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  • Title: Persistence of bacterial growth on antibiotic-loaded beads: is it actually a problem?
    Author: Anagnostakos K, Hitzler P, Pape D, Kohn D, Kelm J.
    Journal: Acta Orthop; 2008 Apr; 79(2):302-7. PubMed ID: 18484259.
    Abstract:
    BACKGROUND AND PURPOSE: Implantation of antibiotic-loaded beads is used for orthopedic infections. However, recent in vitro reports have emphasized that bacteria can persist on-or even colonize-antibiotic-impregnated bone cement. We therefore assessed whether bacterial adherence and growth could be determined on gentami-cin- and gentamicin-vancomycin-loaded beads that had been removed after eradication of infection. MATERIAL AND METHODS: We bacteriologically examined 18 chains of antibiotic-loaded beads (11 gentami-cin-loaded, 7 gentamicin-vancomycin-loaded) that had been implanted because of orthopedic infections. Among the causative agents, Staphylococcus epidermidis, Staph-ylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) were the most frequent organisms identified. RESULTS: In 4 cases (3 with S. epidermidis and one with MRSA), we found that there was persistence of bacterial growth on the beads. S. epidermidis strains persisted only on gentamicin-loaded beads, while MRSA could grow on gentamicin-vancomycin-impregnated cement. In one case, the emergence of a gentamicin-resistant S. epidermidis strain was observed despite the fact that preoperative samples of S. epidermidis from this patient had been susceptible to the antibiotic. INTERPRETATION: Persistence of bacterial growth on bone cement remains a hazardous problem in orthopedic surgery. Adherence of bacteria to cement can lead to emergence of bacterial resistance to antibiotics and might result in clinical recurrence of infection.
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