Vancomycin-loaded bone cement used in arthroplasty in five Malaysian government hospitals / Siti Hir Huraizah Md Tahir

Despite available guidelines on antibiotic prophylaxis for arthroplasty, there is currently no universally defined guideline on the best pharmacological agent for prosthetic joint infection treatment. This research was conducted to investigate the prophylactic antibiotics used in arthroplasty; to assess the clinical practice of antibiotic-loaded bone cement among healthcare practitioners and compare the strength and formulation of vancomycin-loaded bone cement in terms of elution properties and antibacterial activity. A retrospective cross-sectional study in patients who underwent arthroplasty from 2008 until 2015. Only 930 records out of 1,122 were retrieved. Almost all patients (94.6%) received IV ceftriaxone given as 1g or 2g as prophylactic antibiotic. A total of 873 patients (93.9%) were also given IV amoxicillin/clavulanic acid 1.2 g as antibiotic irrigation at the wound site after the implant insertion before wound closing. The practice of antibiotic-loaded bone cement was investigated among the orthopaedic surgeons, medical officers, house officers in five tertiary government hospitals. The practice of antibiotic-loaded bone cement was investigated among the orthopaedic surgeons, medical officers, house officers in five tertiary government hospitals. There were statistically significant findings between the designation and working experience versus knowledge and experience handling ALBC. The antibacterial ability and elution properties were also compared among the different preparation and concentration of vancomycin-loaded bone cement against the methicillin-resistant Staphylococcus aureus (MRSA) using disc diffusion method and high-performance liquid chromatography (HPLC). No differences were observed in the zone of inhibition between the amount of vancomycin and in the preparation of bone cement itself (p>0.05). The addition of vancomycin powder before or after the addition of monomer showed no difference in terms of antibacterial activity (p>0.05). The elution of vancomycin showed a burst during the first hour on the first day that for a few days and reached plateau after 72 hours. As conclusion, overall guideline adherence rate was 5.4% only. The practice of ALBC among orthopaedic surgeons differ in terms of antibiotic choices and doses used. Dose of 2 g vancomycin can be manually added into the bone cement to achieve antibacterial activity and eluted concentration needed in treating methicillin-resistant Staphylococcus aureus (MRSA) infection.