Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Reiter, I.
On the Mechanical and Microbiological Aspects of PMMA with Manually Added Antibiotics in Periprosthetic Joint Infections
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2021. pp. 102
[OPEN ACCESS]
FullText
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Kühn Klaus-Dieter
- Leithner Andreas
- Altmetrics:
- Abstract:
- Introduction: The number of joint replacements is increasing worldwide. Approximately 1% of all hip prosthesis get infected, which is a devastating diagnosis that includes a long treatment pathway. The therapy therefore requires in most cases changing the prosthesis. In those surgeries, bone cements consisting of polymethylmethacrylate (PMMA) utilized as local drug carrier are predominantly applicable. Especially in infections caused by gram-negative bacteria only few antibiotics are recommended, although the dosage in PMMA cement has not yet been sufficiently researched. The mechanical and microbiological properties are not yet fully understood. Material and Methods: Meropenem (Eberth) and Imipenem (Fresenius Kabi) as well as two Fosfomycin salts (Trometamol from Ebert and Sodium from Infectofos) were used in different concentrations with different types of bone cement. Mechanical tests were performed according to ISO 5833 and DIN 53435. The microbiological efficacy was tested through the elution behavior. The effectiveness against predominantly gram-negative bacteria was examined in an inhibition zone assay. Results: Meropenem showed better mechanical features and antimicrobial effectivity in the local usage in PMMA bone cement than Imipenem. The microbiological data indicate slightly better results, mechanically Meropenem is significantly superior to Imipenem. Of the two Fosfomycin salts, Sodium is the material of choice. In summary, not only in the mechanical testing, but also in the microbiological examination Fosfomycin-Sodium showed better properties. Discussion: Meropenem is more suitable for the local usage in PMMA bone cement than Imipenem in infections caused by gram-negative bacteria. Fosfomycin-Sodium should be used locally in bone cements in periprosthetic joint infections, whereas Fosfomycin-Trometamol is inferior due to mechanical and antimicrobial properties. Furthermore, clinical studies are necessary to confirm the results of this in-vitro study in in-vivo circumstances.