Journal Article

Does the use of a closed-suction drain reduce the effectiveness of an antibiotic-loaded spacer in two-stage exchange Arthroplasty for Periprosthetic hip infection? A prospective, randomized, controlled study

Chen, Ji-Ying, Chai, Wei, Zhang, Ming-Hua, Xu, Chi, Jia, Cheng-Qi, Kuo, Feng-Chih

2019

Overview

Background There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. Methods A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids ( n  = 160) were collected every 24 h for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. Results There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p  = 0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P  = 0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. coli . Conclusions The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty. (Chinese Clinical Trial Registry, ChiCTR-INR-17014162. Registered 26 December 2017.)

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Anti-Bacterial Agents - administration & dosage / Anti-Bacterial Agents - chemistry / Antibacterial activity / Antibacterial agents / Antibiotic concentration / Antibiotic-loaded cement spacer / Antibiotics / Arthritis, Infectious - surgery / Arthroplasty / Arthroplasty (hip) / Arthroplasty, Replacement, Hip - adverse effects / Arthroplasty, Replacement, Hip - instrumentation / Arthroplasty, Replacement, Hip - methods / Bioassays / Bone Cements - chemistry / Cement / Chromatography / Clinical trials / Closed-suction drain / Drug resistance / Epidemiology / Escherichia coli / Female / Health aspects / High performance liquid chromatography / Hip / Hip Joint - microbiology / Hip Joint - surgery / Hip Prosthesis - adverse effects / Hip Prosthesis - microbiology / Humans / Infection / Internal Medicine / Joint diseases / Joint surgery / Liquid chromatography / Male / Medicine / Medicine & Public Health / Meropenem / Meropenem - administration & dosage / Meropenem - chemistry / Methicillin / Methylmethacrylate - chemistry / Middle Aged / Orthopedic surgery / Orthopedics / Orthopedics and biomechanics / Periprosthetic joint infection / Polymer industry / Polymers / Prospective Studies / Prosthesis-Related Infections - microbiology / Prosthesis-Related Infections - prevention & control / Prosthesis-Related Infections - surgery / Rehabilitation / Research Article / Rheumatology / Sports Medicine / Staphylococcus aureus / Staphylococcus aureus infections / Staphylococcus infections / Suction - adverse effects / Suction - methods / Suctioning / Treatment Outcome / Two-staged exchange arthroplasty / Vancomycin / Vancomycin - administration & dosage / Vancomycin - chemistry