SLR - April 2010 - Jennifer K. Fong
Reference:
Aykut, S., Ozturk, A., Ozkan, Y., et al. (2010). Evaluation and comparison of the antimicrobial efficacy of teicoplanin- and clindamycin-coated titanium implants. The Journal of Bone and Joint Surgery (British), 92-B: 159-163.
Scientific Literature Reviews
Reviewed by: Jennifer K. Fong, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
This study provides useful data for comparison of the efficacy of antimicrobial-coated titanium implants on a Staphylococcus aureus infection model in vivo and in vitro.
Methods:
A randomized controlled study was conducted on thirty New Zealand White rabbits. The rabbits were randomly assigned to three groups: teicoplanin-coated titanium wire (Group 1), clindamycin-coated titanium wire (Group 2) and uncoated titanium wire (Group 3) as control. The 2mm thick titanium wires were sandblasted, sprayed with a corresponding antimicrobial solution, or none, and irradiated. Incisions were made lateral to the left patella to expose the tibial plateau. The intramedullary (IM) canal was reamed with a 2 mm wire and 500 colony-forming units of methicillin-sensitive Staphylococcus aureus (MSSA) were inoculated in the canal. Depending on the group assigned, a 2mm treated titanium wire was placed in the IM canal. The rabbits were sacrificed one week later and four samples were collected from each: implant wire, bone chips from the tibial plateau, swab culture of the IM canal and 20 mL of blood. All samples were individually bathed in solution that was inoculated onto blood agar plates and incubated for 48 hours to be evaluated for growth. The in vitro study consisted of placing a treated titanium wire on a blood agar culture medium that had been incubated with MSSA for 24 hours prior. Effect on bacterial growth was assessed at 24 and 48 hours of incubation time.
Results:
From the in vivo study, there was no bacterial growth in Group 1 from the samples collected. One rabbit in Group 2 exhibited growth from the wire, bone chips and swab culture. All ten rabbits in Group 3 exhibited growth from the wire, bone chips and swab culture. All blood cultures from the three Groups were negative. A statistical difference in the rate of bacterial growth was observed between Groups 1 and 3 as well as between Groups 2 and 3. The in vitro study revealed a 15 mm and 13 mm zone of inhibition after 48 hours for the teicoplanin-coated titanium wire and clindamycin-coated titanium wire, respectively. There was no zone of inhibition for the uncoated titanium wire.
Conclusions:
Based on the study results, teicoplanin- and clindamycin-coated titanium implants offer protection against MSSA colonization and infection. Therefore, antimicrobial-coated titanium implants may be a viable option for cases in which implants and antibiosis are desired, without the need for additional surgery to remove a separate antibiotic-impregnated carrier.