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Published on: March 3, 2023
Potential interactions between vancomycin and meropenem in culture-negative periprosthetic joint infection: an in
Liqin Yao1, Youcai Ma2, Rui Liu3
1Orthopedic Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China.
Background:
Culture-negative periprosthetic joint infections (CN-PJIs) represent a critical subtype of PJI, and their high prevalence poses substantial challenges for treatment. CN-PJI is commonly managed utilizing antibiotic combinations, however, the interactions between these antibiotics have not been investigated. The aim of study was to investigate the synergistic and antagonistic effects of vancomycin (VAN) and meropenem (MEM), in an in vitro model of CN-PJI.
Methods:
Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC), Minimum Biofilm Inhibitory Concentration (MBIC), and Minimum Biofilm Eradication Concentration (MBEC) were determined for VAN and MEM. Fractional Inhibitory Concentration (FIC) and Fractional Biofilm Eradication Concentration (FBEC) indices were calculated to assess the synergistic or antagonistic effects of VAN in combination with MEM on Staphylococcus aureus (S. aureus), Staphylococcus epidermidis (S. epidermidis), and Escherichia coli (E. coli) incubated alone or in combination.
Results:
In the planktonic bacterial phase, MEM showed higher activity than VAN. Resistance increased when the bacteria were cultured together. The combination of VAN and MEM exhibited an indifferent effect against individual Staphylococci but an antagonistic effect against polymicrobial cultures. In biofilm, MEM demonstrated better antibiofilm activity than VAN, especially against E. coli biofilms. The combination of VAN and MEM showed an indifferent effect against E. coli and S. epidermidis-E. coli biofilms, but an antagonistic effect against S. aureus, S. epidermidis, S. aureus-S. epidermidis, and S. aureus-E. coli biofilms.
Conclusion:
This study provides valuable insights into the effectiveness of VAN and MEM combinations in treating CN-PJIs, highlighting the need for careful consideration when selecting antibiotic treatments for these infections.
Clinical Trial Number:
Not applicable.
Insights
The combination of vancomycin (VAN) and meropenem (MEM) showed antagonistic effects against polymicrobial cultures and biofilms in a culture-negative periprosthetic joint infection (CN-PJI) model. This suggests careful antibiotic selection is crucial for treating these challenging infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Culture-negative periprosthetic joint infections (CN-PJIs) are a significant clinical challenge.
- Current treatment often involves antibiotic combinations, but their interactions are not well understood.
- Investigating antibiotic interactions is crucial for optimizing CN-PJI management.
Purpose of the Study:
- To evaluate the synergistic and antagonistic effects of vancomycin (VAN) and meropenem (MEM) against common pathogens in an in vitro model of CN-PJI.
- To assess the impact of VAN and MEM combinations on planktonic and biofilm bacterial growth.
Main Methods:
- Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC), Minimum Biofilm Inhibitory Concentration (MBIC), and Minimum Biofilm Eradication Concentration (MBEC) were determined for VAN and MEM.
- Fractional Inhibitory Concentration (FIC) and Fractional Biofilm Eradication Concentration (FBEC) indices were calculated.
- Effects were tested on Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli, alone and in combination, in planktonic and biofilm states.
Main Results:
- Meropenem (MEM) demonstrated higher activity than vancomycin (VAN) against planktonic bacteria and biofilms.
- The VAN and MEM combination showed indifferent effects against individual Staphylococci but antagonistic effects against polymicrobial cultures.
- In biofilms, the VAN and MEM combination was antagonistic against most tested combinations, particularly those involving Staphylococcus aureus.
Conclusions:
- The combination of VAN and MEM exhibits antagonistic effects in polymicrobial and biofilm settings relevant to CN-PJI.
- These findings underscore the importance of considering specific bacterial compositions and growth states when selecting antibiotic regimens for CN-PJIs.
- Further research into antibiotic interactions is necessary to improve treatment strategies for culture-negative infections.
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