Zelken Jonathan, Wanich Tony, Gardner Michael, Griffith Matthew, Bostrom Mathias
Hospital for Special Surgery, New York, NY 10021, USA.
Clin Orthop Relat Res. 2007 Sep;462:190-4. doi: 10.1097/BLO.0b013e3180ca9521.
Staphylococcus aureus infection is a serious complication in patients receiving orthopaedic implants. Treatment with antibiotic-loaded cements can deliver high local concentrations and reduce toxic side effects associated with systemic antibiotic administration, but polymethylmethacrylate cement is nondegradable and may necessitate additional surgery for removal. Previous studies provide support for hydroxyapatite as a biodegradable carrier, but consensus has not been achieved. We hypothesized vancomycin-loaded hydroxyapatite was superior to vancomycin-loaded polymethylmethacrylate in reducing the number of bacterial colony-forming units in the setting of osteomyelitis. Osteomyelitis was induced in rats using an established model. Animals then were randomly assigned to a control group (no antibiotics), a group treated with vancomycin-loaded polymethylmethacry-late, and two groups treated with hydroxyapatite loaded with either low-dose or high-dose vancomycin. After 6 weeks we compared the number of colony-forming units per gram of harvested bone between groups. Vancomycin-loaded hydroxyapatite was inferior to vancomycin-loaded polymethylmethacrylate in reducing the number of bacterial colony-forming units and vancomycin-loaded polymethylmethacry-late was superior to the control group. We observed no difference between low- and high-dose vancomycin-loaded hydroxyapatite groups. The poor handling properties of hydroxyapatite paste may explain these findings. Based on these results, a hydroxyapatite carrier cannot be recommended for the treatment of osteomyelitis.
金黄色葡萄球菌感染是接受骨科植入物患者的一种严重并发症。使用载抗生素骨水泥进行治疗可实现高局部浓度，并减少与全身使用抗生素相关的毒副作用，但聚甲基丙烯酸甲酯骨水泥不可降解，可能需要额外手术取出。先前的研究支持将羟基磷灰石作为一种可生物降解的载体，但尚未达成共识。我们假设载万古霉素的羟基磷灰石在减少骨髓炎情况下的细菌菌落形成单位数量方面优于载万古霉素的聚甲基丙烯酸甲酯。使用已建立的模型在大鼠中诱发骨髓炎。然后将动物随机分为对照组（不使用抗生素）、载万古霉素聚甲基丙烯酸甲酯治疗组以及载低剂量或高剂量万古霉素的羟基磷灰石治疗的两组。6周后，我们比较了各组每克收获骨中的菌落形成单位数量。载万古霉素的羟基磷灰石在减少细菌菌落形成单位数量方面不如载万古霉素的聚甲基丙烯酸甲酯，且载万古霉素的聚甲基丙烯酸甲酯优于对照组。我们观察到载低剂量和高剂量万古霉素的羟基磷灰石组之间没有差异。羟基磷灰石糊剂较差的操作性能可能解释了这些结果。基于这些结果，不推荐使用羟基磷灰石载体治疗骨髓炎。
