Department of Clinical Microbiology, Portsmouth Hospitals National Health Service (NHS) Trust, Queen Alexandra Hospital, Cosham, Portsmouth, UK.
Ann Pharmacother. 2013 Jan;47(1):e2. doi: 10.1345/aph.1R486. Epub 2013 Jan 16.
To describe the safe and successful use of daptomycin-impregnated polymethyl methacrylate (PMMA) bone cement in the treatment of a case of recurrent prosthetic joint infection in a patient with multiple antibiotic allergies and past colonization with multiply antibiotic-resistant organisms.
A 79-year-old female had a history of chronic recurrent left prosthetic hip infection. The patient had confirmed allergies to multiple antibiotics and a past history of colonization with methicillin-resistant Staphylococcus aureus. At first-stage revision surgery, the infected prosthesis was removed and samples were sent for microbiologic culture. A spacer device was fashioned, with incorporation of daptomycin and gentamicin into the PMMA bone cement at a concentration of 5% w/w for each antibiotic. Systemic daptomycin and gentamicin were administered postoperatively for 14 days. Propionibacterium acnes was isolated from deep-tissue specimens. The patient made excellent postoperative progress and was discharged after 2 weeks. Second-stage revision surgery was performed at 6 months, with no signs of persistent infection. She remained well, pain free, and mobilizing independently 2 years later.
Daptomycin, a cyclic lipopeptide antibiotic, is approved for systemic treatment of endocarditis and skin and soft tissue infections. In vitro data demonstrate acceptable drug elution from and tensile strength of daptomycin-impregnated PMMA bone cement; however, clinical data are lacking. In our patient's case, the cement formulation was well tolerated, with no adverse effects detected, and demonstrated adequate mechanical strength in vivo. Infection with P. acnes, an unusual pathogen, was successfully treated. Further clinical studies are required to assess the efficacy of daptomycin-impregnated cement in infection with more typical pathogens, such as S. aureus.
Daptomycin impregnation of PMMA bone cement may be an option in cases in which patient or pathogen factors preclude use of routinely incorporated agents.
描述在一位对多种抗生素过敏且过去定植过多种耐药菌的患者中，使用载有达托霉素的聚甲基丙烯酸甲酯（PMMA）骨水泥进行治疗时，如何确保安全并获得成功。
一名 79 岁女性患有慢性复发性左人工髋关节感染。该患者对多种抗生素均有明确过敏史，且曾定植过耐甲氧西林金黄色葡萄球菌。在初次翻修手术中，我们移除了感染的假体，并送检了微生物培养样本。制作了一个间隔装置，将达托霉素和庆大霉素以 5%w/w 的浓度掺入 PMMA 骨水泥中。术后给予患者 14 天的系统达托霉素和庆大霉素治疗。从深部组织标本中分离出痤疮丙酸杆菌。患者术后恢复良好，2 周后出院。6 个月时进行了二期翻修手术，没有持续感染的迹象。2 年后，她仍状态良好，无疼痛，能独立活动。
达托霉素是一种环状脂肽类抗生素，已获批准用于治疗心内膜炎和皮肤及软组织感染。体外数据表明，载有达托霉素的 PMMA 骨水泥具有可接受的药物洗脱率和拉伸强度；然而，目前缺乏临床数据。在我们的患者病例中，这种水泥配方具有良好的耐受性，未发现不良反应，且在体内具有足够的机械强度。成功治疗了罕见病原体痤疮丙酸杆菌感染。需要进一步的临床研究来评估达托霉素浸渍水泥在治疗更典型病原体（如金黄色葡萄球菌）感染方面的疗效。
在患者因素或病原体因素排除了常规使用的药物时，PMMA 骨水泥载有达托霉素可能是一种选择。
