Journal List > J Korean Foot Ankle Soc > v.22(1) > 1043459

J Korean Foot Ankle Soc. 2018 Mar;22(1):38-43. Korean.
Published online March 16, 2018.  https://doi.org/10.14193/jkfas.2018.22.1.38
Copyright © 2018 Korean Foot and Ankle Society
In Vitro Study Evaluating the Antimicrobial Activity of Vancomycin-Impregnated Cement Stored at Room Temperature in Methicillin-Resistant Staphylococcus aureus
Se-Jin Park, Yongun Cho, Seok Won Lee, Hee-Yeon Woo,* and Sang Eun Lim, *
Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
*Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding Author: Se-Jin Park. Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea. Tel: 82-2-2001-2168, Fax: 82-2-2001-2176, Email: qortn97@naver.com
Received November 13, 2017; Revised December 14, 2017; Accepted January 06, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.

Keywords: Methicillin-resistant Staphylococcus aureus; Diabetic foot; Vancomycin-impregnated cement

Figures


Figure 1
The antibiotics-impregnated cements were manufactured as a disk form 6 mm diameter and 2 mm height.
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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.
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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.
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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.
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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.
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Tables


Table 1
The Inhibition Zone Diameter Depending on the Storage Periods
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Notes

Financial support:None.

Conflict of interest:None.

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Se-Jin Park
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