Successful treatment of empyema thoracis with polymethylmethacrylate antibiotic-impregnated beads in the guinea pig.
Two hundred nine Duncan-Harley guinea pigs had intrathoracic inoculation with 10(8) Staphylococcus aureus, accompanied by blood and umbilical tape. One hundred fifty-two animals were excluded because of clinical recovery, early death, or complications related to intrathoracic polymethylmethacrylate (PMMA) bead placement. The remaining 57 animals had clinical signs of empyema thoracis and were the subjects of this study. Group I animals (N = 24) served as the controls and had no therapy. Group II animals (N = 14) were treated by intrathoracic placement of placebo PMMA beads. Group III animals (N = 19) were treated by intrathoracic placement of tobramycin sulfate-impregnated PMMA beads. There were no differences between the groups in pleural reaction or pneumonia scores. These findings demonstrate a similar host response to the established infection. Group III, however, had a higher sterilization rate than Groups I and II (p less than 0.05), a finding underlining the therapeutic effect of tobramycin-treated PMMA beads. We conclude that intrathoracic local antimicrobial therapy with slow-release tobramycin-impregnated PMMA beads may enhance empyema treatment by increasing the rate of local sterilization. More experiments are necessary to assess the efficacy of this potentially important therapeutic arm for the treatment of thoracic empyema.
Mavroudis
C
C
Department of Surgery, University of Louisville School of Medicine, KY 40292.
Katzmark
S L
SL
Ganzel
B L
BL
Gray
L A
LA
Polk
H C
HC
D000818:Animals; D003692:Delayed-Action Preparations; D004337:Drug Carriers; D004653:Empyema / Q000188:drug therapy*; D006168:Guinea Pigs; D008768:Methylmethacrylates; D008863:Microspheres; D010919:Placebos; D010994:Pleura / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy*; D014031:Tobramycin / Q000008:administration & dosage / Q000627:therapeutic use*
D003692:Delayed-Action Preparations; D004337:Drug Carriers; D008768:Methylmethacrylates; D010919:Placebos; D014031:Tobramycin