Voriconazole-impregnated beads in the treatment of candidal prosthetic joint infection

Harvey D., Tomlinson J., Cooper A., Buckley S., Townsend R., Kerry R., Oliver D.

Author address: 

NULL

Abstract: 

Objective: Below we report on the use of voriconazole-loaded bone cement and its elution data in salvage therapy in 2 cases of candidal prosthetic hip infection. Methods: Candida tropicalis and C. albicans respectively were cultured after aseptic aspiration under radiological guidance of two patients with infected hip prostheses. As part of a 2-stage revision procedure, voriconazole beads were inserted at the time of the first stage. 1gram of voriconazole powder was mixed with the bone cement to make the beads. Deep drains were left in situ for 48 hours. The drain volume and voriconazole concentration as well as serum voriconazole concentration were recorded at intervals for 48hrs. The use of prolonged intravenous antifungal therapy was avoided. Results: The above table shows high local voriconazole concentrations in the drain and thus by inference at the operative site, which reduce over 48hrs but still remain relatively high. Furthermore there was no detectable serum voriconazole in the first patient and minimal levels in the second patient. Conclusions: Fungal prosthetic joint infections, whilst rare, provide a difficult treatment challenge. Excision arthroplasty and prolonged intravenous antifungal agents appear to be the mainstay of therapy. Previously our unit has reported the successful use of fluconazole impregnated cement beads to eradicate C. albicans and C. parapsilosis joint infection. Fluconazole is no longer available in powdered form thus this option is not available. Voriconazole is available in powdered form and is thermostable which makes it suitable for incorporation in polymethylmethacrylate beads. Using this method the data presented show very high local concentrations of voriconazole are achieved which would be expected to sterilise the operative site, whilst avoiding any potential systemic side effects of voriconazole. Long-term follow-up data is awaited. In conclusion we present a potential therapeutic option for the treatment of candidal prosthetic joint infections.
2009

abstract No: 

P 1748

Full conference title: 

19th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 19th (2009)