Abstract
Treatment and prophylaxis of uncomplicated infections with standard systemic antibiotics are usually successful. However, standard systemic antibiotic therapy alone is frequently unsatisfactory in certain circumstances, such as the presence of a foreign body (FB), necrotic tissue, overwhelming bacterial inoculum, or poor vascular supply to the involved tissues. We have developed a lipid-based sustained release formulation of amikacin sulfate (DepoFoam encapsulated amikacin sulfate [DEAS]) as a biodegradable, locally injectable antibiotic for such circumstances. The encapsulated drug is released over 7 to 10 days. We tested the efficacy of this formulation in an FB infection model in which Teflon tubes (length, 1 cm; outside diameter, 1.6 mm) were implanted into the subcutaneous tissue in mice and the local site was inoculated with 0.87 x 10(7) CFU of Staphylococcus aureus 3 days later. Inoculation was followed by either no treatment or a local injection of DEAS, free amikacin sulfate, non-drug-containing DepoFoam, or systemic free amikacin sulfate. All drug applications contained 1 mg of amikacin. One group was implanted with the FB and left unchallenged with bacteria and untreated as a sterile control group. All animals were sacrificed 10 days following FB implantation. FBs were retrieved from tissues by an aseptic technique and incubated in liquid culture media for 7 days. Local wound tissue was excised and processed to determine the number of CFU per gram of tissue. Treatment with local or systemic free amikacin had no effect on the number of infected FBs or on the log CFU in wound tissue compared with the untreated or non-drug-containing DepoFoam group. Compared with local free amikacin therapy, the number of infected FBs was reduced from 86 to 25% (P=0.02) following treatment with DEAS, and log CFU per gram of tissue was significantly decreased from 4.8 +/- 0.9 to 1.3 +/- 0.6 (P<0.0005). DEAS may have clinical utility as locally injected antibiotic in certain infections.
Full Text
The Full Text of this article is available as a PDF (265.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bergan T. Pharmacokinetics of tissue penetration of antibiotics. Rev Infect Dis. 1981 Jan-Feb;3(1):45–66. doi: 10.1093/clinids/3.1.45. [DOI] [PubMed] [Google Scholar]
- Bouchenaki N., Vaudaux P. E., Huggler E., Waldvogel F. A., Lew D. P. Successful single-dose prophylaxis of Staphylococcus aureus foreign body infections in guinea pigs by fleroxacin. Antimicrob Agents Chemother. 1990 Jan;34(1):21–24. doi: 10.1128/aac.34.1.21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chamberlain M. C., Khatibi S., Kim J. C., Howell S. B., Chatelut E., Kim S. Treatment of leptomeningeal metastasis with intraventricular administration of depot cytarabine (DTC 101). A phase I study. Arch Neurol. 1993 Mar;50(3):261–264. doi: 10.1001/archneur.1993.00540030027009. [DOI] [PubMed] [Google Scholar]
- Christensen G. D., Simpson W. A., Bisno A. L., Beachey E. H. Experimental foreign body infections in mice challenged with slime-producing Staphylococcus epidermidis. Infect Immun. 1983 Apr;40(1):407–410. doi: 10.1128/iai.40.1.407-410.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Citak M. S., Cué J. I., Peyton J. C., Malangoni M. A. The critical relationship of antibiotic dose and bacterial contamination in experimental infection. J Surg Res. 1992 Feb;52(2):127–130. doi: 10.1016/0022-4804(92)90292-8. [DOI] [PubMed] [Google Scholar]
- ELEK S. D., CONEN P. E. The virulence of Staphylococcus pyogenes for man; a study of the problems of wound infection. Br J Exp Pathol. 1957 Dec;38(6):573–586. [PMC free article] [PubMed] [Google Scholar]
- Edlich R. F., Panek P. H., Rodeheaver G. T., Turnbull V. G., Kurtz L. D., Edgerton M. T. Physical and chemical configuration of sutures in the development of surgical infection. Ann Surg. 1973 Jun;177(6):679–688. doi: 10.1097/00000658-197306000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Edson R. S., Terrell C. L. The aminoglycosides. Mayo Clin Proc. 1991 Nov;66(11):1158–1164. doi: 10.1016/s0025-6196(12)65798-x. [DOI] [PubMed] [Google Scholar]
