Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, ON, Canada; Orthopaedics and Trauma Department, Consorci Sanitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain.
Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
J Shoulder Elbow Surg. 2022 Jan;31(1):159-164. doi: 10.1016/j.jse.2021.06.015. Epub 2021 Aug 2.
Intra-incisional deposition of vancomycin powder is a strategy to limit Cutibacterium acnes infection after shoulder surgery. Unfortunately, limited research exists examining the effectiveness of vancomycin in a clinically relevant joint infection model. This basic science study investigated the efficacy of vancomycin administration as prophylaxis for C acnes growth in vitro using a mimetic shoulder arthroplasty.
A new bioartificial shoulder joint mimetic implant (S-JIM) was used to investigate the effect of vancomycin powder on C acnes growth within the first 48 hours after surgery. The impact of vancomycin was assessed on a skin-derived (ATCC 11827) C acnes strain and a periprosthetic joint infection-derived strain. C acnes strains were applied to titanium alloy foil and embedded beneath multiple layers of collagen-impregnated cellulose scaffold strips containing human shoulder joint capsular fibroblasts, facilitating the development of an oxygen gradient with an anaerobic environment around the foil and inner layers. Ten milligrams of vancomycin powder was applied between the C acnes layer and the human cell-containing scaffold strips to model direct antibiotic application, and intravenous vancomycin prophylaxis was modeled by adding vancomycin in media at 5 or 20 μg/mL. After 48 hours, the C acnes inoculum layer was subcultured from each S-JIM onto agar plates to assess the formation of viable C acnes colonies. Primary human shoulder capsule cells were assessed microscopically to detect any detrimental effects of vancomycin on cellular integrity.
Agar plates inoculated with extracts from untreated S-JIMs consistently resulted in the growth of large numbers of C acnes colonies, whereas treatments with vancomycin powder or vancomycin in media at 20-μg/mL dilution effectively prevented the recovery of any C acnes colonies. The lowest vancomycin dilution tested (5 μg/mL) was insufficient to prevent the recovery of C acnes colonies. Vancomycin powder had no discernible short-term impact on shoulder capsule cell morphology, and the presence of these cells had no discernible impact on vancomycin degradation over time.
Vancomycin administration effectively prevented C acnes growth in a bioartificial S-JIM. These results support the hypothesis that intra-incisional vancomycin application may limit C acnes prosthetic joint infections.
关节内注射万古霉素粉末是一种限制术后肩袖感染痤疮丙酸杆菌的策略。不幸的是，目前还没有研究探讨万古霉素在临床相关的关节感染模型中的效果。本基础科学研究使用模拟肩关节炎假体，调查万古霉素给药作为痤疮丙酸杆菌生长的预防措施的效果。
使用新的生物人工肩关节模拟植入物（S-JIM）研究万古霉素粉末在手术后前 48 小时内对 C 痤疮生长的影响。评估了万古霉素对皮肤来源（ATCC 11827）C 痤疮菌株和假体周围关节感染来源菌株的影响。将 C 痤疮菌株应用于钛合金箔片，并嵌入多层胶原蛋白浸渍纤维素支架条中，其中含有人类肩关节囊成纤维细胞，有利于在箔片和内层周围形成一个具有厌氧环境的氧气梯度。在 C 痤疮层和含有人体细胞的支架条之间应用 10 毫克万古霉素粉末模拟直接抗生素应用，通过在 5 或 20μg/mL 的培养基中添加万古霉素模拟静脉内万古霉素预防。48 小时后，从每个 S-JIM 中的 C 痤疮接种层接种琼脂平板，以评估活菌 C 痤疮菌落的形成。用万古霉素处理后，用显微镜评估原代人肩关节囊细胞，以检测万古霉素对细胞完整性的任何有害影响。
未经处理的 S-JIM 接种的琼脂平板始终导致大量 C 痤疮菌落的生长，而万古霉素粉末或 20μg/mL 稀释培养基中的万古霉素处理有效地防止了任何 C 痤疮菌落的恢复。测试的最低万古霉素稀释度（5μg/mL）不足以防止 C 痤疮菌落的恢复。万古霉素粉末对肩囊细胞形态没有明显的短期影响，并且这些细胞的存在对万古霉素随时间的降解没有明显影响。
万古霉素给药有效地防止了生物人工 S-JIM 中 C 痤疮的生长。这些结果支持了这样一种假设，即在关节内注射万古霉素可能会限制 C 痤疮假体关节感染。
