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. 2022 May;40(5):1143-1153.
doi: 10.1002/jor.25135. Epub 2021 Jul 12.

Identifying alternative antibiotics that elute from calcium sulfate beads for treatment of orthopedic infections

Ashley E Levack  1   2 , Kathleen Turajane  3 , Daniel A Driscoll  1 , Xu Yang  3 , Andy O Miller  4 , Mathias P Bostrom  2   5 , David S Wellman  1   6 , Alberto V Carli  2   5
Affiliations

Identifying alternative antibiotics that elute from calcium sulfate beads for treatment of orthopedic infections

Ashley E Levack et al. J Orthop Res. 2022 May.

Abstract

There has been increasing interest in the use of a synthetic absorbable calcium sulfate (CaSO4 ) for local antibiotic delivery in orthopaedic infections. The purpose of this study was to quantify elution kinetics of six antibiotics (amikacin, meropenem, fosfomycin, minocycline, cefazolin, and dalbavancin) from a clinically relevant CaSO4 bead model and compare elution and antimicrobial activity to the current clinical gold standards: vancomycin and tobramycin. Antibiotic-loaded synthetic CaSO4 beads were immersed in phosphate buffered saline and incubated at 37°C. Eluent was harvested at eight time points over 28 days. Antibiotic concentrations were measured by high performance liquid chromatography to quantify elution rates. CaSO4 beads demonstrated burst release kinetics. Dalbavancin, cefazolin, and minocycline all demonstrated similar elution profiles to vancomycin. Amikacin and meropenem demonstrated favorable elution profiles and durations of above-minimum inhibitory concentration when compared to tobramycin. Clinical Significance: This study provides important novel data regarding the utility of amikacin, meropenem and dalbavancin as alternative choices to place in CaSO4 carriers when treating orthopaedic infections.

Keywords: calcium sulfate; elution; infection; local antibiotic delivery; osteomyelitis.

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Figures

Figure 1:
Figure 1:
Commercially available calcium sulfate bead mold (Stimulan Rapid Cure; Biocomposites, Ltd.; Staffordshire, UK) with 4.8mm (red box) bead sizes for CaSO4 beads.
Figure 2:
Figure 2:
Calcium sulfate bead weights pre- and post- testing
Figure 3:
Figure 3:
Elution of each antibiotic from 4.8mm CaSO4 beads over time (μg/ml).
Figure 4:
Figure 4:
Hourly elution rate of each antibiotic from 4.8mm CaSO4 beads over time (μg/ml/hour). Baseline MIC values for the three tested organisms are illustrated.
Figure 5:
Figure 5:
Cumulative released drug mass per antibiotic by bead size (μg)
Figure 6:
Figure 6:
Cumulative released drug mass as a percent of available antibiotic contained within the beads, by bead size (%)
See this image and copyright information in PMC

References

    1. Steinmetz S, Wernly D, Moerenhout K, Trampuz A, Borens O. Infection after fracture fixation. EFORT Open Rev 2019. Jul 15;4(7):468–75. - PMC - PubMed
    1. Kurtz SM, Ong KL, Schmier J, Mowat F, Saleh K, Dybvik E, et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007. Oct;89 Suppl 3:144–51. - PubMed
    1. Ktistakis I, Giannoudi M, Giannoudis PV. Infection rates after open tibial fractures: are they decreasing? Injury 2014. Jul;45(7):1025–7. - PubMed
    1. Aggarwal VK, Bakhshi H, Ecker NU, Parvizi J, Gehrke T, Kendoff D. Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States. J Knee Surg 2014. Oct;27(5):399–406. - PubMed
    1. Torbert JT, Joshi M, Moraff A, Matuszewski PE, Holmes A, Pollak AN, et al. Current bacterial speciation and antibiotic resistance in deep infections after operative fixation of fractures. J Orthop Trauma 2015. Jan;29(1):7–17. - PubMed

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