title: Residual gentamicin-release from antibiotic-loaded polymethylmethacrylate beads after 5 years of implantation.
abstract: In infected joint arthroplasty, high local levels of antibiotics are achieved through temporary implantation of non-biodegradable gentamicin-loaded polymethylmethacrylate beads. Despite their antibiotic release, these beads act as a biomaterial surface to which bacteria preferentially adhere, grow and potentially develop antibiotic resistance. In routine clinical practice, these beads are removed after 14 days, but for a variety of reasons, we were confronted with a patient in which these beads were left in situ for 5 years. Retrieval of gentamicin-loaded beads from this patient constituted an exceptional case to study the effects of long-term implantation on potentially colonizing microflora and gentamicin release. Gentamicin-release test revealed residual antibiotic release after being 5 years in situ and extensive microbiological sampling resulted in recovery of a gentamicin-resistant staphylococcal strain from the bead surface. This case emphasizes the importance of developing biodegradable antibiotic-loaded beads as an antibiotic delivery system.
authors.affiliation: Department of Orthopedic Surgery, University Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
authors.forename: Daniëlle
authors.initials: D
authors.lastname: Neut
authors.forename: Hilbrand
authors.initials: H
authors.lastname: van de Belt
authors.forename: Jim R
authors.initials: JR
authors.lastname: van Horn
authors.forename: Henny C
authors.initials: HC
authors.lastname: van der Mei
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Busscher
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001672:Biocompatible Materials; D004343:Drug Implants / Q000009:adverse effects; D024881:Drug Resistance, Bacterial; D005839:Gentamicins / Q000008:administration & dosage*; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D019904:Polymethyl Methacrylate; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000209:etiology / Q000382:microbiology; D013210:Staphylococcus / Q000187:drug effects / Q000302:isolation & purification; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D004343:Drug Implants; D005839:Gentamicins; D019904:Polymethyl Methacrylate