Hsu Yuan-Ming, Liao Chun-Hsing, Wei Yu-Hong, Fang Hsu-Wei, Hou Hsiang-Huan, Chen Chia-Chun, Chang Chih-Hung
Division of Orthopaedics, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan.
Artif Organs. 2014 Jun;38(6):484-92. doi: 10.1111/aor.12197. Epub 2013 Oct 29.
Antibiotic-loaded acrylic bone cement has been frequently used as an infection prophylaxis or antibiotic-loaded spacer in infected arthroplasty. In addition, daptomycin has been used recently against broad spectrum Gram-positive organisms. The goal of this in vitro study is to investigate the bacteriacidal and mechanical properties of daptomycin-incorporated polymethylmethacrylate (PMMA) bone cement and evaluate its feasibility for clinical use. Daptomycin (0.5, 1, or 2 g) was premixed with 40 g of PMMA bone cement powder before curing. The mechanical properties of the daptomycin-loaded acrylic bone cement (DLABC) were estimated following standard guidance, and the release profile and kinetics of daptomycin from PMMA were analyzed. The antimicrobial efficacy of DLABC was determined with a zone of inhibition (ZOI) assay against Staphylococcus aureus, Staphylococcus epidermis, Enterococcus faecalis, and Enterococcus faecium, respectively. The results showed that the compressive strength, of PMMA bone cement, which was higher than 100 MPa in all groups, was sufficient according to ISO 5833 after incorporation of daptomycin. The encapsulated daptomycin was released for 2 weeks with a 9.59 ± 0.85%, 15.25 ± 0.69%, and 20.64 ± 20.33% released percentage on the first day in the low, mid, and high groups, respectively. According to the calculated release kinetics, incorporated daptomycin should be 3.3 times the original dose to double its release. Although all recipes of DLABC had a microbial inhibitory effect, the effect with a higher encapsulated amount of daptomycin was more significant. Therefore, we believe that daptomycin can be locally delivered from PMMA bone cement at the surgical site as a prophylactic or treatment for osteomyelitis against Gram-positive organisms with intact cement function.
载抗生素丙烯酸骨水泥已被频繁用作感染预防措施或用于感染性关节成形术中的载抗生素间隔物。此外,达托霉素最近已被用于对抗广谱革兰氏阳性菌。本体外研究的目的是研究掺入达托霉素的聚甲基丙烯酸甲酯(PMMA)骨水泥的杀菌和力学性能,并评估其临床应用的可行性。在固化前,将达托霉素(0.5、1或2 g)与40 g PMMA骨水泥粉末预混合。按照标准指南评估载达托霉素丙烯酸骨水泥(DLABC)的力学性能,并分析达托霉素从PMMA中的释放曲线和动力学。分别通过对金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌和屎肠球菌的抑菌圈(ZOI)试验来确定DLABC的抗菌效果。结果显示,掺入达托霉素后,所有组的PMMA骨水泥抗压强度均高于100 MPa,根据ISO 5833标准,该强度是足够的。包封的达托霉素在低、中、高剂量组分别于第一天释放9.59±0.85%、15.25±0.69%和20.64±20.33%,持续释放2周。根据计算的释放动力学,掺入的达托霉素剂量应为原始剂量的3.3倍才能使其释放量翻倍。尽管所有配方的DLABC都有抑菌作用,但达托霉素包封量较高时效果更显著。因此,我们认为达托霉素可从PMMA骨水泥在手术部位局部递送,作为针对革兰氏阳性菌的骨髓炎预防或治疗手段,同时保持骨水泥功能完好。