Daptomycin-Tobramycin Cement Beads have Lethal Local Antibacterial Effect in Resistant Periprosthetic Joint Infections
| Autor: | Keith M Nord, Robert Achilike, Vivek Jagadale |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
musculoskeletal diseases
total knee arthroplasty medicine.medical_specialty total hip arthroplasty medicine.drug_class daptomycin medicine.medical_treatment Antibiotics tobramycin Periprosthetic Infectious Disease Synovectomy pmma beads 030204 cardiovascular system & hematology Joint infections 03 medical and health sciences 0302 clinical medicine Tobramycin Medicine prosthetic joint infection bone cement business.industry staph aureus General Engineering Bone cement Surgery Orthopedics Daptomycin business Complication 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Cureus |
| ISSN: | 2168-8184 |
| Popis: | Background Resistant periprosthetic joint infection (PJI) can be a devastating complication of surgery and is difficult to treat. We attempted to identify the utility of Daptomycin/Tobramycin-impregnated polymethylmethacrylate (PMMA) beads in resistant PJIs. Methods Charts of patients with hip or knee PJI at a single academic medical center, with surgeries performed from May 2008 through May 2018, were reviewed retrospectively. The diagnosis of PJI was consistent with the Musculoskeletal Infection Society recommendations. Prosthetic joints underwent radical anterior-posterior synovectomy and placement of antibiotic cement beads in the infected joint. Clinical cure rate and local intraarticular antibiotic concentration were measured. Results Forty-four patients experienced 53 episodes of PJI, requiring 88 surgeries. There was a fairly even split between hip and knee PJI. The cure rate was 92% (11/12) for patients who had any infection with methicillin-resistant staphylococci during the evaluation period, compared with 62% (13/21) for patients with methicillin-susceptible Staphylococci. On days one and seven, the addition of tobramycin increased daptomycin concentrations by 47% and 3374%, respectively, for beads made onsite compared to elution of daptomycin alone. Elution increased by 44% and 8394%, respectively, for commercial beads compared to beads fabricated onsite. Conclusions Daptomycin-Tobramycin-loaded PMMA beads are safe and powerful bactericidal agents in prosthetic joint infections. |
| Databáze: | OpenAIRE |
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