Kwong Jeffrey W, Abramowicz Michael, Kühn Klaus Dieter, Foelsch Christian, Hansen Erik N
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
KABEG, LKH Villach, 9500 Villach, Austria.
Antibiotics (Basel). 2024 Aug 28;13(9):818. doi: 10.3390/antibiotics13090818.
Prosthetic joint infections (PJIs) are difficult to treat and represent a significant burden to the healthcare system. Two-stage revision surgery with placement of an antibiotic-loaded cement spacer is currently the gold standard for treatment in the United States for late-onset infections. We evaluate the efficacy of varying doses of vancomycin added to antibiotic-containing acrylic cement spacers and discuss the biomechanical and antimicrobial properties of using high versus low doses of vancomycin in cement spacers in the hip and knee.
Commercially available Copal cement containing either gentamicin and clindamycin (G + C) or gentamicin and vancomycin (G + V) was prepared with the manual addition of low (2 g) and high (6 g) doses of vancomycin. In vitro mechanical testing was then carried out according to ISO 5833 and DIN 53435, as well as inhibition zone assays against common PJI pathogens. Additionally, inhibition zone assays were conducted on two commercially available prefabricated spacers containing gentamicin: Copal Exchange G and Cemex Spacer-K.
In biomechanical testing, Copal G + V with the addition of 6 g of vancomycin failed to meet the ISO standard. Copal G + C and Copal G + V with low and high dosages of vancomycin were all effective against the tested pathogens and displayed constant efficacy for a duration of 42 days. High doses of vancomycin showed significantly lower mechanical stability. Moreover, Copal Exchange G showed significantly larger inhibition zones across 42 days.
While higher concentrations of vancomycin appear to improve the antimicrobial efficacy of cement, they also reduce its mechanical stability. Despite its smoother surface, the Copal Exchange G spacer exhibits large inhibition zones after 1 day and maintains consistently large inhibition zones over 6 weeks. Thus, it may be preferred for use in two-stage revision surgery.
Copal Exchange G is more effective than Cemex Spacer K against and . The manual addition of vancomycin to cement containing double antibiotics is very effective. The influence on ISO compression is low, the ISO bending modulus is increased, and ISO bending, DIN bending, and DIN impact, are reduced.
人工关节感染（PJI）难以治疗，给医疗系统带来了沉重负担。在美国，采用含抗生素的骨水泥间隔器的两阶段翻修手术目前是治疗迟发性感染的金标准。我们评估了添加不同剂量万古霉素的含抗生素丙烯酸骨水泥间隔器的疗效，并讨论了在髋部和膝部骨水泥间隔器中使用高剂量与低剂量万古霉素的生物力学和抗菌特性。
通过手动添加低剂量（2克）和高剂量（6克）万古霉素，制备了含有庆大霉素和克林霉素（G + C）或庆大霉素和万古霉素（G + V）的市售科帕尔骨水泥。然后根据ISO 5833和DIN 53435进行体外力学测试，以及针对常见PJI病原体的抑菌圈试验。此外，对两种市售含庆大霉素的预制间隔器进行了抑菌圈试验：科帕尔交换G和西麦斯间隔器 - K。
在生物力学测试中，添加6克万古霉素的科帕尔G + V未达到ISO标准。添加低剂量和高剂量万古霉素的科帕尔G + C和科帕尔G + V对受试病原体均有效，并在42天内显示出持续疗效。高剂量万古霉素显示出明显较低的机械稳定性。此外，科帕尔交换G在42天内显示出明显更大的抑菌圈。
虽然较高浓度的万古霉素似乎可提高骨水泥的抗菌疗效，但也会降低其机械稳定性。尽管科帕尔交换G间隔器表面更光滑，但在1天后显示出较大的抑菌圈，并在6周内保持一致的大抑菌圈。因此，它可能更适合用于两阶段翻修手术。
科帕尔交换G在对抗……方面比西麦斯间隔器K更有效。向含双重抗生素的骨水泥中手动添加万古霉素非常有效。对ISO压缩的影响较小，ISO弯曲模量增加，而ISO弯曲、DIN弯曲和DIN冲击则降低。
