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Release of gentamicin and vancomycin from preformed spacers in infected total hip arthroplasties: measurement of concentrations and inhibitory activity in patients' drainage fluids and serum.

Regis D, Sandri A, Samaila E, Benini A, Bondi M, Magnan B - ScientificWorldJournal (2013)

Bottom Line: Antibiotics concentrations and drains bactericidal titer of combination were determined against multiresistant staphylococcal strains.Serum levels were below the limit of detection.The local release kinetics of G and V from PMMA cement was similar, exerting a pronounced, combined inhibitory effect in the implant site.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic and Trauma Surgery, Integrated University Hospital, 37126 Verona, Italy.

ABSTRACT
Gentamicin (G) and vancomycin (V) concentrations in drainage fluids obtained from patients during the first 24 hours after implantation of antibiotic-loaded polymethylmethacrylate (PMMA) spacers in two-stage revision of infected total hip arthroplasty were studied. The inhibitory activity of drainage fluids against different multiresistant clinical isolates was investigated as well. Seven hips were treated by implantation of industrial G-loaded spacers. Vancomycin was added by manually mixing with PMMA bone cement. Serum and drainage fluid samples were collected 1, 4, and 24 hours after spacer implantation. Antibiotics concentrations and drains bactericidal titer of combination were determined against multiresistant staphylococcal strains. The release of G and V from PMMA cement at the site of infection was prompt and effective. Serum levels were below the limit of detection. The local release kinetics of G and V from PMMA cement was similar, exerting a pronounced, combined inhibitory effect in the implant site. The inhibitory activity of drainage fluids showed substantial intersubject variability related to antibiotic concentrations and differed according to the pathogens tested. Gentamicin and vancomycin were released from temporary hip spacers at bactericidal concentrations, and their use in combination exerted strong inhibition against methicillin-resistant S. aureus and Coagulase Negative Staphylococci strains.

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Preoperative X-ray of a total hip arthroplasty complicated by chronic infection (a). Radiograph obtained after removal of the infected prosthesis and implantation of an industrially manufactured spacer (b).
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fig1: Preoperative X-ray of a total hip arthroplasty complicated by chronic infection (a). Radiograph obtained after removal of the infected prosthesis and implantation of an industrially manufactured spacer (b).

Mentions: Removal of the septic implant was followed by a thorough periprosthetic debridement and implantation of the spacer (Figures 1(a) and 1(b)). A vancomycin-loaded bone cement was prepared manually by mixing 40 g of powered cement PMMA polymer (Cemex, Tecres S.p.A., Sommacampagna, Verona, Italy) and 1 g of vancomycin (Vancocin, Eli Lilly, Milan, Italy). Finally, 35 mL of liquid MMA monomer was added and carefully mixed with a spatula [11, 19]. Vancomycin addition to hip spacers was obtained by filling with the cement mixture 17-18 holes (10–12 mm diameter, 2-3 mm depth) which were drilled in the surface of the Spacer-G immediately before implantation (Figure 2). Each device received 6-7 g of cement, corresponding to 150–170 mg of vancomycin, respectively. Vancomycin (Vancocin, 1 g, twice daily) was also administered intravenously to 1 patient as control case.


Release of gentamicin and vancomycin from preformed spacers in infected total hip arthroplasties: measurement of concentrations and inhibitory activity in patients' drainage fluids and serum.

Regis D, Sandri A, Samaila E, Benini A, Bondi M, Magnan B - ScientificWorldJournal (2013)

Preoperative X-ray of a total hip arthroplasty complicated by chronic infection (a). Radiograph obtained after removal of the infected prosthesis and implantation of an industrially manufactured spacer (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3794627&req=5

fig1: Preoperative X-ray of a total hip arthroplasty complicated by chronic infection (a). Radiograph obtained after removal of the infected prosthesis and implantation of an industrially manufactured spacer (b).
Mentions: Removal of the septic implant was followed by a thorough periprosthetic debridement and implantation of the spacer (Figures 1(a) and 1(b)). A vancomycin-loaded bone cement was prepared manually by mixing 40 g of powered cement PMMA polymer (Cemex, Tecres S.p.A., Sommacampagna, Verona, Italy) and 1 g of vancomycin (Vancocin, Eli Lilly, Milan, Italy). Finally, 35 mL of liquid MMA monomer was added and carefully mixed with a spatula [11, 19]. Vancomycin addition to hip spacers was obtained by filling with the cement mixture 17-18 holes (10–12 mm diameter, 2-3 mm depth) which were drilled in the surface of the Spacer-G immediately before implantation (Figure 2). Each device received 6-7 g of cement, corresponding to 150–170 mg of vancomycin, respectively. Vancomycin (Vancocin, 1 g, twice daily) was also administered intravenously to 1 patient as control case.

Bottom Line: Antibiotics concentrations and drains bactericidal titer of combination were determined against multiresistant staphylococcal strains.Serum levels were below the limit of detection.The local release kinetics of G and V from PMMA cement was similar, exerting a pronounced, combined inhibitory effect in the implant site.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic and Trauma Surgery, Integrated University Hospital, 37126 Verona, Italy.

ABSTRACT
Gentamicin (G) and vancomycin (V) concentrations in drainage fluids obtained from patients during the first 24 hours after implantation of antibiotic-loaded polymethylmethacrylate (PMMA) spacers in two-stage revision of infected total hip arthroplasty were studied. The inhibitory activity of drainage fluids against different multiresistant clinical isolates was investigated as well. Seven hips were treated by implantation of industrial G-loaded spacers. Vancomycin was added by manually mixing with PMMA bone cement. Serum and drainage fluid samples were collected 1, 4, and 24 hours after spacer implantation. Antibiotics concentrations and drains bactericidal titer of combination were determined against multiresistant staphylococcal strains. The release of G and V from PMMA cement at the site of infection was prompt and effective. Serum levels were below the limit of detection. The local release kinetics of G and V from PMMA cement was similar, exerting a pronounced, combined inhibitory effect in the implant site. The inhibitory activity of drainage fluids showed substantial intersubject variability related to antibiotic concentrations and differed according to the pathogens tested. Gentamicin and vancomycin were released from temporary hip spacers at bactericidal concentrations, and their use in combination exerted strong inhibition against methicillin-resistant S. aureus and Coagulase Negative Staphylococci strains.

Show MeSH
Related in: MedlinePlus