Local Application of Vancomycin in One-Stage Revision of Prosthetic Joint Infection Caused by Methicillin-Resistant Staphylococcus aureus

Area of Science:

• Orthopedics
• Infectious Diseases
• Pharmacology

Background:

• Periprosthetic joint infection (PJI) caused by methicillin-resistant Staphylococcus aureus (MRSA) presents a significant challenge.
• Current systemic vancomycin treatment for MRSA PJI after one-stage revision arthroplasty has unsatisfactory eradication rates.

Purpose of the Study:

• To evaluate the efficacy and safety of intraarticular (IA) vancomycin injection compared to intraperitoneal (IP) vancomycin for controlling MRSA PJI in a rat model.
• To determine the optimal vancomycin administration route for MRSA PJI eradication.

Main Methods:

• A rat model of MRSA PJI was established following one-stage revision surgery.
• Animals received two weeks of either IP vancomycin, IA vancomycin, or a combination of both IP and IA vancomycin.
• Outcomes were assessed by measuring skin temperature, bacterial counts, biofilm formation, serum inflammatory markers, bone volume, and joint tissue inflammation.

Main Results:

• IA vancomycin treatment demonstrated superior outcomes in reducing infection markers compared to IP vancomycin alone.
• Combined IP and IA vancomycin administration yielded the best overall results.
• Only the combination therapy achieved complete MRSA eradication.
• Minimal renal pathology was observed in the IP and combined IP/IA groups, with no significant liver or serum marker changes.

Conclusions:

• Intraarticular vancomycin is an effective and safe adjunctive treatment for MRSA PJI in a rat model, outperforming systemic administration.
• Combined intraarticular and systemic vancomycin administration is necessary for complete MRSA eradication within a 2-week treatment course.
• This approach offers a promising strategy for managing challenging MRSA PJI cases.