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Infusion of antibiotics into infection may maintain concentration level, minimize toxicity following TKA
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ORLANDO, Fla. — As infection is the one of the major complications of total joint arthroplasty, a direct infusion of antibiotics into the infected area maintains a high, local concentration level and minimizes systematic toxicity, according to a speaker here.
“Intra-articular antibiotics, I think, make a big difference, because it has a high-level concentration that eradicates the biofilm” Leo A. Whiteside, MD, said at the Current Concepts in Joint Replacement Winter Meeting.
Between 2001 and 2007, Whiteside and his colleagues evaluated the safety and efficacy of the direct infusion of antibiotics in 18 patients with MRSA. Researchers used one-stage revision, which included debridement, uncemented revision of total knee components and intra-articular infusion of 500 mg of vancomycin with a Hickman catheter once or twice daily for 6 weeks.
There were no IV antibiotics used after the first 24 hours. Serum vancomycin levels were monitored to maintain between 3 μg/mL and 10 μg/mL.
At 2-year follow-up, mean Knee Society score was 83. In addition, researchers found there was one infected knee with MRSA, which underwent reoperation, and a necrotic case which was debrided and revised. The case with the necrotic bone was administered the antibiotic infusion protocol, and the knee remained infection-free for 42 months.
“This method avoids the use of antibiotic-loaded cement and the potential growth of antibiotic-resistant strains of bacteria,” Whiteside said. – by Nhu Te
Reference:
Whiteside L. Paper #92. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 14-17; Orlando, Fla.
Disclosure: Whiteside reports he receives a salary for ownership interest in Signal Medical Corp and receives royalties for implant design from Smith & Nephew.