Vancomycin Properties in Ca Sulfate and Bone Graft

Discussion:
     - vancomycin and addition of antibiotics to cement,  and local delivery of antibiotics to infected joints):
     - calcium sulfate:
              - biologically inert osteoconductive material which serves as a temporary scaffold for osteoblasts;
              - osteoset (wright medical technology):
              - typically dissolves in one to two months; 
     - vancomycin: local pharmokinetics vs systemic:
              - has much slower and more consitent elution characteristics than tobramycin and gent; 
              - vancomycin shows very poor tissue penetration, which is a disadvantage of IV infusion;
              - in contrast, w/ local application there will also be reduced penetration from the implanted site into the vascular system,
                          which keeps local tissue levels high and systemic levels low;
     - safety:
              - vancomycin shows the least cytotoxic effect of all commonly used antibiotics and is not likely to cause systemic side effects
                         after local application;
      - bactericidal activity and biofilm:
              - vancomycin is one of the antibiotics with intracellular bactericidal activity and therefore should cover small colony variants
                         of staphylococci and MRSA;
              - penetrates glycocalices very rapidly;
              - once incorporated in biofilm Vancomycin shows a strain dependent bactericidal biofilm activity between 8 times and 128
                        times the MIC of planktonic bacteria;
              - shows superior bactericidal activity against biofilm embedded staphylococci and MRSA compared with most other
                        antibiotics;
              - references:
                    - Impact of biofilm on activity of vancomycin alone and in combination with tigecycline and rifampicin against Staph.
                    - Comparison of biofilm-associated cell survival following in vitro exposure of MRSA biofilms to the antibiotics

- Elution Characteristics:

      - references:
              - The levels of vancomycin in the blood and the wound after the local treatment of bone and soft-tissue infection with antibiotic-loaded calcium sulphate as carrier material
              - The in vitro elution characteristics of vancomycin from calcium phosphate-calcium sulfate.
              - Local release of antibiotics for surgical site infection management using high-purity Ca sulfate: an in vitro elution study.
              - Size and composition of synthetic calcium sulfate beads influence dissolution and elution rates in vitro.
              - The in vitro elution characteristics of vancomycin from calcium phosphate-calcium sulfate beads
              - Preliminary in vitro evaluation of therapy for wound infection reduction: rapidly resorbing local antibiotic delivery.
              - Antibiotic-loaded Ca sulfate beads for prevention of colonization and biofilm formation in periprosthetic infections.
              - Effects of bead size and polymerization in PMMA bone cement on vancomycin release.

 - General References:
         - Calcium sulfates: what is the evidence?
         - The Use of Calcium Sulfate Impregnated with Vanc in Treatment of Open Fractures of Long Bones: A Preliminary Study.
         - The use of a biodegradable antibiotic-loaded calcium sulphate carrier containing tobramycin for the treatment of chronic osteomyelitis: a series of 195 cases.
         - Calcium Sulfate- and Calcium Phosphate-Based Bone Substitutes. Mimicry of the Mineral Phase of Bone
         - 50 Years ago in CORR: The use of plaster of Paris to fill defects in bone Leonard F. Peltier, MD CORR 1961;21:1-31.

- References from Addition of Vancomycin to Bone Grafts: (see osteomyelitis and bone grafts)
      - High active local levels of vancomycin without nephrotoxicity released from impacted bone allografts in 20 revision hip arthroplasties.
      - Vancomycin-supplemented cancellous bone allografts in hip revision surgery.
      - Results of vancomycin-impregnated cancellous bone grafting for infected tibial nonunion.
      - Cancellous bone as an antibiotic carrier
      - Vancomycin-supplemented impacted bone allografts in infected hip arthroplasty. Two-stage revision results. 
      - Histology of vancomycin-supplemented impacted bone allografts in revision total hip arthroplasty
      - Antibiotic-autogenic cancellous grafting is an effective method for management of infected tibial defects: a comparison study.
      - Results of vancomycin-impregnated cancellous bone grafting for infected tibial nonunion.
      - In vitro release of vancomycin and tobramycin from impregnated human and bovine bone grafts.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, June 11, 2018 2:01 am