The in vitro antibacterial effect of S53P4 bioactive glass and gentamicin impregnated polymethylmethacrylate beads

Osteomyelitis is a disease that is still difficult to treat, with considerable morbidity and associated costs. The current "gold standard" in treatment - debridement and implantation of antibiotic impregnated polymethylmethacrylate (PMMA) beads - presents the disadvantage of a second surgical intervention required for the removal of the beads. We comparatively investigated the in vitro antibacterial effect of S53P4 bioactive glass (BAG) and gentamicin impregnated PMMA beads. Bacterial viability was assessed hourly by Standard Plate Count during 24 hours of incubation, by determining the number of colony forming units (CFU) of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli and Klebsiella pneumoniae. Both tested materials showed an antibacterial effect on all studied bacteria. In case of S. aureus, BAG granules were almost as effective as gentamicin impregnated PMMA beads, with no statistically significant differences. In contrast, PMMA beads had a superior antibacterial effect on S. epidermidis and K. pneumoniae. The antibacterial effect of BAG was greatly influenced by granule size and contact time. There was a statistically significant correlation between pH values and the number of CFU in the case of S53P4 BAG granules. As a biocompatible and biodegradable bone substitute, S53P4 bioactive glass can be a good alternative in the local management of osteomyelitis.