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Antibiotic-loaded synthetic calcium sulfate beads for prevention of bacterial colonization and biofilm formation in periprosthetic infections

Antibiotic-loaded synthetic calcium sulfate beads for prevention of bacterial colonization and biofilm formation in periprosthetic infections
Antibiotic-loaded synthetic calcium sulfate beads for prevention of bacterial colonization and biofilm formation in periprosthetic infections
Periprosthetic infection (PI) causes significant morbidity and mortality in fixation and joint arthroplasty and has been extensively linked to the formation of bacterial biofilms. Poly(methyl methacrylate) (PMMA) cement or beads are commonly used for antibiotic release to the site of infection but display variable elution kinetics and also represent a potential nidus for infection, therefore requiring surgical removal. Absorbable cements have shown improved elution of a wider range of antibiotics and, crucially, complete biodegradation but limited data exist as to their antimicrobial and antibiofilm efficacy.

Synthetic calcium sulfate beads loaded with tobramycin, vancomycin and a vancomycin & tobramycin dual treatment (1:0.24 w/w ratio) were assessed for their ability to eradicate planktonic methicillin resistant S. aureus (MRSA) and S. epidermidis, relative to PMMA beads. The ability of the beads to prevent biofilm formation over multiple days and eradicate preformed biofilms was studied using a combination of viable cell counts, confocal microscopy and scanning electron microscopy of the bead surface.

Biofilm bacteria displayed a greater tolerance to the antibiotics than their planktonic counterparts. Antibiotic-loaded beads were able to kill planktonic cultures of 106 CFU/mL, prevent bacterial colonisation and significantly reduce biofilm formation over multiple days. However, established biofilms were harder to eradicate.

This data further demonstrates the difficulty in clearing established biofilms and therefore early preventative measures are key to reducing the risk of PI. Synthetic calcium sulfate loaded with antibiotics has the potential to reduce or eliminate biofilm formation on adjacent periprosthetic tissue and prosthesis material, and thus reduce rates of periprosthetic infection.
Antibiotic-loaded synthetic calcium sulfate beads for the prevention of bacterial colonisation and biofilm formation in periprosthetic infections
0066-4804
111-120
Howlin, R. P.
8b128b91-cf1e-4e77-a1b8-bc80dd829d8e
Brayford, M. J.
453ffa1d-1d30-4ffd-8ee6-d6f83f4c95b6
Webb, J. S.
ec0a5c4e-86cc-4ae9-b390-7298f5d65f8d
Cooper, J. J.
b4fe47c0-3ec1-4cb3-bf3d-43a38ed07924
Aiken, S. S.
9f2a80c8-e8a3-45a9-9e9b-b2c801fdde82
Stoodley, P.
08614665-92a9-4466-806e-20c6daeb483f
Howlin, R. P.
8b128b91-cf1e-4e77-a1b8-bc80dd829d8e
Brayford, M. J.
453ffa1d-1d30-4ffd-8ee6-d6f83f4c95b6
Webb, J. S.
ec0a5c4e-86cc-4ae9-b390-7298f5d65f8d
Cooper, J. J.
b4fe47c0-3ec1-4cb3-bf3d-43a38ed07924
Aiken, S. S.
9f2a80c8-e8a3-45a9-9e9b-b2c801fdde82
Stoodley, P.
08614665-92a9-4466-806e-20c6daeb483f

Howlin, R. P., Brayford, M. J., Webb, J. S., Cooper, J. J., Aiken, S. S. and Stoodley, P. (2014) Antibiotic-loaded synthetic calcium sulfate beads for prevention of bacterial colonization and biofilm formation in periprosthetic infections. Antimicrobial Agents and Chemotherapy, 59 (1), 111-120. (doi:10.1128/AAC.03676-14).

Record type: Article

Abstract

Periprosthetic infection (PI) causes significant morbidity and mortality in fixation and joint arthroplasty and has been extensively linked to the formation of bacterial biofilms. Poly(methyl methacrylate) (PMMA) cement or beads are commonly used for antibiotic release to the site of infection but display variable elution kinetics and also represent a potential nidus for infection, therefore requiring surgical removal. Absorbable cements have shown improved elution of a wider range of antibiotics and, crucially, complete biodegradation but limited data exist as to their antimicrobial and antibiofilm efficacy.

Synthetic calcium sulfate beads loaded with tobramycin, vancomycin and a vancomycin & tobramycin dual treatment (1:0.24 w/w ratio) were assessed for their ability to eradicate planktonic methicillin resistant S. aureus (MRSA) and S. epidermidis, relative to PMMA beads. The ability of the beads to prevent biofilm formation over multiple days and eradicate preformed biofilms was studied using a combination of viable cell counts, confocal microscopy and scanning electron microscopy of the bead surface.

Biofilm bacteria displayed a greater tolerance to the antibiotics than their planktonic counterparts. Antibiotic-loaded beads were able to kill planktonic cultures of 106 CFU/mL, prevent bacterial colonisation and significantly reduce biofilm formation over multiple days. However, established biofilms were harder to eradicate.

This data further demonstrates the difficulty in clearing established biofilms and therefore early preventative measures are key to reducing the risk of PI. Synthetic calcium sulfate loaded with antibiotics has the potential to reduce or eliminate biofilm formation on adjacent periprosthetic tissue and prosthesis material, and thus reduce rates of periprosthetic infection.

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More information

Accepted/In Press date: 8 October 2014
e-pub ahead of print date: 13 October 2014
Published date: 13 October 2014
Keywords: Antibiotic-loaded synthetic calcium sulfate beads for the prevention of bacterial colonisation and biofilm formation in periprosthetic infections
Organisations: Centre for Biological Sciences

Identifiers

Local EPrints ID: 370069
URI: http://eprints.soton.ac.uk/id/eprint/370069
ISSN: 0066-4804
PURE UUID: 94b75ea7-a7ce-4d51-9aaa-e65290883ab4
ORCID for J. S. Webb: ORCID iD orcid.org/0000-0003-2068-8589
ORCID for P. Stoodley: ORCID iD orcid.org/0000-0001-6069-273X

Catalogue record

Date deposited: 15 Oct 2014 12:54
Last modified: 17 Dec 2019 01:45

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