Intra-articular versus systemic vancomycin for the treatment of periprosthetic joint infection after debridement and spacer implantation in a rat model

Bone & Joint Research

article

Jian Wei¹  Kai Tong¹  Hui Wang²  Yinxian Wen¹  Liaobin Chen¹ 

[1] Department of Joint Surgery and Sports Medicine, Zhongnan Hospital of Wuhan University;Department of Pharmacology, Department of Basic Medicine, Wuhan University

关键词: Periprosthetic joint infection;    Two-stage revision;    Methicillin-resistant S. aureus;    Intra-articular injection;    Vancomycin;    Debridement;    vancomycin;    rat model;    Periprosthetic joint infection (PJI);    methicillin-resistant Staphylococcus aureus (MRSA);    antibiotics;    knees;    Serum;    infections;    joint tissues;   

DOI  :  10.1302/2046-3758.116.BJR-2021-0319.R3

学科分类：骨科学

来源: British Editorial Society Of Bone And Joint Surgery

【 摘 要 】

AimsTreatment outcomes for methicillin-resistant Staphylococcus aureus (MRSA) periprosthetic joint infection (PJI) using systemic vancomycin and antibacterial cement spacers during two-stage revision arthroplasty remain unsatisfactory. This study explored the efficacy and safety of intra-articular vancomycin injections for PJI control after debridement and cement spacer implantation in a rat model.MethodsTotal knee arthroplasty (TKA), MRSA inoculation, debridement, and vancomycin-spacer implantation were performed successively in rats to mimic first-stage PJI during the two-stage revision arthroplasty procedure. Vancomycin was administered intraperitoneally or intra-articularly for two weeks to control the infection after debridement and spacer implantation.ResultsRats receiving intra-articular vancomycin showed the best outcomes among the four treatment groups, with negative bacterial cultures, increased weight gain, increased capacity for weightbearing activities, increased residual bone volume preservation, and reduced inflammatory reactions in the joint tissues, indicating MRSA eradication in the knee. The vancomycin-spacer and/or systemic vancomycin failed to eliminate the MRSA infections following a two-week antibiotic course. Serum vancomycin levels did not reach nephrotoxic levels in any group. Mild renal histopathological changes, without changes in serum creatinine levels, were observed in the intraperitoneal vancomycin group compared with the intra-articular vancomycin group, but no changes in hepatic structure or serum alanine aminotransferase or aspartate aminotransferase levels were observed. No local complications were observed, such as sinus tract or non-healing surgical incisions.ConclusionIntra-articular vancomycin injection was effective and safe for PJI control following debridement and spacer implantation in a rat model during two-stage revision arthroplasties, with better outcomes than systemic vancomycin administration.

【 授权许可】

CC BY-NC