Incorporation of large amounts of gentamicin sulphate into acrylic bone cement: effect on handling and mechanical properties, antibiotic release, ad biofilm formation
Incorporation of large amounts of gentamicin sulphate into acrylic bone cement: effect on handling and mechanical properties, antibiotic release, ad biofilm formation
复制标题
DOI：
10.1243/09544119jeim355
复制
发表时间：
2008-04-01
期刊：
影响因子：
1.8
通讯作者：
Tunney, M.
中科院分区：
文献类型：
--
作者：
Dunne, N. I.;Hill, I.;Tunney, M.
细菌感染仍然是全关节置换术后的重要并发症。如果在进行翻修手术时怀疑感染，则通常将大剂量抗生素（通常为硫酸庆大霉素）与丙烯酸骨水泥粉末混合，以降低复发感染的风险。在这项体外研究中，研究了小剂量和大剂量硫酸庆大霉素对骨水泥处理和机械性能、骨水泥中庆大霉素释放以及临床葡萄球菌属体外生物膜形成的影响。测定骨水泥上的分离物。在40 g的骨水泥粉末质量中，庆大霉素加载量增加1、2、3或4 g，导致压缩和四点弯曲强度显著降低，但在72 h内释放的庆大霉素量显著增加。当建立显性感染模型时，使用葡萄球菌属（Staphylococcus spp.）临床分离株接种1 × 10（7）菌落形成单位/ml，庆大霉素的量增加（1、2、3或4g）加入到40 g聚（甲基丙烯酸甲酯）粘固剂导致细菌定殖的初始减少但该有益效果到72小时时不再明显，尽管释放了高水平的庆大霉素，但细菌菌株在骨水泥上形成生物膜。研究结果表明，整形外科医生应仔细考虑将大剂量（每40 g聚甲基丙烯酸甲酯1 g或更多）庆大霉素混合到Palacos（R）R骨水泥中用于翻修手术的临床后果，因为增加庆大霉素负荷并不能防止细菌生物膜形成，并且对机械性能的影响可能对假体关节的寿命很重要。
Bacterial infection remains a significant complication following total joint replacement. If infection is suspected when revision surgery is being performed, a large dose of antibiotic, usually gentamicin sulphate, is often blended with the acrylic bone cement powder in an attempt to reduce the risk of recurrent infection. In this in-vitro study the effect of small and large doses of gentamicin sulphate on the handling and mechanical properties of the cement, gentamicin release from the cement, and in-vitro biofilm formation by clinical Staphylococcus spp. isolates on the cement was determined. An increase in gentamicin loading of 1, 2, 3, or 4 g, in a cement powder mass of 40 g, resulted in a significant decrease in the compressive and four-point bending strength, but a significant increase in the amount of gentamicin released over a 72 h period. When overt infection was modelled, using Staphylococcus spp. clinical isolates at an inoculum of 1 x 10(7) colony-forming units/ml, an increase in the amount of gentamicin (1, 2, 3, or 4 g) added to 40 g of poly(methyl methacrylate) cement resulted in an initial decrease in bacterial colonization but this beneficial effect was no longer apparent by 72 h, with the bacterial strains forming biofilms on the cements despite the release of high levels of gentamicin. The findings suggest that orthopaedic surgeons should carefully consider the clinical consequences of blending large doses (1 g or more per 40 g of poly(methyl methacrylate)) of gentamicin into Palacos (R) R bone cement for use in revision surgery as the increased gentamicin loading does not prevent bacterial biofilm formation and the effect on the mechanical properties could be important to the longevity of the prosthetic joint.