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Synovial vancomycin and meropenem concentrations in periprosthetic joint infection treated by single-stage revision
Chen Zou1, Wentao Guo1, Wenbo Mu1
1Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Aims:
We aimed to determine the concentrations of synovial vancomycin and meropenem in patients treated by single-stage revision combined with intra-articular infusion following periprosthetic joint infection (PJI), thereby validating this drug delivery approach.
Methods:
We included 14 patients with PJI as noted in their medical records between November 2021 and August 2022, comprising eight hip and seven knee joint infections, with one patient experiencing bilateral knee infections. The patients underwent single-stage revision surgery, followed by intra-articular infusion of vancomycin and meropenem (50,000 µg/ml). Synovial fluid samples were collected to assess antibiotic concentrations using high-performance liquid chromatography.
Results:
The peak concentrations of vancomycin and meropenem in the joint cavity were observed at one hour post-injection, with mean values of 14,933.9 µg/ml (SD 10,176.3) and 5,819.1 µg/ml (SD 6,029.8), respectively. The trough concentrations at 24 hours were 5,495.0 µg/ml (SD 2,360.5) for vancomycin and 186.4 µg/ml (SD 254.3) for meropenem. The half-life of vancomycin was 6 hours, while that of meropenem ranged between 2 and 3.5 hours. No significant adverse events related to the antibiotic administration were observed.
Conclusion:
This method can achieve sustained high antibiotic concentrations within the joint space, exceeding the reported minimum biofilm eradication concentration. Our study highlights the remarkable effectiveness of intra-articular antibiotic infusion in delivering high intra-articular concentrations of antibiotics. The method provided sustained high antibiotic concentrations within the joint cavity, and no severe side-effects were observed. These findings offer evidence to improve clinical treatment strategies. However, further validation is required through studies with larger sample sizes and higher levels of evidence.
Insights
This study shows that intra-articular antibiotic infusion effectively delivers high concentrations of vancomycin and meropenem to the joint space, aiding periprosthetic joint infection treatment with no observed adverse events.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Pharmacology
Background:
- Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
- Effective antibiotic delivery to the infected joint space is crucial for successful treatment.
- Single-stage revision surgery combined with intra-articular antibiotic infusion is a potential treatment strategy.
Purpose of the Study:
- To determine synovial fluid concentrations of vancomycin and meropenem after intra-articular infusion during single-stage revision for PJI.
- To validate the efficacy of intra-articular antibiotic delivery for PJI treatment.
Main Methods:
- 14 patients with PJI underwent single-stage revision and received intra-articular vancomycin and meropenem infusion.
- Synovial fluid samples were collected at various time points post-infusion.
- Antibiotic concentrations were quantified using high-performance liquid chromatography.
Main Results:
- Peak vancomycin and meropenem concentrations were achieved at 1 hour post-injection (mean 14,933.9 µg/ml and 5,819.1 µg/ml, respectively).
- Trough concentrations at 24 hours remained high (vancomycin 5,495.0 µg/ml, meropenem 186.4 µg/ml).
- Vancomycin half-life was 6 hours; meropenem half-life was 2-3.5 hours, with no significant adverse events.
Conclusions:
- Intra-articular antibiotic infusion achieves sustained, high antibiotic concentrations in the joint space, exceeding minimum biofilm eradication concentrations.
- This method is effective and safe for treating PJI, offering a promising clinical strategy.
- Further validation with larger studies is recommended.
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