Related Experiment Videos
Elution of vancomycin, daptomycin, and amikacin from acrylic bone cement
D K Kuechle1, G C Landon, D M Musher
1Orthopedic Surgery Service, Veterans Administration Medical Center, Houston, Texas.
Abstract:
Increasing antibiotic resistance of bacteria that infect prosthetic joints has stimulated interest in the incorporation of more effective antimicrobial agents into polymethylmethacrylate (PMMA). Vancomycin and daptomycin are effective against nearly all staphylococci and streptococci, and amikacin has a broader spectrum against gram-negative bacilli than do other aminoglycosides such as gentamicin. These three antibiotics maintained bioactivity after incorporation into several commonly used preparations of PMMA and eluted readily into the surrounding medium. Preparing PMMA under negative atmospheric pressure, which decreases porosity, caused a 50% reduction in antibiotic release; the addition of 25% dextran, which increases porosity, greatly facilitated elution of these antibiotics. Based on their broad antibacterial effect against gram-positive and gram-negative bacteria, inclusion of vancomycin and amikacin in PMMA merits clinical study. The addition of these antibiotics to PMMA, together with dextran, may be applicable when structural integrity is unimportant but a substantial local antimicrobial effect is desired, such as in the use of antibiotic-containing beads to treat osteomyelitis.
Insights
Incorporating antibiotics like vancomycin and amikacin into polymethylmethacrylate (PMMA) shows promise for combating prosthetic joint infections. Modifying PMMA porosity impacts antibiotic release, suggesting tailored applications for enhanced antimicrobial effects.
Area of Science:
- Biomaterials Science
- Infectious Disease Research
- Orthopedic Surgery
Background:
- Rising antibiotic resistance in prosthetic joint infections necessitates novel antimicrobial strategies.
- Polymethylmethacrylate (PMMA) is a common bone cement used in orthopedic procedures.
- Effective antimicrobial agents are needed to prevent and treat implant-associated infections.
Purpose of the Study:
- To evaluate the bioactivity and elution of vancomycin, daptomycin, and amikacin from PMMA.
- To investigate the effect of PMMA porosity on antibiotic release kinetics.
- To assess the potential of antibiotic-loaded PMMA for treating orthopedic infections.
Main Methods:
- Incorporation of vancomycin, daptomycin, and amikacin into PMMA formulations.
- Measurement of antibiotic bioactivity and elution rates.
- Modification of PMMA porosity using negative atmospheric pressure and dextran addition.
Main Results:
- Vancomycin, daptomycin, and amikacin maintained bioactivity and eluted from PMMA.
- Reduced PMMA porosity (negative pressure) decreased antibiotic release by 50%.
- Increased PMMA porosity (25% dextran) significantly enhanced antibiotic elution.
Conclusions:
- Vancomycin and amikacin demonstrate broad-spectrum efficacy suitable for PMMA incorporation.
- PMMA porosity is a critical factor influencing local antibiotic delivery.
- Antibiotic-loaded PMMA, particularly with dextran, offers potential for treating osteomyelitis and other orthopedic infections where structural integrity is secondary to antimicrobial effect.