID: PMC6292632 DOI: 10.1371/journal.pone.0207753] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/06/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Antibiotic-loaded poly(methyl methacrylate) bone cements (ALBCs) are widely used in total joint replacement (TJR), for local delivery of antibiotics to provide prophylaxis against prosthetic joint infections (PJI). One of the shortcomings of the current generation of ALBCs is that the antibiotic release profile is characterized by a burst over the first few hours followed by a sharp decrease in rate for the following several days (often below minimum inhibitory concentration (MIC)), and, finally, exhaustion (after, typically, ~ 20 d). This profile means that the ALBCs provide only short-term antimicrobial action against bacterial strains involved PJI. RATIONALE The purpose of the present study was to develop an improved antibiotic delivery system for an ALBC. This system involved using a layer-by-layer technique to load the antibiotic (gentamicin sulphate) (GEN) on silica nanoparticles, which are then blended with the powder of the cement. Then, the powder was mixed with the liquid of the cement (NP-GEN cement). For controls, two GEN-loaded brands were used (Cemex Genta and Palacos R+G). Gentamicin release and a host of other relevant properties were determined for all the cements studied. RESULTS Compared to control cement specimens, improved GEN release, longer antimicrobial activity (against clinically-relevant bacterial strains), and comparable setting time, cytocompatibility, compressive strength (both prior to and after aging in PBS at 37 oC for 30 d), 4-point bend strength and modulus, fracture toughness, and PBS uptake. CONCLUSIONS NP-GEN cement may have a role in preventing or treating PJI.
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Affiliation(s)
- Yazan Al Thaher
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, United Kingdom
| | - Lirong Yang
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, United Kingdom
| | - Steve A. Jones
- University Hospital Llandough, Cardiff & Vale University Health Board, Vale of Glamorgan, Wales, United Kingdom
| | - Stefano Perni
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, United Kingdom
| | - Polina Prokopovich
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, United Kingdom
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Hameister R, Lim CT, Lohmann CH, Wang W, Singh G. What Is the Role of Diagnostic and Therapeutic Sonication in Periprosthetic Joint Infections? J Arthroplasty 2018; 33:2575-2581. [PMID: 29599035 DOI: 10.1016/j.arth.2018.02.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/17/2018] [Accepted: 02/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is one of the most dreaded complications in joint replacement surgery. Diagnosis and treatment can be difficult and biofilms are of major concern due to their low susceptibility toward antibiotics. METHODS This review focuses on the use of sonication as an evolving diagnostic and adjunct treatment modality in the context of PJI. Therapeutic application of sonication is discussed separately for its (i) direct action on bacteria, (ii) synergistic effects with antibiotics, and (iii) effects on release of antibiotics from bone cement. RESULTS Used as a diagnostic tool, sonication shows promising results with respect to sensitivity and specificity when compared to conventional methods, notably after previous administration of antibiotics. As an adjunct treatment modality, the chemical, physical, and mechanical effects of sonication are primarily driven by cavitation and recognized as the main cause for bactericidal effects but the exact underlying mechanisms have not been identified yet. Sonication alone does not have the ability to completely eradicate biofilms but synergistic effects when used in conjunction with antibiotics have been reported. There is also evidence for enhanced antibiotic release from bone cement. CONCLUSION Sonication is as an evolving modality in the context of PJIs. As a diagnostic tool, it has not been introduced in routine clinical practice and sonication as a treatment modality in PJIs is still in an experimental stage. Factors such as frequency, pressure, chemical activity, intensity, and exposure time need to be evaluated for optimal application of sonication and may also improve study comparison.
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Affiliation(s)
- Rita Hameister
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chin T Lim
- National University Health System, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, Singapore, Singapore
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Wilson Wang
- National University Health System, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, Singapore, Singapore
| | - Gurpal Singh
- National University Health System, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, Singapore, Singapore
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Zhou J, Zhou XG, Wang JW, Zhou H, Dong J. Treatment of osteomyelitis defects by a vancomycin-loaded gelatin/β-tricalcium phosphate composite scaffold. Bone Joint Res 2018; 7:46-57. [PMID: 29330343 PMCID: PMC5805826 DOI: 10.1302/2046-3758.71.bjr-2017-0129.r2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE In the present study, we aimed to assess whether gelatin/β-tricalcium phosphate (β-TCP) composite porous scaffolds could be used as a local controlled release system for vancomycin. We also investigated the efficiency of the scaffolds in eliminating infections and repairing osteomyelitis defects in rabbits. METHODS The gelatin scaffolds containing differing amounts of of β-TCP (0%, 10%, 30% and 50%) were prepared for controlled release of vancomycin and were labelled G-TCP0, G-TCP1, G-TCP3 and G-TCP5, respectively. The Kirby-Bauer method was used to examine the release profile. Chronic osteomyelitis models of rabbits were established. After thorough debridement, the osteomyelitis defects were implanted with the scaffolds. Radiographs and histological examinations were carried out to investigate the efficiency of eliminating infections and repairing bone defects. RESULTS The prepared gelatin/β-TCP scaffolds exhibited a homogeneously interconnected 3D porous structure. The G-TCP0 scaffold exhibited the longest duration of vancomycin release with a release duration of eight weeks. With the increase of β-TCP contents, the release duration of the β-TCP-containing composite scaffolds was decreased. The complete release of vancomycin from the G-TCP5 scaffold was achieved within three weeks. In the treatment of osteomyelitis defects in rabbits, the G-TCP3 scaffold showed the most efficacious performance in eliminating infections and repairing bone defects. CONCLUSIONS The composite scaffolds could achieve local therapeutic drug levels over an extended duration. The G-TCP3 scaffold possessed the optimal porosity, interconnection and controlled release performance. Therefore, this scaffold could potentially be used in the treatment of chronic osteomyelitis defects.Cite this article: J. Zhou, X. G. Zhou, J. W. Wang, H. Zhou, J. Dong. Treatment of osteomyelitis defects by a vancomycin-loaded gelatin/β-tricalcium phosphate composite scaffold. Bone Joint Res 2018;7:46-57. DOI: 10.1302/2046-3758.71.BJR-2017-0129.R2.
