Vancomycin and Ceftazidime in Bone Cement as a Potentially Effective Treatment for Knee Periprosthetic Joint Infection
Vancomycin and Ceftazidime in Bone Cement as a Potentially Effective Treatment for Knee Periprosthetic Joint Infection
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DOI：
10.2106/jbjs.16.00290
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发表时间：
2017-02-01
影响因子：
5.3
通讯作者：
Chang, Yuhan
中科院分区：
文献类型：
--
作者：
Hsu, Yung-Heng;Hu, Chih-chien;Chang, Yuhan
背景：本研究的目的是确定治疗膝关节假体周围感染的抗生素骨水泥的最佳配方。我们使用了包含各种广谱抗生素的体外和体内模型，并测试了它们对革兰氏阳性和革兰氏阴性细菌的功效。方法：研究了负载有 4 g 万古霉素或替考拉宁和 4 g 头孢他啶、亚胺培南或氨曲南的骨水泥样本，以测量其体外抗生素释放特性和 对甲氧西林敏感金黄色葡萄球菌、耐甲氧西林金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌和大肠杆菌有抗菌能力。然后，将装载有具有优异体外抗菌能力的抗生素的骨水泥垫片植入8名被诊断患有慢性膝假体周围关节感染的患者（4名女性和4名男性，年龄在51至79岁之间）体内。植入间隔物后，测量感染部位关节液中的抗生素浓度和抗菌活性。结果：负载万古霉素和头孢他啶的水泥样品对测试微生物表现出体外抗菌活性，其持续时间与负载其他抗生素组合的水泥样品一样长或更长。关节液样本表现出对细菌的活性，包括美国典型培养物保藏中心（ATCC）菌株和临床分离菌株。结论：负载万古霉素和头孢他啶的骨水泥在体外和体内均具有广谱抗菌能力，被证明是治疗膝关节假体周围感染的潜在有效治疗措施。
Background: The aim of this study was to determine the optimal formulation of antibiotic-loaded bone cement for knee periprosthetic joint infection. We used both in vitro and in vivo models incorporating various broad-spectrum antibiotics and tested their efficacy against gram-positive and gram-negative bacteria.Methods: Bone cement specimens loaded with 4 g of either vancomycin or teicoplanin and 4 g of ceftazidime, imipenem, or aztreonam were studied to measure their in vitro antibiotic release characteristics and antibacterial capacities against methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Escherichia coli. Bone cement spacers loaded with the antibiotics with the superior in vitro antibacterial capacity were then implanted into 8 patients (4 women and 4 men between 51 and 79 years of age) diagnosed with chronic knee periprosthetic joint infection. The antibiotic concentrations and antibacterial activities in the joint fluid at the site of the infection were measured following spacer implantation.Results: Cement samples loaded with vancomycin and ceftazidime exhibited in vitro antibacterial activity against the test microorganisms that lasted for as long as or longer than that of cement loaded with the other antibiotic combinations. Joint fluid samples exhibited activity against bacteria including American Type Culture Collection (ATCC) strains and clinically isolated strains.Conclusions: Bone cement loaded with vancomycin and ceftazidime provided broad-spectrum antibacterial capacity both in vitro and in vivo and was shown to be a potentially effective therapeutic measure in the treatment of knee periprosthetic joint infections.