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
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DOI：
10.1128/aac.03676-14
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发表时间：
2015-01-01
影响因子：
4.9
通讯作者：
Stoodley, P.
中科院分区：
文献类型：
--
作者：
Howlin, R. P.;Brayford, M. J.;Stoodley, P.
假体周围感染（PI）在固定和关节置换术后引起显着的发病率和死亡率，并且与细菌生物膜的形成广泛相关。聚甲基丙烯酸甲酯 (PM M A) 作为水泥或珠子，通常用于将抗生素释放到感染部位，但显示出可变的洗脱动力学，并且也代表潜在的感染病灶，因此一旦抗生素洗脱就需要手术切除。可吸收水泥已显示出对更广泛抗生素的洗脱能力得到改善，并且最重要的是完全生物降解，但关于其抗菌和抗生物膜功效的数据有限。评估了负载妥布霉素、万古霉素或万古霉素-妥布霉素双重处理（重量比为 1:0.24）的合成硫酸钙珠相对于 PM MA 珠根除浮游耐甲氧西林金黄色葡萄球菌 (MRSA) 和表皮葡萄球菌的能力。通过结合活细胞计数、共聚焦显微镜和珠表面的扫描电子显微镜，研究了硫酸钙珠在多天内防止生物膜形成和根除预先形成的生物膜的能力。生物膜细菌比浮游细菌对抗生素表现出更大的耐受性。载有抗生素的珠子能够杀死 106 CFU/ml 的浮游培养物，防止细菌定植，并在多天内显着减少生物膜的形成。然而，已形成的生物膜更难根除。这些数据进一步证明了清除已形成的生物膜的难度；因此，早期预防措施是降低感染风险的关键。载有抗生素的合成硫酸钙有可能减少或消除邻近假体周围组织和假体材料上生物膜的形成，从而降低假体周围感染的发生率。
Periprosthetic infection (PI) causes significant morbidity and mortality after fixation and joint arthroplasty and has been extensively linked to the formation of bacterial bio films. Poly(methyl methacrylate) (PM M A), as a cement or as beads, is commonly used for antibiotic release to the site of infection but displays variable elution kinetics and also represents a potential nidus for infection, therefore requiring surgical removal once antibiotics have eluted. 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, or vanco mycin-tobramycin dual treatment (in a 1:0.24 [wt/wt] ratio) were assessed for their abilities to eradicate planktonic methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis relative to that of PM MA beads. The ability of the calcium sulfate beads to prevent biofilm formation over multiple days and to 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 colonization, and significantly reduce biofilm formation over multiple days. However, established biofilms were harder to eradicate. These data further demonstrate the difficulty in clearing established biofilms; therefore, early preventive measures are key to reducing the risk of Pl. Synthetic calcium sulfate loaded with antibiotics has the potential to reduce or eliminate biofilm formation on adjacent periprosthetic tissue and prosthesis material and, thus, to reduce the rates of periprosthetic infection.