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Affiliation(s)
- J. Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - X. G. Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - J. W. Wang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - H. Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - J. Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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13
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Kummer A, Tafin UF, Borens O. Effect of Sonication on the Elution of Antibiotics from Polymethyl Methacrylate (PMMA). J Bone Jt Infect 2017; 2:208-212. [PMID: 29188172 PMCID: PMC5704002 DOI: 10.7150/jbji.22443] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 10/11/2017] [Indexed: 11/12/2022] Open
Abstract
Background: In the setting of prosthetic joint infections treated with a two-stage procedure, spacers can be sonicated after removal. We hypothesize that the sonication process may cause an increased elution of antibiotics from the spacer, leading to elevated concentrations of antibiotics in the sonication fluid inhibiting bacterial growth. We aimed to evaluate in vitro the influence of sonication on the elution of antibiotics from polymethyl methacrylate (PMMA) over time and to determine whether these concentrations are above the minimum inhibitory concentrations (MIC) for microorganisms relevant in prosthetic joint infections. Methods: PMMA blocks impregnated with vancomycin, fosfomycin, gentamicin or daptomycin were incubated in phosphate-buffered saline (PBS) at 37°C for up to 6 weeks. PBS was changed once a week. Concentrations were determined from samples of each antibiotic every week, and after 5 minutes of sonication at 2, 4 and 6 weeks. Results: With sonication there was a trend toward an increase of the elution of antibiotics. This increase was significant for vancomycin at 2 and 4 weeks (p=0.008 and 0.002 respectively) and for fosfomycin at 2 weeks (p=0.01). Conclusion: The effect of sonication could play a role in clinical results, especially for daptomycin and gentamicin for which the MIC is close to the concentration of antibiotics at 4 and 6 weeks. We conclude that elution of antibiotics from PMMA along with the effect of sonication could inhibit bacterial growth from spacers, resulting in false negative results in the setting of two-stage exchange procedures for prosthetic joint infections.
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Affiliation(s)
| | | | - Olivier Borens
- University Hospital Lausanne (CHUV), Service of Orthopedics and Traumatology, University of Lausanne, Lausanne, Switzerland
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A Review of the Combination Therapy of Low Frequency Ultrasound with Antibiotics. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2317846. [PMID: 29124063 PMCID: PMC5662814 DOI: 10.1155/2017/2317846] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022]
Abstract
Single antimicrobial therapy has been unable to resist the global spread of bacterial resistance. Literatures of available in vitro and in vivo studies were reviewed and the results showed that low frequency ultrasound (LFU) has a promising synergistic bactericidal effect with antibiotics against both planktonic and biofilm bacteria. It also can facilitate the release of antibiotics from medical implants. As a noninvasive and targeted therapy, LFU has great potential in treating bacterial infections. However, more in-depth and detailed studies are still needed before LFU is officially applied as a combination therapy in the field of anti-infective treatment.
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Abstract
Non-union is a devastating consequence of a fracture. Non-unions cause substantial patient morbidity with patients suffering from loss of function of the affected extremity, increased pain, and a substantial decrease in the quality of life. The management is often associated with repeated, unsuccessful operations resulting in prolonged hospital stays, which has social and economic consequences to both the patient and the healthcare system. The rates of non-union following intramedullary (IM) nailing vary according to anatomical location. There is currently no consensus regarding the treatment of infected non-unions following IM nailing, but the most common procedures reported are; exchange IM nail with antibiotic suppression or excision of the non-union, (stabilisation with external fixation or less commonly plate or IM nail) and then reconstruction of the bone defect with distraction osteogenesis or the Masquelet technique. This article explores the general principles of treatment, fixation modalities and proposes a treatment strategy for the management of infected non-unions following intramedullary nailing.
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Affiliation(s)
- A Hamish Simpson
- Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Jerry S T Tsang
- Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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16
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Carver DC, Kuehn SB, Weinlein JC. Role of Systemic and Local Antibiotics in the Treatment of Open Fractures. Orthop Clin North Am 2017; 48:137-153. [PMID: 28336038 DOI: 10.1016/j.ocl.2016.12.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The orthopedic community has learned much about the treatment of open fractures from the tremendous work of Ramon Gustilo, Michael Patzakis, and others; however, open fractures continue to be very difficult challenges. Type III open fractures continue to be associated with high infection rates. Some combination of systemic and local antibiotics may be most appropriate in these high-grade open fractures. Further research is still necessary in determining optimal systemic antibiotic regimens as well as the role of local antibiotics. Any new discoveries related to novel systemic antibiotics or local antibiotic carriers will need to be evaluated related to cost.
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Affiliation(s)
- David C Carver
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Sean B Kuehn
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - John C Weinlein
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
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17
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Moreno Juez J, Artoni R, Cazacliu B. Monitoring of concrete mixing evolution using image analysis. POWDER TECHNOL 2017. [DOI: 10.1016/j.powtec.2016.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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