title: Daptomycin-loaded polymethylmethacrylate bone cement for joint arthroplasty surgery.
abstract: Antibiotic-loaded acrylic bone cement has been frequently used as an infection prophylaxis or antibiotic-loaded spacer in infected arthroplasty. In addition, daptomycin has been used recently against broad spectrum Gram-positive organisms. The goal of this in vitro study is to investigate the bacteriacidal and mechanical properties of daptomycin-incorporated polymethylmethacrylate (PMMA) bone cement and evaluate its feasibility for clinical use. Daptomycin (0.5, 1, or 2 g) was premixed with 40 g of PMMA bone cement powder before curing. The mechanical properties of the daptomycin-loaded acrylic bone cement (DLABC) were estimated following standard guidance, and the release profile and kinetics of daptomycin from PMMA were analyzed. The antimicrobial efficacy of DLABC was determined with a zone of inhibition (ZOI) assay against Staphylococcus aureus, Staphylococcus epidermis, Enterococcus faecalis, and Enterococcus faecium, respectively. The results showed that the compressive strength, of PMMA bone cement, which was higher than 100 MPa in all groups, was sufficient according to ISO 5833 after incorporation of daptomycin. The encapsulated daptomycin was released for 2 weeks with a 9.59 ± 0.85%, 15.25 ± 0.69%, and 20.64 ± 20.33% released percentage on the first day in the low, mid, and high groups, respectively. According to the calculated release kinetics, incorporated daptomycin should be 3.3 times the original dose to double its release. Although all recipes of DLABC had a microbial inhibitory effect, the effect with a higher encapsulated amount of daptomycin was more significant. Therefore, we believe that daptomycin can be locally delivered from PMMA bone cement at the surgical site as a prophylactic or treatment for osteomyelitis against Gram-positive organisms with intact cement function.
authors.affiliation: Division of Orthopaedics, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan.
authors.forename: Yuan-Ming
authors.initials: YM
authors.lastname: Hsu
authors.forename: Chun-Hsing
authors.initials: CH
authors.lastname: Liao
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Wei
authors.forename: Hsu-Wei
authors.initials: HW
authors.lastname: Fang
authors.forename: Hsiang-Huan
authors.initials: HH
authors.lastname: Hou
authors.forename: Chia-Chun
authors.initials: CC
authors.lastname: Chen
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chang
mesh_terms: D000900:Anti-Bacterial Agents / Q000737:chemistry / Q000494:pharmacology*; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods*; D001419:Bacteria / Q000187:drug effects* / Q000254:growth & development; D001843:Bone Cements / Q000737:chemistry*; D019245:Compressive Strength; D017576:Daptomycin / Q000737:chemistry / Q000494:pharmacology*; D052978:Disk Diffusion Antimicrobial Tests; D004337:Drug Carriers; D005240:Feasibility Studies; D007700:Kinetics; D008422:Materials Testing; D019904:Polymethyl Methacrylate / Q000737:chemistry*; D012995:Solubility
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004337:Drug Carriers; D019904:Polymethyl Methacrylate; D017576:Daptomycin
keywords: Acrylic bone cement; Antimicrobial efficacy; Daptomycin; Mechanical properties; Release kinetics