In vivo efficacy of antimicrobial-coated devices.
BACKGROUND
Since device colonization is a prelude to infection, an antimicrobial-coated device that reduces bacterial colonization can potentially protect against infection. The objective of this animal study was to assess the efficacy of a coating with minocycline and rifampin to prevent colonization of a grit-blasted titanium implant and subsequent osteomyelitis.


METHODS
Twenty-five rabbits underwent implantation of a titanium-alloy pin, either coated with minocycline and rifampin (thirteen rabbits) or uncoated (twelve rabbits), into the right femoral medullary canal. The implanted devices were inoculated with 500 CFU (colony-forming units) of Staphylococcus aureus prior to wound closure. The rabbits were killed one week later, and the removed device, femoral bone, a specimen obtained by swabbing the track surrounding the device, and blood were cultured. The rates of device colonization, osteomyelitis, and device-related osteomyelitis were compared between the two groups of rabbits.


RESULTS
The antimicrobial-coated devices had a significantly lower rate of colonization than the uncoated devices (five of thirteen compared with twelve of twelve, p = 0.0016) and were associated with significantly lower rates of osteomyelitis (six of thirteen compared with twelve of twelve, p = 0.005) and device-related osteomyelitis (five of thirteen compared with twelve of twelve, p = 0.0016). Bacteremia did not develop in any rabbit.


CONCLUSIONS
Orthopaedic devices coated with minocycline and rifampin significantly protected against device colonization and infection due to Staphylococcus aureus in this in vivo rabbit model.


CONCLUSIONS
It is possible that orthopaedic devices coated with this unique combination of antimicrobial agents may protect against the development of clinical infection in humans.
Darouiche
Rabih O
RO
Center for Prostheses Infection, Baylor College of Medicine, 1333 Moursund Avenue, Suite A221, Houston, TX 77030, USA. rdarouiche@aol.com
Mansouri
Mohammad D
MD
Zakarevicz
Devin
D
Alsharif
Atef
A
Landon
Glenn C
GC
D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems; D008911:Minocycline / Q000008:administration & dosage*; D010019:Osteomyelitis / Q000517:prevention & control*; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D011817:Rabbits; D012293:Rifampin / Q000008:administration & dosage*; D013203:Staphylococcal Infections / Q000517:prevention & control*
D000890:Anti-Infective Agents; D008911:Minocycline; D012293:Rifampin