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Bioabsorbable gel better at killing bacteria than PMMA beads in open fractures

Issue: November 2011

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Joseph C. Wenke

SAN ANTONIO, Texas — A bioabsorbable antibiotic gel was superior to polymethylmethacrylate beads for bacteria reduction in open fractures, according to a presenter at the Orthopaedic Trauma Association 2011 Annual Meeting, here.

“We all know that local antibiotic delivery — PMMA beads — have a lot of advantages and are often used,” Joseph C. Wenke, PhD, of the U.S. Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas, said. “We really don’t have a lot of great data to support they’re really effective.”

Polymethylmethacrylate (PMMA) beads have disadvantages including requirement of removal. They are a depot and do not provide good delivery and have unpredictable elution rates, according to Wenke.

Wenke and colleagues compared rat models with segmental defect wounds contaminated with Staphylococcus aureus treated with either PMMA beads or the biogel. The gel was a mixture of 1.7% vancomycin and 1.9% gentamicin. The PMMA beads contained 3.3% vancomycin and 4% tobramycin. The bead group received two PMMA beads in the wound and two beads in the tissue envelope. The researchers then performed a microbiologic analysis of the tissue and fracture hardware used in both groups after 14 days.

Rats treated with the biogel showed a significantly lower infection rate and a significant reduction in bacteria compared to those treated with PMMA beads, the results showed.

“Ideally, a good antibiotic vehicle would be delivered throughout the entire wound surface,” Wenke said. “When you put beads in there, they don’t always reach the entire area. If you put a gel in there, it’s delivered throughout the entire wound and it’s much more effective. This will allow more bacteria to come into contact with the minimum inhibitory concentration and the minimum biofilm eliminating concentration of the antibiotic.”

Reference:

• Penn-Barwell JG, Murray CK, Wenke JC. Local antibiotic delivery by a bioabsorbable gel is superior to PMMA beads at reducing infection in an open fracture model. Paper #35. Presented at the Orthopaedic Trauma Association 2011 Annual Meeting. Oct. 12-15. San Antonio, Texas.
• Disclosure: Wenke receives financial support from Smith & Nephew Extra Ortho.

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