Stravinskas M, Nilsson M, Vitkauskiene A, Tarasevicius S, Lidgren L
Orthopaedic Surgeon, Lithuanian University of Health, Kaunas, Lithuania.
Department of Orthopedics, Lund University Hospital, Lund, Sweden.
Bone Joint Res. 2019 Mar 2;8(2):49-54. doi: 10.1302/2046-3758.82.BJR-2018-0174.R2. eCollection 2019 Feb.
The aim of this study was to analyze drain fluid, blood, and urine simultaneously to follow the long-term release of vancomycin from a biphasic ceramic carrier in major hip surgery. Our hypothesis was that there would be high local vancomycin concentrations during the first week with safe low systemic trough levels and a complete antibiotic release during the first month.
Nine patients (six female, three male; mean age 75.3 years (sd 12.3; 44 to 84)) with trochanteric hip fractures had internal fixations. An injectable ceramic bone substitute, with hydroxyapatite in a calcium sulphate matrix, containing 66 mg of vancomycin per millilitre, was inserted to augment the fixation. The vancomycin elution was followed by simultaneously collecting drain fluid, blood, and urine.
The antibiotic concentration in the drain reached a peak during the first six hours post-surgery (mean 966.1 mg/l), which decreased linearly to a mean value of 88.3 mg/l at 2.5 days. In the urine, the vancomycin concentration reached 99.8 mg/l during the first two days, followed by a logarithmic decrease over the next two weeks to reach 0 mg/l at 20 days. The systemic concentration of vancomycin measured in blood serum was low and decreased linearly from 2.17 mg/l at one hour post-surgery to 0 mg/l at four days postoperatively.
This is the first long-term pharmacokinetic study that reports vancomycin release from a biphasic injectable ceramic bone substitute. The study shows initial high targeted local vancomycin levels, sustained and complete release at three weeks, and systemic concentrations well below toxic levels. The plain ceramic bone substitute has been proven to regenerate bone but should also be useful in preventing bone infection.: M. Stravinskas, M. Nilsson, A. Vitkauskiene, S. Tarasevicius, L. Lidgren. Vancomycin elution from a biphasic ceramic bone substitute. 2019;8:49-54. DOI: 10.1302/2046-3758.82.BJR-2018-0174.R2.
本研究旨在同时分析引流液、血液和尿液，以追踪万古霉素在髋关节大手术中从双相陶瓷载体的长期释放情况。我们的假设是，在第一周会有较高的局部万古霉素浓度，同时全身谷浓度安全较低，且在第一个月内抗生素完全释放。
9例（6例女性，3例男性；平均年龄75.3岁（标准差12.3；44至84岁））转子间髋部骨折患者接受了内固定手术。一种可注射的陶瓷骨替代物被插入以增强固定，该替代物是硫酸钙基质中的羟基磷灰石，每毫升含有66毫克万古霉素。通过同时收集引流液、血液和尿液来追踪万古霉素的洗脱情况。
引流液中的抗生素浓度在术后前6小时达到峰值（平均966.1毫克/升），在2.5天时线性下降至平均88.3毫克/升。在尿液中，万古霉素浓度在头两天达到99.8毫克/升，随后在接下来的两周内呈对数下降，在20天时降至0毫克/升。血清中测得的万古霉素全身浓度较低，从术后1小时的2.17毫克/升线性下降至术后4天的0毫克/升。
这是第一项报告万古霉素从双相可注射陶瓷骨替代物释放情况的长期药代动力学研究。该研究显示，最初局部万古霉素水平较高且靶向性好，在三周时持续且完全释放，全身浓度远低于中毒水平。普通陶瓷骨替代物已被证明可促进骨再生，但也应有助于预防骨感染。：M. 斯特拉文斯卡斯、M. 尼尔森、A. 维特考斯基内、S. 塔拉塞维丘斯、L. 利德格伦。万古霉素从双相陶瓷骨替代物中的洗脱。2019年；8：49 - 54。DOI：10.1302/2046 - 3758.82.BJR - 2018 - 0174.R2 。
