scholarly journals Evaluation of Antibiotic-Releasing Triphasic Bone Void Filler In-Vitro

2018 ◽  
Vol 9 (4) ◽  
pp. 55 ◽  
Author(s):  
Michael Harris ◽  
Hamza Ahmed ◽  
Leslie Pace ◽  
Jon Minter ◽  
Michael Neel ◽  
...  

Bone void fillers (BVFs) containing calcium sulfate, tricalcium phosphate (TCP), and hydroxyapatite can be loaded with antibiotics for infection treatment or prevention under surgeon-directed use. The aim of this study was to characterize the handling and elution properties of a triphasic BVF loaded with common antibiotics. BVF was mixed with vancomycin and/or tobramycin to form pellets, and the set time was recorded. A partial refreshment elution study was conducted with time points at 4, 8, and 24 h, as well as 2, 7, 14, 28, and 42 days. Effects on dissolution were evaluated in a 14-day dissolution study. Set time increased to over 1 h for groups containing tobramycin, although vancomycin had a minimal effect. Pellets continued to elute antibiotics throughout the 42-day elution study, suggesting efficacy for the treatment or prevention of orthopedic infections. BVF containing vancomycin or tobramycin showed similar dissolution at 14 days compared to BVF without antibiotics; however, BVF containing both antibiotics showed significantly more dissolution.

Materials ◽  
2018 ◽  
Vol 11 (11) ◽  
pp. 2265 ◽  
Author(s):  
Phillip Laycock ◽  
John Cooper ◽  
Robert Howlin ◽  
Craig Delury ◽  
Sean Aiken ◽  
...  

15 different antibiotics were individually mixed with commercially available calcium sulfate bone void filler beads. The antibiotics were: amikacin, ceftriaxone, cefuroxime, ciprofloxacin, clindamycin, colistamethate sodium, daptomycin, gentamicin, imipenem/cilastatin, meropenem, nafcillin, rifampicin, teicoplanin, tobramycin and vancomycin. The efficacy of specific released antibiotics was validated by zone of inhibition (ZOI) testing using a modified Kirby–Bauer disk diffusion method against common periprosthetic joint infection pathogens. With a subset of experiments (daptomycin, rifampin, vancomycin alone and rifampin and vancomycin in combination), we investigated how release varied over 15 days using a repeated ZOI assay. We also tested the ability of these beads to kill biofilms formed by Staphylococcus epidermidis 35984, a prolific biofilm former. The results suggested that certain antibiotics could be combined and released from calcium sulfate with retained antibacterial efficacy. The daptomycin and rifampin plus vancomycin beads showed antimicrobial efficacy for the full 15 days of testing and vancomycin in combination with rifampin prevented resistant mutants. In the biofilm killing assay, all of the antibiotic combinations showed a significant reduction in biofilm bacteria after 24 h. The exposure time was an important factor in the amount of killing, and varied among the antibiotics.


2011 ◽  
Vol 101 (2) ◽  
pp. 146-152 ◽  
Author(s):  
Jeffrey C. Karr ◽  
Joseph Lauretta ◽  
Georgia Keriazes

Background: Several absorbable and nonabsorbable antibiotic carrier systems are available in the adjunctive surgical management of osteomyelitis of the foot, ankle, and lower leg. These carrier systems have significant limitations regarding which antibiotics can be successfully incorporated into the carrier vehicle. The calcium sulfate and hydroxyapatite Cerament Bone Void Filler is a biocompatible, absorbable ceramic bone void filler that can successfully deliver multiple heat-stable and heat-unstable antibiotics that have not been generally used before with antibiotic beads in treating musculoskeletal infections. Methods: Cerament Bone Void Filler discs with the antibiotics rifampin, vancomycin, tobramycin, cefazolin, cefepime hydrochloride, vancomycin-tobramycin, piperacillin-tazobactam, ceftazidime, and ticarcillin-clavulanate were tested in vitro against methicillin-resistant Staphylococcus aureus. Results: The zones of inhibition for the Cerament Bone Void Filler antibiotic discs plated against Staphylococcus aureus obtained were 33% to 222% greater than the minimum zones of inhibition breakpoints for bacteria susceptibility as defined by the standard set by the Clinical and Laboratory Standards Institute. Cerament Bone Void Filler discs with the antibiotics plated against Pseudomonas aeruginosa produced zones of inhibition of 93% to 200% greater than the minimum zones of inhibition breakpoints for bacteria susceptibility as defined by the standard set by the Clinical and Laboratory Standards Institute. Conclusions: The calcium sulfate and hydroxyapatite Cerament Bone Void Filler was an excellent carrier vehicle for multiple antibiotics creating in vitro significant zones of inhibition, thus demonstrating susceptibility against Staphylococcus aureus and Pseudomonas aeruginosa, which holds tremendous promise in treating osteomyeilits. (J Am Podiatr Med Assoc 101(2): 146–152, 2011)


2015 ◽  
Vol 105 (2) ◽  
pp. 104-110 ◽  
Author(s):  
Jeffrey C. Karr ◽  
Joseph Lauretta

