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In Vivo Efficacy of Antimicrobial-Coated Devices

¹ Center for Prostheses Infection, Baylor College of Medicine, 1333 Moursund Avenue, Suite A221, Houston, TX 77030. E-mail address: rdarouiche{at}aol.com
² Spinal Cord Injury Laboratory, Michael E. DeBakey Veterans Affairs Medical Center, Room 178, 2002 Holcombe Boulevard., Houston, TX 77030. E-mail address for M.D. Mansouri: mansouri{at}bcm.tmc.edu. E-mail address for A. AlSharif: alsharif{at}bcm.tmc.edu
³ Section of Orthopedic Surgery, Kelsey-Seybold Clinic, 2727 West Holcombe Boulevard, Houston, TX 77025. E-mail address for D. Zakarevicz: dmzakarevicz{at}kelsey-seybold.com. E-mail address for G.C. Landon: gclandon{at}kelsey-seybold.com

Investigation performed at the Center for Prostheses Infection, Baylor College of Medicine; the Section of Orthopedic Surgery, Kelsey-Seybold Clinic; and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Biomet Orthopedics, Inc, and funding or grants of less than $10,000 from the Department of Veterans Affairs. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Biomet Orthopedics, Inc.). Also, a commercial entity (Biomet Orthopedics, Inc.) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: Twenty-five rabbits underwent implantation of a titanium-alloy pin, either coated with minocycline and rifampin (thirteen rabbits) or uncoated (twelve rabbits), into the right femoral medullary canal. The implanted devices were inoculated with 500 CFU (colony-forming units) of Staphylococcus aureus prior to wound closure. The rabbits were killed one week later, and the removed device, femoral bone, a specimen obtained by swabbing the track surrounding the device, and blood were cultured. The rates of device colonization, osteomyelitis, and device-related osteomyelitis were compared between the two groups of rabbits.

Results: The antimicrobial-coated devices had a significantly lower rate of colonization than the uncoated devices (five of thirteen compared with twelve of twelve, p = 0.0016) and were associated with significantly lower rates of osteomyelitis (six of thirteen compared with twelve of twelve, p = 0.005) and device-related osteomyelitis (five of thirteen compared with twelve of twelve, p = 0.0016). Bacteremia did not develop in any rabbit.

Conclusions: Orthopaedic devices coated with minocycline and rifampin significantly protected against device colonization and infection due to Staphylococcus aureus in this in vivo rabbit model.

Clinical Relevance: It is possible that orthopaedic devices coated with this unique combination of antimicrobial agents may protect against the development of clinical infection in humans.

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