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JAC Advance Access originally published online on October 13, 2006
Journal of Antimicrobial Chemotherapy 2006 58(6):1287-1290; doi:10.1093/jac/dkl402
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

The combination of ultrasound with antibiotics released from bone cement decreases the viability of planktonic and biofilm bacteria: an in vitro study with clinical strains

Geert T. Ensing1,2, Daniëlle Neut1,2,*, Jim R. van Horn2, Henny C. van der Mei1 and Henk J. Busscher1

1 Department of Biomedical Engineering, University Medical Center Groningen, and University of Groningen Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands 2 Department of Orthopaedic Surgery, University Medical Center Groningen Hanzeplein 1, 9713 EZ Groningen, The Netherlands

Received 12 July 2006; returned 8 August 2006; revised 21 August 2006; accepted 10 September 2006

*Correspondence address. Department of Biomedical Engineering, University Medical Center Groningen and University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. Tel: +31-50-3633140; Fax: +31-50-3633159; E-mail: d.neut{at}med.umcg.nl

Objectives: Antibiotic-loaded bone cements are used for the permanent fixation of joint prostheses. Antibiotic-loaded cements significantly decrease the incidence of infection. The objective of this study was to investigate whether the viability of bacteria derived from patients with a prosthesis-related infection could be further decreased when antibiotic release from bone cements was combined with application of pulsed ultrasound.

Methods: Escherichia coli ATCC 10798, Staphylococcus aureus 7323, coagulase-negative staphylococci (CoNS 7368 and CoNS 7391) and Pseudomonas aeruginosa 5148 were grown planktonically in suspension and as a biofilm on three different bone cements: Palacos R without gentamicin as control, gentamicin-loaded Palacos R-G and gentamicin/clindamycin-loaded Copal. The viability of planktonic and biofilm bacteria was measured in the absence and presence of pulsed ultrasound for 40 h.

Results: Ultrasound itself did not affect bacterial viability. However, application of pulsed ultrasound in combination with antibiotic release by antibiotic-loaded bone cements yielded a reduction of both planktonic and biofilm bacterial viability compared with antibiotic release without application of ultrasound.

Conclusions: This study shows that antibiotic release in combination with ultrasound increases the antimicrobial efficacy further than antibiotic release alone against a variety of clinical isolates. Application of ultrasound in combination with antibiotic release in clinical practice could therefore lead to better prevention or treatment of prosthesis-related infections.

Keywords: antimicrobial efficacy , gentamicin , clindamycin , prosthesis-related infections


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X.-Z. Cai, S.-G. Yan, H.-B. Wu, R.-X. He, X.-S. Dai, H.-X. Chen, R.-J. Yan, and X.-H. Zhao
Effect of Delayed Pulsed-Wave Ultrasound on Local Pharmacokinetics and Pharmacodynamics of Vancomycin-Loaded Acrylic Bone Cement In Vivo
Antimicrob. Agents Chemother., September 1, 2007; 51(9): 3199 - 3204.
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