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Abstract
Purpose:
Treatment of diabetic foot infection due to methicillin-resistant Staphylococcus aureus (MRSA) remains challenging. Applying vancomycin-impregnated cement is one of the best methods of treatment. Vancomycin-impregnated cement has been used worldwide; however, to date, there is a limited number of studies regarding its use. We evaluated the duration of antimicrobial activity of vancomycin-impregnated cement stored at room temperature after manufacturing.
Materials and Methods:
The vancomycin-impregnated cement was manufactured by mixing 1 g of vancomycin with 40 g of polymer and adding 17.90 g of liquid monomer. The cement dough was shaped into flat cylinders with diameter and height of 6 mm and 2 mm, respectively. Another cement of the same shape without mixing vancomycin was prepared as the negative control. All manufactured cements were sterilized with ethylene oxide gas and stored at room temperature. Each cement was placed on Mueller Hinton agar plate lawned with standard MRSA strain. Standard vancomycin disk and gentamicin disk were placed together. After 24 hours, the diameter of inhibition zone was measured, and if the diameter was less than 15 mm, vancomycin-impregnated cement was regarded as a loss of antimicrobial activity. The study was repeated every 2 weeks until vancomycin-impregnated cements lost their antimicrobial activity.
Results:
Vancomycin-impregnated cement stored for a duration of 16 weeks created a 14 mm inhibition zone, while vancomycin disk created a 15 mm inhibition zone. Vancomycin-impregnated cement stored for a duration of 17 weeks created 7 mm and 9 mm inhibition zones, while vancomycin disk created 16 mm and 15 mm inhibition zones, respectively.
Conclusion:
We found a decrease of antimicrobial activity in vancomycin-impregnated cements after 16 weeks. After 17 weeks, they showed definite loss of antimicrobial activity. Therefore, we recommend not using vancomycin-impregnated cement spacers that has been stored for more than 16 weeks at room temperature.
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Figure 1.
The antibiotics-impregnated cements were manufactured as a disk form 6 mm diameter and 2 mm height.
Figure 2.
The vancomycin-impregnated cement and the gentamicin-impregnated cement were placed on Mueller Hinton agar plate lawned with methicillin-resistant Staphylococcus aureus. Commercially available vancomycin disk and gentamicin disk were placed on the same plate. Each cement and disk was placed with at least 24 mm distance.
Figure 3.
In every agar plate, the gentamicin-impregnated cements (*) and gentamicin disks (†) as negative control didn’t create inhibition zones while vancomycin disks (‡) as positive control created inhibition zones after 24 hours incubation which were larger than 15 mm wide.
Figure 4.
The vancomycin-impregnated cement, vancomycin disk and gentamicin disk were placed on the Mueller Hinton agar plate lawned with methicillin-resistant Staphylococcus aureus (A) and incubated for 24 hours. The vancomycin-impregnated cement stored for 17 weeks (B) created 7 mm inhibition zone while vancomycin disk as positive control (C) created 16 mm inhibition zone after 24 hours incubation.
Figure 5.
The vancomycin-impregnated cement, vancomycin disk and gentamicin disk were placed on the Mueller Hinton agar plate lawned with methicillin-resistant Staphylococcus aureus (A) and incubated for 24 hours. The vancomycin-impregnated cement stored for 17 weeks (B) created 9 mm inhibition zone while vancomycin disk as positive control (C) created 15 mm inhibition zone after 24 hours incubation.
Table 1.
The Inhibition Zone Diameter Depending on the Storage Periods
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