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PMMA bead versus parenteral treatment of Staphylococcus aureus osteomyelitis
Abstract:
A. rabbit model of Staphylococcus aureus osteomyelitis was used to compare 3 weeks of clindamycin-impregnated polymethylmethacralate (PMMA) bead treatment with 3 weeks of gentamicin-impregnated polymethylmethacralate bead treatment, 4 weeks of parenteral clindamycin treatment, and surgical debridement without any antibiotic treatment. The animals were weighed throughout the course of the experiment and cortical bone and marrow flush specimens were obtained for bacterial culture at the end of therapy. The cortical specimens were bacteria free in 100% (6/6) of the animals receiving parenteral clindamycin, 83% (5/6) of the animals in the clindamycin PMMA group and, none of the animals in the gentamicin PMMA group. The marrow flush specimens were bacteria free in 83% (5/6) of the animals in the parenteral clindamycin group, 67% (4/6) of the animals in the clindamycin PMMA group, and 40% (2/5) of the animals in the gentamicin PMMA group. While these findings are preliminary and further studies with larger numbers of animals are needed, the authors suggest that when PMMA bead therapy is being contemplated, serious consideration should be given to replacing gentamicin with clindamycin in treatment of gram-positive osteomyelitis. Furthermore, incorporation of clindamycin with gentamicin (or tobramycin) should be considered when treating mixed gram-positive and gram-negative osteomyelitis.
Insights
Clindamycin-impregnated polymethylmethacrylate (PMMA) beads show promise for treating Staphylococcus aureus osteomyelitis in rabbits, outperforming gentamicin beads. Consider clindamycin for gram-positive bone infections.
Area of Science:
- Orthopedics
- Infectious Diseases
- Biomaterials Science
Background:
- Osteomyelitis, a bone infection, poses significant treatment challenges.
- Polymethylmethacrylate (PMMA) beads are utilized for localized antibiotic delivery in bone infections.
- Evaluating the efficacy of different antibiotic-impregnated PMMA beads is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare the efficacy of clindamycin-impregnated PMMA beads versus gentamicin-impregnated PMMA beads in a rabbit model of Staphylococcus aureus osteomyelitis.
- To assess parenteral clindamycin treatment and surgical debridement alone as control groups.
- To guide the selection of antibiotics for PMMA bead therapy in gram-positive and mixed bacterial bone infections.
Main Methods:
- A rabbit model of Staphylococcus aureus osteomyelitis was established.
- Treatment groups included clindamycin-PMMA beads, gentamicin-PMMA beads, parenteral clindamycin, and surgical debridement alone.
- Cortical bone and marrow flush specimens were cultured post-treatment to assess bacterial eradication.
Main Results:
- Parenteral clindamycin achieved 100% bacterial eradication in cortical bone specimens.
- Clindamycin-PMMA beads resulted in 83% eradication in cortical bone and 67% in marrow flush.
- Gentamicin-PMMA beads showed lower efficacy, with 0% cortical and 40% marrow eradication.
Conclusions:
- Clindamycin appears more effective than gentamicin when impregnated in PMMA beads for Staphylococcus aureus osteomyelitis.
- The study suggests replacing gentamicin with clindamycin for gram-positive osteomyelitis treated with PMMA beads.
- Combination therapy with clindamycin and gentamicin/tobramycin may be beneficial for mixed infections.
