手动向聚甲基丙烯酸甲酯(PMMA)骨水泥中添加万古霉素的影响。
Impact of Manual Addition of Vancomycin to Polymethylmethacrylate (PMMA) Cements.
作者信息
Kittinger Clemens, Eder-Halbedl Michael, Kühn Klaus Dieter
机构信息
Development and Research Insitute of Hygiene, Microbiology and Environmental Medicine, Hygiene Medical University of Graz, Neue Stiftingtalstraße 6/III 1, 8010 Graz, Austria.
Department of Orthopedics and Trauma, LKH-Feldbach, Ottokar-Kernstock-Straße 18, 8330 Feldbach, Austria.
出版信息
Antibiotics (Basel). 2024 Aug 1;13(8):721. doi: 10.3390/antibiotics13080721.
(1) Background: The addition of antibiotics to bone cements is a common practice in the treatment of periprosthetic joint infections. In revision cases, the amount and type of antibiotic is often insufficient and additional antibiotics must be added. The addition, however, changes the product itself, and the surgeon becomes the "manufacturer" of the bone cement. PMMAe wished to clarify whether the admixture of antibiotics changes the mechanical stability of the bone cements used and if the added antibiotics were still functional and released in sufficient quantities. (2) Methods: We compared two industrially manufactured vancomycin-containing PMMA cements; the low-viscous VancogenX (TECRES, Sommacampagna, Italy) and the high-viscous Copal G+V (Heraeus Medical GmbH, Wehrheim, Germany), with two PMMA cements loaded with aminoglycosides, to which 2.0 g of vancomycin (Hexal CT1631) were manually added-the high-viscous Smartset GHV and the medium-viscous Antibiotic Simplex with Tobramycin (antibiotic Simplex T). Test specimens of the bone cements were used to determine mechanical stability (bending strength and bending module), and the release of the antibiotics was determined by HLPC and modified Kirby-Bauer assays. (3) Results: All tested bone cements showed an initial high release within the first hours. Repeated testing after 24 h showed a reduced efficacy of VancogenX and Smartset GHV in Kirby-Bauer assays. Long-time release over days showed a release of functional antimicrobial active ingredients over this period of time in anti-microbial assays, but no activity of VancogenX from day 21 onward. No significant differences in the ISO bending modules could be detected, but in contrast to the bending module, the ISO bending strength was substantially reduced by 10-15 mPal in comparison to both cements of the reference group. The SimplexT met just the ISO 5833; the Smartset GHV did not after adding vancomycin. (4) Conclusions: In conclusion, the manual addition of 2 g of vancomycin to 40 g of PMMA powder is recommended for the treatment of methicillin-resistant staphylococci. Vancomycin is released over a period of 42 days with concentrations above the MIC for typical staphylococci. The mechanical properties of the PMMA just met, or did not fulfill, ISO mechanical specification. Copal G+V showed a better elution than VancogenX over time.
(1) 背景:在治疗假体周围关节感染时,向骨水泥中添加抗生素是一种常见做法。在翻修病例中,抗生素的用量和类型往往不足,必须添加额外的抗生素。然而,这种添加会改变产品本身,外科医生成为骨水泥的“制造商”。PMMAe希望阐明抗生素的混合是否会改变所用骨水泥的机械稳定性,以及添加的抗生素是否仍具有功能并能充分释放。(2) 方法:我们将两种工业生产的含万古霉素的PMMA骨水泥——低粘度的VancogenX(TECRES,意大利索马坎帕尼亚)和高粘度的Copal G+V(贺利氏医疗有限公司,德国韦尔海姆),与两种添加了氨基糖苷类抗生素且手动添加了2.0克万古霉素(Hexal CT1631)的PMMA骨水泥——高粘度的Smartset GHV和中粘度的含妥布霉素的抗生素 Simplex(抗生素Simplex T)进行比较。使用骨水泥的测试样本确定机械稳定性(弯曲强度和弯曲模量),并通过高效液相色谱法和改良的 Kirby-Bauer 试验确定抗生素的释放情况。(3) 结果:所有测试的骨水泥在最初几小时内都显示出高释放率。24小时后重复测试表明,VancogenX和Smartset GHV在Kirby-Bauer试验中的效力降低。数天的长时间释放显示,在此期间抗菌试验中有功能性抗菌活性成分释放,但从第21天起VancogenX无活性。在ISO弯曲模量方面未检测到显著差异,但与弯曲模量不同的是,与参考组的两种骨水泥相比,ISO弯曲强度大幅降低了10 - 15 mPal。SimplexT仅符合ISO 5833标准;添加万古霉素后的Smartset GHV不符合该标准。(4) 结论:总之,对于耐甲氧西林葡萄球菌的治疗,建议在40克PMMA粉末中手动添加2克万古霉素。万古霉素在42天内释放,其浓度高于典型葡萄球菌的最低抑菌浓度。PMMA的机械性能刚好达到或未达到ISO机械规格。随着时间推移,Copal G+V的洗脱效果比VancogenX更好。