Neut Daniëlle, Hendriks Johannes G E, van Horn Jim R, Kowalski Rick S Z, van der Mei Henny C, Busscher Henk J
Department of Orthopedic Surgery, University Medical Center Groningen, and University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
J Orthop Res. 2006 Feb;24(2):291-9. doi: 10.1002/jor.20058.
The increasing gentamicin resistance among bacteria in septic joint arthroplasty has stimulated interest in adding a second antibiotic into gentamicin-loaded bone cement. A first aim of this in vitro study is to investigate whether addition of fusidic acid or clindamycin to gentamicin-loaded bone cement has an additional antimicrobial effect against a collection of 38 clinical isolates, including 16 gentamicin-resistant strains. A modified Kirby-Bauer test, involving measurement of the inhibition zone around antibiotic-loaded bone cement discs on agar plates, was used to investigate whether adding a second antibiotic has an additional antimicrobial effect. Second, a selected number of strains was used to study their survival in an interfacial gap made in the different bone cements to mimic the gap between bone and cement as existing near a prosthesis. Gentamicin-loaded bone cement had an antimicrobial activity against 58% of the 38 bacterial strains included in this study, while 68% of the strains were affected by bone cement loaded with a combination of gentamicin and clindamycin. Bone cement loaded with the combination of gentamicin and fusidic acid had antimicrobial activity against 87% of the bacterial strains. In the prosthesis-related gap model, there was a clear trend toward less bacterial survival for gentamicin-loaded bone cement after adding clindamycin or fusidic acid. Addition of clindamycin or fusidic acid into gentamicin-loaded bone cement yields an additional antimicrobial effect. The combination gentamicin and fusidic acid was effective against a higher number of clinical isolates than the combination of gentamicin with clindamycin, including gentamicin-resistant strains.
在化脓性关节置换术中，细菌对庆大霉素的耐药性不断增加，这激发了人们在载有庆大霉素的骨水泥中添加第二种抗生素的兴趣。这项体外研究的首要目的是调查在载有庆大霉素的骨水泥中添加夫西地酸或克林霉素，是否对38株临床分离菌（包括16株耐庆大霉素菌株）具有额外的抗菌作用。采用改良的 Kirby-Bauer 试验，通过测量琼脂平板上载有抗生素的骨水泥圆盘周围的抑菌圈，来研究添加第二种抗生素是否具有额外的抗菌作用。其次，选择一定数量的菌株，研究它们在不同骨水泥制成的界面间隙中的存活情况，以模拟假体附近骨与骨水泥之间存在的间隙。载有庆大霉素的骨水泥对本研究中包含的38株细菌中的58%具有抗菌活性，而68%的菌株受到载有庆大霉素和克林霉素组合的骨水泥的影响。载有庆大霉素和夫西地酸组合的骨水泥对87%的细菌菌株具有抗菌活性。在假体相关间隙模型中，添加克林霉素或夫西地酸后，载有庆大霉素的骨水泥中细菌存活明显减少。在载有庆大霉素的骨水泥中添加克林霉素或夫西地酸可产生额外的抗菌作用。与庆大霉素和克林霉素的组合相比，庆大霉素和夫西地酸的组合对更多的临床分离菌有效，包括耐庆大霉素菌株。
