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Vancomycin elution from a biphasic ceramic bone substitute

Stravinskas, M.; Nilsson, M.; Vitkauskiene, A.; Tarasevicius, S. LU and Lidgren, L. LU (2019) In Bone and Joint Research 8(2). p.49-54
Abstract

Objectives: The aim of this study was to analyze drain fluid, blood, and urine simultaneously to follow the long-term release of vancomycin from a biphasic ceramic carrier in major hip surgery. Our hypothesis was that there would be high local vancomycin concentrations during the first week with safe low systemic trough levels and a complete antibiotic release during the first month.

Methods: Nine patients (six female, three male; mean age 75.3 years (sd 12.3; 44 to 84)) with trochanteric hip fractures had internal fixations. An injectable ceramic bone substitute, with hydroxyapatite in a calcium sulphate matrix, containing 66 mg of vancomycin per millilitre, was inserted to augment the fixation. The vancomycin elution was... (More)

Objectives: The aim of this study was to analyze drain fluid, blood, and urine simultaneously to follow the long-term release of vancomycin from a biphasic ceramic carrier in major hip surgery. Our hypothesis was that there would be high local vancomycin concentrations during the first week with safe low systemic trough levels and a complete antibiotic release during the first month.

Methods: Nine patients (six female, three male; mean age 75.3 years (sd 12.3; 44 to 84)) with trochanteric hip fractures had internal fixations. An injectable ceramic bone substitute, with hydroxyapatite in a calcium sulphate matrix, containing 66 mg of vancomycin per millilitre, was inserted to augment the fixation. The vancomycin elution was followed by simultaneously collecting drain fluid, blood, and urine.

Results: The antibiotic concentration in the drain reached a peak during the first six hours post-surgery (mean 966.1 mg/l), which decreased linearly to a mean value of 88.3 mg/l at 2.5 days. In the urine, the vancomycin concentration reached 99.8 mg/l during the first two days, followed by a logarithmic decrease over the next two weeks to reach 0 mg/l at 20 days. The systemic concentration of vancomycin measured in blood serum was low and decreased linearly from 2.17 mg/l at one hour post-surgery to 0 mg/l at four days postoperatively.

Conclusion: This is the first long-term pharmacokinetic study that reports vancomycin release from a biphasic injectable ceramic bone substitute. The study shows initial high targeted local vancomycin levels, sustained and complete release at three weeks, and systemic concentrations well below toxic levels. The plain ceramic bone substitute has been proven to regenerate bone but should also be useful in preventing bone infection.Cite this article: M. Stravinskas, M. Nilsson, A. Vitkauskiene, S. Tarasevicius, L. Lidgren. Vancomycin elution from a biphasic ceramic bone substitute. Bone Joint Res 2019;8:49-54. DOI: 10.1302/2046-3758.82.BJR-2018-0174.R2.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Antibiotics, Bone graft substitute, Bone infection, Elution, Prevention, Vancomycin
in
Bone and Joint Research
volume
8
issue
2
pages
6 pages
publisher
British Editorial Soc Bone Joint Surgery
external identifiers
  • scopus:85062296993
ISSN
2046-3758
DOI
10.1302/2046-3758.82.BJR-2018-0174.R2https://doi.org/10.1302/2046-3758.82.BJR-2018-0174.R2
language
English
LU publication?
yes
id
7ed55c3c-6811-4dd7-ab33-46f2ab3befc7
date added to LUP
2019-03-13 13:14:13
date last changed
2019-06-12 07:22:48
@article{7ed55c3c-6811-4dd7-ab33-46f2ab3befc7,
  abstract     = {<p>Objectives: The aim of this study was to analyze drain fluid, blood, and urine simultaneously to follow the long-term release of vancomycin from a biphasic ceramic carrier in major hip surgery. Our hypothesis was that there would be high local vancomycin concentrations during the first week with safe low systemic trough levels and a complete antibiotic release during the first month.</p><p>Methods: Nine patients (six female, three male; mean age 75.3 years (sd 12.3; 44 to 84)) with trochanteric hip fractures had internal fixations. An injectable ceramic bone substitute, with hydroxyapatite in a calcium sulphate matrix, containing 66 mg of vancomycin per millilitre, was inserted to augment the fixation. The vancomycin elution was followed by simultaneously collecting drain fluid, blood, and urine.</p><p>Results: The antibiotic concentration in the drain reached a peak during the first six hours post-surgery (mean 966.1 mg/l), which decreased linearly to a mean value of 88.3 mg/l at 2.5 days. In the urine, the vancomycin concentration reached 99.8 mg/l during the first two days, followed by a logarithmic decrease over the next two weeks to reach 0 mg/l at 20 days. The systemic concentration of vancomycin measured in blood serum was low and decreased linearly from 2.17 mg/l at one hour post-surgery to 0 mg/l at four days postoperatively.</p><p>Conclusion: This is the first long-term pharmacokinetic study that reports vancomycin release from a biphasic injectable ceramic bone substitute. The study shows initial high targeted local vancomycin levels, sustained and complete release at three weeks, and systemic concentrations well below toxic levels. The plain ceramic bone substitute has been proven to regenerate bone but should also be useful in preventing bone infection.Cite this article: M. Stravinskas, M. Nilsson, A. Vitkauskiene, S. Tarasevicius, L. Lidgren. Vancomycin elution from a biphasic ceramic bone substitute. Bone Joint Res 2019;8:49-54. DOI: 10.1302/2046-3758.82.BJR-2018-0174.R2.</p>},
  author       = {Stravinskas, M. and Nilsson, M. and Vitkauskiene, A. and Tarasevicius, S. and Lidgren, L.},
  issn         = {2046-3758},
  keyword      = {Antibiotics,Bone graft substitute,Bone infection,Elution,Prevention,Vancomycin},
  language     = {eng},
  month        = {02},
  number       = {2},
  pages        = {49--54},
  publisher    = {British Editorial Soc Bone Joint Surgery},
  series       = {Bone and Joint Research},
  title        = {Vancomycin elution from a biphasic ceramic bone substitute},
  url          = {http://dx.doi.org/10.1302/2046-3758.82.BJR-2018-0174.R2https://doi.org/10.1302/2046-3758.82.BJR-2018-0174.R2},
  volume       = {8},
  year         = {2019},
}