| Autor: |
Sinclair, Sarina, Lyman, Kade S., Annis, Prokopis, Spiker, Ryan, Brodke, Darrel S., Lawrence, Brandon D. |
| Zdroj: |
Global Spine Journal; May 2015, Vol. 5 Issue: Supplement 1 ps-0035-155-s-0035-155 |
| Abstrakt: |
Introduction The addition of powdered vancomycin inside the surgical wound site has become a common practice in recent years to decrease the incidence of postoperative orthopedic infections. The effectiveness of vancomycin against bone infections has been well documented and it is commonly delivered locally during a variety of surgeries. While several studies have been conducted to review the effect of using this drug at the surgical site on infections, few studies have examined its impact on local bone cells at the cellular level. A wide range of antibiotic concentrations has been used within cell studies. The purpose of this pilot study was to examine the effect of vancomycin on osteoblasts at a concentration based on surgical drain samples following spinal fusion procedures using established in vitro techniques.Materials and Methods Postanesthesia care unit (PACU) drain samples were collected from 37 patients following spinal fusion procedures where powdered vancomycin was placed inside the surgical site. Vancomycin levels in the drain samples were measured using the inpatient laboratory and the hospital's standard operating procedures. A human osteoblast cell line was used to model osteoblasts in vitro. Cells were seeded in triplicate on tissue culture plates and fed the recommended base medium for 48 hours. After 48 hours (day 2), baseline data were collected and cell medium was changed to include vancomycin at a concentration of 0 or 1,000 µg/mL based on the PACU drain level results. After 3 days of exposure to vancomycin (day 5), cells were rinsed and cultured in plain base medium for three additional days (day 8). Cellular metabolic and osteogenic activity and was evaluated using well-established in vitro assays.Results The average vancomycin level present in the PACU drain samples was determined to be 1,253.67 µg/mL (STD = 0 701). This study found that the metabolic activity of the human osteoblasts appeared to be unaffected by the exposure to vancomycin. There was no significant difference in metabolic activity observed between the cells fed 0 and 1,000 µg/mL vancomycin at any time point. The addition of vancomycin did have an effect on the osteogenic activity, based on alkaline phosphatase (ALP) expression. Cells had lower ALP levels after 3 days of vancomycin exposure at the clinically relevant level (p= 0.05). The vancomycin group continued to express lower levels of ALP after 3 days of recovery following removal of the drug (p= 0.02).Conclusion This study is one of the first to test the cellular activity of human osteoblast cells after exposure to a clinically relevant concentration of vancomycin. The results suggest that the addition of vancomycin within the surgical wound to combat infection may result in a local antibiotic concentration level that can have an adverse impact on the cellular activity of local bone cells. |
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