Vancomycin and Imipenem Release from Nails Covered with Antibiotic- Loaded Acrylic Cement

BARLA JORGE; SANCINETO, CARLOS F.; ROSSI LUCIANO ANDRES; GIMENEZ MARISA; VISUS M.; ELIZONDO, CRISTINA M.

Internacional Journal of Surgery Research and Practice

Elsevier

Año: 2015

2378 3397

Background: There is a lack of information in the literature regarding pharmacokinetic properties of nails covered with antibiotic-loaded acrylic cement. The aim of this research work was to describe the release of vancomycin and imipenem from nails covered with ALAC over a period of 6 weeks. Furthermore, we analyzed if an increased nail diameter associated to a thicker ALAC coat could result in an increased antibiotic elution from the cement and if the combination of the two antibiotics in the same cement affects the amount of antibiotics released. Materials and Methods: Two groups of three nails each were defined. Group 1: consisting of three 10 mm nails covered with cement with a final diameter of 14 mm. Nail 1: Simplex cement with tobramycin + 4 g of vancomycin per 40 g of cement. Nail 2: Simplex cement with tobramycin + 2 g of imipenem per 40 g of cement. Nail 3: Simplex cement with tobramycin + 4 g of vancomycin + 2 g of imipenem per 40 g of cement. Group 2: we used the same antibiotics but the three 10 mm nails were covered with cement with a final external diameter of 16 mm. Results: In vitro concentrations of vancomycin and imipenem maintained above the MIC for at least 6 weeks. Increasing the external diameter of the nail did not modified the concentration of antibiotics released significantly (p = 0.481). The release of the antibiotics was not significantly modified by the combination of vancomycin and imipenem in the same nail (p = 0.38). Conclusions: It is possible to achieve in vitro concentrations of vancomycin and imipenem above the MIC for at least 6 weeks with nails covered with antibiotic-loaded acrylic cement. Neither the combination of both antibiotics nor the increase in the diameter of the nail significantly modified the release of the antibiotics