- Gerding D. N., Larson T. A. Aminoglycoside resistance in gram-negative bacilli during increased amikacin use. Comparison of experience in 14 United States hospitals with experience in the Minneapolis Veterans Administration Medical Center. Am J Med. 1985 Jul 15;79(1A):1–7. doi: 10.1016/0002-9343(85)90184-6. [DOI] [PubMed] [Google Scholar]
- Grayson L. S., Hansbrough J. F., Zapata-Sirvent R. L., Kim T., Kim S. Pharmacokinetics of DepoFoam gentamicin delivery system and effect on soft tissue infection. J Surg Res. 1993 Nov;55(5):559–564. doi: 10.1006/jsre.1993.1184. [DOI] [PubMed] [Google Scholar]
- Grayson L. S., Hansbrough J. F., Zapata-Sirvent R., Roehrborn A. J., Kim T., Kim S. Soft tissue infection prophylaxis with gentamicin encapsulated in multivesicular liposomes: results from a prospective, randomized trial. Crit Care Med. 1995 Jan;23(1):84–91. doi: 10.1097/00003246-199501000-00016. [DOI] [PubMed] [Google Scholar]
- Haley R. W., Schaberg D. R., Crossley K. B., Von Allmen S. D., McGowan J. E., Jr Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med. 1981 Jan;70(1):51–58. doi: 10.1016/0002-9343(81)90411-3. [DOI] [PubMed] [Google Scholar]
- Hedström S. A., Lidgren L., Törholm C., Onnerfält R. Antibiotic containing bone cement beads in the treatment of deep muscle and skeletal infections. Acta Orthop Scand. 1980 Dec;51(6):863–869. doi: 10.3109/17453678008990886. [DOI] [PubMed] [Google Scholar]
- Kim S., Chatelut E., Kim J. C., Howell S. B., Cates C., Kormanik P. A., Chamberlain M. C. Extended CSF cytarabine exposure following intrathecal administration of DTC 101. J Clin Oncol. 1993 Nov;11(11):2186–2193. doi: 10.1200/JCO.1993.11.11.2186. [DOI] [PubMed] [Google Scholar]
- Kim S., Turker M. S., Chi E. Y., Sela S., Martin G. M. Preparation of multivesicular liposomes. Biochim Biophys Acta. 1983 Mar 9;728(3):339–348. doi: 10.1016/0005-2736(83)90504-7. [DOI] [PubMed] [Google Scholar]
- Pasic M., von Segesser L., Turina M. Implantation of antibiotic-releasing carriers and in situ reconstruction for treatment of mycotic aneurysm. Arch Surg. 1992 Jun;127(6):745–746. doi: 10.1001/archsurg.1992.01420060125019. [DOI] [PubMed] [Google Scholar]
- Patzakis M. J., Mazur K., Wilkins J., Sherman R., Holtom P. Septopal beads and autogenous bone grafting for bone defects in patients with chronic osteomyelitis. Clin Orthop Relat Res. 1993 Oct;(295):112–118. [PubMed] [Google Scholar]
- Price C. I., Horton J. W., Baxter C. R. Liposome encapsulation: a method for enhancing the effectiveness of local antibiotics. Surgery. 1994 Apr;115(4):480–487. [PubMed] [Google Scholar]
- Sugarman B., Young E. J. Infections associated with prosthetic devices: magnitude of the problem. Infect Dis Clin North Am. 1989 Jun;3(2):187–198. [PubMed] [Google Scholar]
- Vogel P., Lenz J. Die Behandlung des Sinus pilonidalis mittels Excision und Primärnaht unter Verwendung eines lokalen, resorbierbaren Antibioticumträgers. Ergebnisse einer prospektiven, randomisierten Untersuchung. Chirurg. 1992 Sep;63(9):748–753. [PubMed] [Google Scholar]
- Vécsei V., Barquet A. Treatment of chronic osteomyelitis by necrectomy and gentamicin-PMMA beads. Clin Orthop Relat Res. 1981 Sep;(159):201–207. [PubMed] [Google Scholar]
- Warren M. D., Kernodle D. S., Kaiser A. B. Correlation of in-vitro parameters of antimicrobial activity with prophylactic efficacy in an intradermal model of Staphylococcus aureus infection. J Antimicrob Chemother. 1991 Nov;28(5):731–740. doi: 10.1093/jac/28.5.731. [DOI] [PubMed] [Google Scholar]
- Wenzel R. P. Preoperative antibiotic prophylaxis. N Engl J Med. 1992 Jan 30;326(5):337–339. doi: 10.1056/NEJM199201303260509. [DOI] [PubMed] [Google Scholar]