In vitro elution characteristics of antibiotic‐loaded polymethylmethacrylate cement and a calcium sulfate bone substitute using staphylococci isolated from orthopedic implant‐associated infections

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Abstract
Polymethylmethacrylate (PMMA) remains the gold standard antibiotic carrier in the management of osteomyelitis. However, biodegradable ceramic carriers may exhibit more efficient antibiotic elution properties. Through zone of inhibition (ZOI) testing and biofilm killing assays, we assessed the in vitro elution efficacy of vancomycin released from calcium sulfate (PG‐CSH) and PMMA beads as carriers on clinical strains of Staphylococcus aureus and Staphylococcus epidermidis, which were isolated from sonication fluid of orthopedic implant‐associated infections. Overall, vancomycin‐loaded PMMA and PG‐CSH beads showed potency (ZOI above 4 cm2) for up to 14 days against ATCC and clinical strains. Vancomycin‐loaded PG‐CSH beads displayed higher rates, exhibited a more stable antibiotic elution, had greater impacts on bacterial colony‐forming unit counts and produced higher ZOIs; additionally, statistically significant differences (Student's t test) were observed in different time sets during the experiment. In the biofilm killing assay, PG‐CSH loaded with vancomycin resulted in more bacterial deaths. In conclusion, in the present study, both PG‐CSH and PMMA beads acted as good carriers, but greater antimicrobial elution and biofilm bacterial killing were observed with PG‐CSH than PMMA. Future in vitro research should focus on testing other difficult‐to‐treat clinical strains, including multidrug resistant coagulase‐negative staphylococci and Gram‐negative bacilli.

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