Background Regarding antibiotic-loaded cements, there is an abundant amount of literature regarding the antibacterial in vitro inhibitory and clinical applications for the treatment of osteomyelitis. The opposite can be said about literature regarding in vitro antifungal-loaded cement drug delivery for the treatment of fungal osteomyelitis. Methods Aspergillus fumigatus and Candida (ATCC 1023ATCC, Manassas, Virginia) were plated on antibiotic/antifungal-free plates. Voriconazole- and amphotericin B–impregnated calcium sulfate and hydroxyapatite (HA) disks, calcium sulfate + HA control disks, and control polymethylmethacrylate disks were laid separately onto plates separately inoculated with Aspergillus and Candida spp. The zones of inhibition obtained were measured in millimeters at 24, 36, and 96 hours. Results Etest (bioMérieux, Marcy l'Etoile, France) results demonstrated susceptibility of Aspergillus and Candida to amphotericin B and voriconazole. The zone of inhibition data demonstrated that voriconazole and amphotericin B retained their antifungal activity when mixed into the calcium sulfate + HA bone void filler and eluted at biologically effective antifungal concentrations over 96 hours. Conclusions The calcium sulfate + HA bone void filler is a biocompatible ceramic carrier vehicle that can successfully deliver the antifungal drugs voriconazole and amphotericin B in the adjunctive treatment of fungal osteomyelitis. It is a reliable strategy in the local delivery of antifungal drugs to an area of osteomyelitis.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nan Jiang ◽  
Devendra H. Dusane ◽  
Jacob R. Brooks ◽  
Craig P. Delury ◽  
Sean S. Aiken ◽  
...  

AbstractThis study investigated the efficacy of a biphasic synthetic β-tricalcium phosphate/calcium sulfate (β-TCP/CS) bone graft substitute for compatibility with vancomycin (V) in combination with tobramycin (T) or gentamicin (G) evidenced by the duration of potency and the prevention and killing efficacies of P. aeruginosa (PAO1) and S. aureus (SAP231) biofilms in in vitro assays. Antibiotic loaded β-TCP/CS beads were compared with antibiotic loaded beads formed from a well characterized synthetic calcium sulfate (CS) bone void filler. β-TCP/CS antibiotic loaded showed antimicrobial potency against PAO1 in a repeated Kirby-Bauer like zone of inhibition assay for 6 days compared to 8 days for CS. However, both bead types showed potency against SAP231 for 40 days. Both formulations loaded with V + T completely prevented biofilm formation (CFU below detection limits) for the 3 days of the experiment with daily fresh inoculum challenges (P < 0.001). In addition, both antibiotic loaded materials and antibiotic combinations significantly reduced the bioburden of pre-grown biofilms by between 3 and 5 logs (P < 0.001) with V + G performing slightly better against PAO1 than V + T. Our data, combined with previous data on osteogenesis suggest that antibiotic loaded β-TCP/CS may have potential to stimulate osteogenesis through acting as a scaffold as well as simultaneously protecting against biofilm infection. Future in vivo experiments and clinical investigations are warranted to more comprehensively evaluate the use of β-TCP/CS in the management of orthopaedic infections.


Author(s):  

Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased surgical time, reabsorption, blood loss, and longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate, hydroxyapatite, titanium, or porous polyethylene, are expected to have optimal properties, including easy adaptation, biocompatibility, ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant should be easily shaped and positioned, allowing easy tissue growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally with different types of materials. However, this procedure is very expensive with various infection rates depending on the kind of material used and on the chemicophysical composition of the implant. Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an alloplastic biphasic material, composed of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the fronto-orbital area. Conclusion: The patient was first hospitalized as the result of a serious craniofacial trauma. One year after the first emergency cranio-orbital reconstructive operation, a marked deformity of the frontal region appeared with a “grid effect” due to the inadequate plate-bony fixation of the fractures applied during the first bony recomposition and because it was not as rigid as it should have been . A secondary surgery for deformity correction was performed. The hardware was totally removed and the bony deformity smoothed, reshaped, covered and filled using Cerament® Bone Void Filler, a biomaterial. The patient recovered with a satisfactory cranium-forehead shape, no complications, and complete disappearance of a frowning look of the fronto-orbital region. Recently, increased use of bone substitutes in the reconstruction of bone defects has been fuelled by donor site complications associated with autologous bone harvesting. Cerament® BoneVoid Filler is a biphasic and injectable bone substitute that has a highly compressive strength and the ability to promote cancellous bone healing


2000 ◽  
Vol 11 (4) ◽  
pp. 327-333 ◽  
Author(s):  
William S. Pietrzak ◽  
Robert Ronk

2002 ◽  
Vol 10 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Steven Gitelis ◽  
Gregory T. Brebach

The use of local antibiotics from a biodegradable implant for chronic osteomyelitis is an attractive alternative. The implant delivers high tissue levels, obliterates dead space, aids bone repair and does not need to be removed. The purpose of this paper is to review our early clinical experience with custom-made calcium sulfate (Osteoset bone void filler) antibiotic-impregnated implants.


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