Daptomycin: local application in implant-associated infection and complicated osteomyelitis.
BACKGROUND
The rise of highly resistant bacteria creates a persistent urge to develop new antimicrobial agents. This paper investigates the application of the lipopeptide antibiotic daptomycin in infections involving the human bone.


METHODS
Compressive and tensile strength testing of daptomycin-laden PMMA was performed referring to the ISO 5833. The microstructure of the antibiotic-laden PMMA was evaluated by scanning electron microscopy. Intracellular activity of daptomycin was determined by a human osteoblast infection model. Elution kinetics of the antibiotic-laden bone cement was measured by using a continuous flow chamber setup.


RESULTS
There was no significant negative effect of adding 1.225% and 7.5% per weight of daptomycin to the PMMA. There was no significant difference in intracellular activity comparing gentamicin to daptomycin. Elution of daptomycin from PMMA showed within the first-hour initial peak values of 15-20 μg/mL.


CONCLUSIONS
Daptomycin has a certain degree of activity in the intracellular environment of osteoblasts. Daptomycin admixed to PMMA remains bactericidal and does not significantly impair structural characteristics of the PMMA. The results of this paper suggest that daptomycin might be a potent alternative for treating osteomyelitis and implant-associated infection in trauma and orthopedic surgery caused by multiresistant strains.
Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelm's-University Muenster, 48149 Muenster, Germany. steffen.rosslenbroich@ukmuenster.de
Steffen B
SB
Rosslenbroich
Michael J
MJ
Raschke
Carolin
C
Kreis
Nancy
N
Tholema-Hans
Andreas
A
Uekoetter
Rudolf
R
Reichelt
Thomas F
TF
Fuchs
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001843:Bone Cements / Q000737:chemistry; D002478:Cells, Cultured; D002626:Chemistry, Pharmaceutical; D017576:Daptomycin / Q000008:administration & dosage*; D004343:Drug Implants / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D008954:Models, Biological; D010019:Osteomyelitis / Q000188:drug therapy*; D019904:Polymethyl Methacrylate / Q000737:chemistry; D016459:Prosthesis-Related Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004343:Drug Implants; D019904:Polymethyl Methacrylate; D017576:Daptomycin