In vitro testing of gentamicin-vancomycin loaded bone cement to prevent prosthetic joint infection
In vitro testing of gentamicin-vancomycin loaded bone cement to prevent prosthetic joint infection
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DOI：
10.5507/bp.2005.019
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发表时间：
2005-06-01
期刊：
影响因子：
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通讯作者：
Kesselova, Michaela
中科院分区：
文献类型：
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作者：
Gallo, Jiri;Kolar, Milan;Kesselova, Michaela
脓毒症是全关节置换术后最令人担心的并发症。一个关键问题是如何防止围手术期细菌粘附，从而防止感染并发症的可能性。本研究的目的是评估葡萄球菌在假体材料上存活的能力，并分析庆大霉素和万古霉素载聚甲基丙烯酸甲酯（PMMA）骨水泥对细菌粘附和生长的体外影响。将医院获得的葡萄球菌菌株系统性接种到四种骨科材料上（高分子量聚乙烯、不含抗生素的PMMA、市售的载有庆大霉素的PMMA以及手动混合的载有庆大霉素和万古霉素的PMMA）。采用培养和生化试验鉴定葡萄球菌。将接种的材料在液体肉汤生长培养基中孵育，随后制备用于扫描电子显微镜检查和细菌生长定量。没有抗生素的材料显示葡萄球菌生长的证据。仅装载庆大霉素的PMMA生长耐甲氧西林金黄色葡萄球菌。载庆大霉素-万古霉素的PMMA完全抑制任何细菌生长。低剂量载庆大霉素-万古霉素的PMMA比市售载庆大霉素的PMMA更好地防止葡萄球菌定植。我们建议在需要骨水泥的高风险手术和翻修手术中使用该组合。
Sepsis is a greatly feared complication of total joint arthroplasty. One key question is how to prevent perioperative bacterial adherence, and therefore the potential for infectious complications. The objective of our study was to appraise the emerging capacity of staphylococcal survival on prosthetic materials and to analyze the in vitro effects of gentamicin and vancomycin loaded polymethylmethacrylate (PMMA) cement on bacterial adherence and growth. Hospital acquired staphylococcal strains were systematically inoculated on four orthopedic materials (ultrahigh molecular weight polyethylene, PMMA without antibiotic, commercially produced PMMA loaded with gentamicin, and manually mixed PMMA loaded with gentamicin and vancomycin). Staphylococci were identified using culture and biochemical tests. The inoculated material was allowed to incubate in a liquid broth growth media and subsequently prepared for scanning electron microscopy and bacterial growth quantification. Materials without antibiotics showed evidence of staphylococcal growth. PMMA loaded with only gentamicin grew methicillin-resistant Staphylococcus aureus. Gentamicin-vancomycin loaded PMMA completely inhibited any bacterial growth.Low-dose gentamicin-vancomycin loaded PMMA prevents staphylococcal colonization better than commercially manufactured PMMA loaded with gentamicin. We recommend this combination in high-risk procedures and revision surgeries requiring bone cement.