title: Pharmacokinetic properties and systemic safety of vancomycin-impregnated cancellous bone grafts in the treatment of spondylodiscitis.
abstract: The aim of the present study was to investigate the local pharmacokinetic properties and the systemic safety of vancomycin-impregnated cancellous bone grafts in the treatment of spondylodiscitis. Between 2010 and 2012, 8 patients (5 females, 3 males, mean age 68.75 y.) were treated with this method. Local vancomycin concentrations reached median values of 179 µg/mL (maximum 365 µg/mL) on day 1, decreasing to 98 µg/mL on day 3. The urine vancomycin concentrations showed similar pharmacokinetic properties as those locally determined. On day 1, median values were at 28.05 µg/mL (maximum 287 µg/mL). All serum vancomycin concentrations were in all cases and on every day below < 2 µg/mL. The median serum creatinine values were preoperatively 0.87 mg/dL, followed by 0.625 mg/dL, 0.705 mg/dL, and 0.835 mg/dL on day 7, 14, and 28, respectively. No cases of ototoxicity could be observed. At a mean follow-up of 16.5 [4-36] months no cases of reinfections or persistent infections could be seen. In conclusion, the implantation of vancomycin-loaded cancellous bone grafts is an effective option in the treatment of spondylodiscitis with a high infection eradication rate and no risk of any systemic toxicity. The pharmacokinetic properties can be easily monitored locally, in the urine and the serum.
authors: Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstr. 1, 66421 Homburg, Germany. k.anagnostakos@web.de
authors: Konstantinos
authors: K
authors: Anagnostakos
authors: Katrin
authors: K
authors: Koch
mesh_terms: D000368:Aged; D016025:Bone Transplantation; D003404:Creatinine / Q000097:blood; D015299:Discitis / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014640:Vancomycin / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D014640:Vancomycin; D003404:Creatinine
references: Arch Orthop Trauma Surg. 2005 Jul;125(6):369-75
references: 15965701
references: J Bone Joint Surg Br. 2008 Dec;90(12):1580-4
references: 19043128
references: J Biomed Mater Res A. 2010 Jan;92(1):52-5
references: 19165791
references: Int Orthop. 1998;22(3):197-9
references: 9728317
references: Acta Orthop Scand. 2002 Apr;73(2):199-205
references: 12079020
references: Int J Biomater. 2012;2012:538061
references: 22899933
references: Ann Pharmacother. 2006 Nov;40(11):2037-42
references: 17032907
references: Eur Surg Res. 2009;43(3):298-305
references: 19684405
references: J Trauma. 2000 Feb;48(2):246-55
references: 10697082
references: J Arthroplasty. 2001 Oct;16(7):882-92
references: 11607905
references: Acta Orthop Scand. 1999 Jun;70(3):298-304
references: 10429610
references: Clin Orthop Relat Res. 2004 Oct;(427):47-51
references: 15552135
references: J Antimicrob Chemother. 2000 Sep;46(3):423-8
references: 10980169
references: Orthopade. 2012 Sep;41(9):727-35
references: 22914914
references: Spine (Phila Pa 1976). 2008 Oct 1;33(21):2300-4
references: 18827695
references: Acta Orthop Scand. 2000 Feb;71(1):80-4
references: 10743999
references: Acta Orthop. 2005 Jun;76(3):336-40
references: 16156460
references: J Antimicrob Chemother. 2010 Nov;65 Suppl 3:iii11-24
references: 20876624
references: Clin Orthop Relat Res. 1986 Jun;(207):83-93
references: 3720107