title: Bacterial survival in the interfacial gap in gentamicin-loaded acrylic bone cements.
abstract: Clinical experience indicates the beneficial effects of antibiotic-loaded bone cement. Although in vitro studies have shown the formation of a biofilm on its surface they have not considered the gap between the cement and the bone. We have investigated bacterial survival in that gap. Samples with gaps 200 microm wide were made of different bone cements. These were stored dry ('pre-elution') or submersed in phosphate-buffered saline to simulate the initial release of gentamicin ('post-elution'). The gaps were subsequently inoculated with bacteria, which had been isolated from infected orthopaedic prostheses and assessed for their sensitivity to gentamicin. Bacterial survival was measured 24 hours after inoculation. All the strains survived in plain cements. In the pre-elution gentamicin-loaded cements only the most gentamicin-resistant strain, CN5115, survived, but in post-elution samples more strains did so, depending on the cement tested. Although high concentrations of gentamicin were demonstrated in the gaps only the gentamicin-sensitive strains were killed. This could explain the increased prevalence of gentamicin-resistant infections which are seen clinically.
authors.affiliation: University of Groningen, The Netherlands.
authors.forename: J G E
authors.initials: JG
authors.lastname: Hendriks
authors.forename: D
authors.initials: D
authors.lastname: Neut
authors.forename: J R
authors.initials: JR
authors.lastname: van Horn
authors.forename: H C
authors.initials: HC
authors.lastname: van der Mei
authors.forename: H J
authors.initials: HJ
authors.lastname: Busscher
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects*; D018441:Biofilms; D001843:Bone Cements; D015169:Colony Count, Microbial; D004305:Dose-Response Relationship, Drug; D024881:Drug Resistance, Bacterial; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D016459:Prosthesis-Related Infections / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D013210:Staphylococcus / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins