Background: Use of antibiotic-impregnated cement beads [ICB] for the treatment of various bacterial bone and joint infections is common in clinical practice. However, little is known about the efficacy of antifungal-ICB. We propose to assess antifungal release characteristics from ICB. Methods: Polymethylmethacrylate [PMMA] and hydroxyapatite [HAC] cements were separately permeated with various antifungal agents (amphotericin B 64.4 mg, fluconazole 16.1 mg, flucytosine 128.8 mg, anidulafungin 1.9 mg, micafungin 4 mg, and terbinafine 64.4 mg), to prepare twelve combinations of antifungal-ICBs, each combination in triplicates. Uniform ICBs were fabricated using a spherical mold and individually immersed in 0.5 mL of fetal calf serum. The ICBs were allowed to agitate horizontally at 15 cycles per minute and incubated at 37Â°C. Serum eluents were collected and replaced with fresh fetal calf serum at various time intervals for up to 16 weeks. Eluents were stored at -80Â°C until assayed using microbiological disk diffusion bioassay. Results: HAC ICBs exhibited released concentrations well above the minimum inhibitory concentrations [MIC90]through at least the indicated sampling days for the following antifungals: micafungin, day 7; fluconazole, day 17; and anidulafungin, day 19. PMMA-antifungal combinations fell below their respective MIC90’s by days 1, 2, and 9, respectively. All ICBs containing amphotericin B maintained concentrations above the MIC90 for at least 28 days. Conclusions: In this experimental model, most HAC-antifungal combinations demonstrate better elution profiles compared to PMMA combinations. However, amphotericin B ICBs from both cement types maintained fungicidal concentrations for at least 4 weeks, the longest period of all combinations tested.
Full conference title:
47th Interscience Conference on Antimicrobial agents and Chemotherapy
- ICAAC 47th