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JAC Advance Access published online on October 13, 2006
Journal of Antimicrobial Chemotherapy, 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
Received July 12, 2006
Revised August 21, 2006
Accepted September 10, 2006

Brief report

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. Ensing 1, Daniëlle Neut 1 *, Jim R. van Horn 2, Henny C. van der Mei 3, and Henk J. Busscher 3

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

* To whom correspondence should be addressed.
Daniëlle Neut, E-mail: d.neut{at}med.umcg.nl


  Abstract

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
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