title: Combined local and systemic antibiotic treatment is effective against experimental Staphylococcus aureus peri-implant biofilm infection.
abstract: We hypothesized that systemic ceftriaxone and high concentration local antibiotics might eradicate peri-implant sepsis. Experiment 1: Eighty-four implants inoculated with biofilm-forming Staphylococcus aureus were treated in vitro with gentamicin, vancomycin, gentamicin + rifampin, or vancomycin + rifampin for 2, 4, or 8 days. Experiment 2: Forty-five implants were wired in vivo to rat femurs and inoculated with 1 × 10(6) CFU S. aureus. After 48 h, rats were treated once daily for 5 days with systemic ceftriaxone, local tobramycin or ceftriaxone, and tobramycin. Experiment 3: Forty implants with established S. aureus biofilms were wired in vivo to rat femurs. After 48 h, rats were treated with systemic ceftriaxone alone or in combination with local gentamicin, gentamicin and rifampin, or vancomycin. Experiment 1: 100% of implants treated in vitro with gentamicin were sterile after 48 h. The other treatments did not become sterile until 4 days. Experiment 2: No implant was culture negative. The combination of systemic ceftriaxone and local tobramycin was significantly better than others (p < 0.008). Experiment 3: Systemic ceftriaxone alone was ineffective. All implants treated with systemic ceftriaxone and local gentamicin were sterile (p < 0.001), the other groups were less effective.
authors: School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors: Anna S
authors: AS
authors: van der Horst
authors: School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors: Suman
authors: S
authors: Medda
authors: School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors: Ethan
authors: E
authors: Ledbetter
authors: School of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors: Alexander
authors: A
authors: Liu
authors: Orthopaedic Research Labs, University of North Carolina, Chapel Hill, North Carolina.
authors: Paul
authors: P
authors: Weinhold
authors: Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina.
authors: Daniel J
authors: DJ
authors: Del Gaizo
authors: Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina.
authors: Laurence
authors: L
authors: Dahners
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D018441:Biofilms / Q000187:drug effects*; D002443:Ceftriaxone / Q000008:administration & dosage; D005260:Female; D005269:Femur / Q000187:drug effects; D005839:Gentamicins / Q000008:administration & dosage; D019736:Prostheses and Implants / Q000009:adverse effects*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012293:Rifampin / Q000008:administration & dosage; D018805:Sepsis / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013234:Stem Cells; D013997:Time Factors; D014031:Tobramycin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D002443:Ceftriaxone; D012293:Rifampin; D014031:Tobramycin
keywords: Staphylococcus aureus; biofilm; local antibiotics; peri-implant