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Elution of antibiotics from poly(methyl methacrylate) bone cement after extended implantation does not necessarily clear the infection despite susceptibility of the clinical isolates

Elution of antibiotics from poly(methyl methacrylate) bone cement after extended implantation does not necessarily clear the infection despite susceptibility of the clinical isolates
Elution of antibiotics from poly(methyl methacrylate) bone cement after extended implantation does not necessarily clear the infection despite susceptibility of the clinical isolates
Chronic orthopedic infections are commonly caused by bacterial biofilms, which are recalcitrant to antibiotic treatment. In many cases, the revision procedure for periprosthetic joint infection or trauma cases includes the implantation of antibiotic-loaded bone cement to kill infecting bacteria via the elution of a strong local dose of antibiotic(s) at the site. While many studies have addressed the elution kinetics of both non-absorbable and absorbable bone cements both in vitro and in vivo, the potency of ALBC against pathogenic bacteria after extended implantation time is not clear. In this communication, we use two case studies, a Viridans streptococci infected total knee arthroplasty (TKA) and a MRSA-polymicrobial osteomyelitis of a distal tibial traumatic amputation (TA) to demonstrate that an antibiotic-loaded poly(methyl methacrylate) (ALPMMA) coated intermedullary rod implanted for 117 days (TKA) and three ALPMMA suture-strung beads implanted for 210 days (TA) retained killing ability against Pseudomonas aeruginosa and Staphylococcus aureus in vitro, despite different clinical efficacies. The TKA infection resolved and the patient progressed to an uneventful second stage. However, the TA infection only resolved after multiple rounds of debridement, IV vancomycin and removal of the PMMA beads and placement of vancomycin and tobramycin loaded calcium sulfate beads.
biofilm, chronic infection, antibiotic-loaded poly(methyl methacrylate, bone cement, MRSA, MSSA, Pseudomonas, elution zone of inhibition, extended implantation
1-4
Swearingen, Matthew C.
3725ae2f-b98d-4be4-b7fe-70499e716631
Granger, Jeffrey F.
3237fc0c-8964-4eb1-bf5a-50cdaf30c342
Sullivan, Anne
2fc4e087-c92c-405d-9071-18d5873b4cbd
Stoodley, Paul
08614665-92a9-4466-806e-20c6daeb483f
Coenye, Tom
de2d4149-c84c-4dbb-a7ae-c5da5dc29c7f
Swearingen, Matthew C.
3725ae2f-b98d-4be4-b7fe-70499e716631
Granger, Jeffrey F.
3237fc0c-8964-4eb1-bf5a-50cdaf30c342
Sullivan, Anne
2fc4e087-c92c-405d-9071-18d5873b4cbd
Stoodley, Paul
08614665-92a9-4466-806e-20c6daeb483f
Coenye, Tom
de2d4149-c84c-4dbb-a7ae-c5da5dc29c7f

Swearingen, Matthew C., Granger, Jeffrey F., Sullivan, Anne, Stoodley, Paul and Coenye, Tom (2016) Elution of antibiotics from poly(methyl methacrylate) bone cement after extended implantation does not necessarily clear the infection despite susceptibility of the clinical isolates. Pathogens and Disease, 74 (1), 1-4. (doi:10.1093/femspd/ftv103).

Record type: Article

Abstract

Chronic orthopedic infections are commonly caused by bacterial biofilms, which are recalcitrant to antibiotic treatment. In many cases, the revision procedure for periprosthetic joint infection or trauma cases includes the implantation of antibiotic-loaded bone cement to kill infecting bacteria via the elution of a strong local dose of antibiotic(s) at the site. While many studies have addressed the elution kinetics of both non-absorbable and absorbable bone cements both in vitro and in vivo, the potency of ALBC against pathogenic bacteria after extended implantation time is not clear. In this communication, we use two case studies, a Viridans streptococci infected total knee arthroplasty (TKA) and a MRSA-polymicrobial osteomyelitis of a distal tibial traumatic amputation (TA) to demonstrate that an antibiotic-loaded poly(methyl methacrylate) (ALPMMA) coated intermedullary rod implanted for 117 days (TKA) and three ALPMMA suture-strung beads implanted for 210 days (TA) retained killing ability against Pseudomonas aeruginosa and Staphylococcus aureus in vitro, despite different clinical efficacies. The TKA infection resolved and the patient progressed to an uneventful second stage. However, the TA infection only resolved after multiple rounds of debridement, IV vancomycin and removal of the PMMA beads and placement of vancomycin and tobramycin loaded calcium sulfate beads.

Full text not available from this repository.

More information

Accepted/In Press date: 8 October 2015
e-pub ahead of print date: 1 November 2015
Published date: February 2016
Keywords: biofilm, chronic infection, antibiotic-loaded poly(methyl methacrylate, bone cement, MRSA, MSSA, Pseudomonas, elution zone of inhibition, extended implantation
Organisations: Engineering Science Unit

Identifiers

Local EPrints ID: 384475
URI: http://eprints.soton.ac.uk/id/eprint/384475
PURE UUID: c4ec2887-ebf4-4585-83dc-ba00ce8fa72b
ORCID for Paul Stoodley: ORCID iD orcid.org/0000-0001-6069-273X

Catalogue record

Date deposited: 04 Jan 2016 13:55
Last modified: 17 Dec 2019 01:42

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