Antibiotic-impregnated cement use in U.S. hospitals

Area of Science:

• Orthopedics
• Infectious Diseases
• Hospital Pharmacy Practice

Background:

• Antibiotic-impregnated bone cement and beads are utilized to prevent and treat bone infections.
• Understanding the current utilization patterns and pharmacy involvement is crucial for optimizing antimicrobial stewardship.

Purpose of the Study:

• To survey the use of antibiotic-impregnated bone cement and cement beads in U.S. hospitals.
• To assess the extent of product use and the degree of pharmacy involvement.

Main Methods:

• A national survey of 547 U.S. hospitals using a mailed questionnaire.
• Analysis of responses from 336 hospitals (61.7% response rate).

Main Results:

• 26.9% of hospitals reported using antibiotic-impregnated bone cement or beads.
• Usage was higher in urban, larger ( >200 beds), teaching, and hospitals with operating room pharmacy services.
• Common indications include total hip/knee arthroplasty and chronic osteomyelitis; systemic antibiotics were co-administered.
• Products used in <1 procedure/month; aminoglycosides and cephalosporins most common, often without adequate study.
• Pharmacies purchased antibiotics but did not mix cement or extensively prepare beads.

Conclusions:

• Antibiotic-impregnated bone cement and beads are used by a notable minority of U.S. hospitals, particularly for specific orthopedic and infectious indications.
• Despite use, the overall volume is low, and the specific antibiotics employed often lack robust study for these applications.
• Hospital pharmacies are involved in procurement but not typically in the preparation of these antibiotic delivery systems.