AJBM Volume 2, Issue 1, pages 19–25, January 2014
An 82-year-old woman was referred to the orthopedic department with a three month history of low-grade fever. She had a known past history of type 2 diabetes. She had been unwell for last 5-days, complaining of feeling hot and 'shivery' with general aches, particularly in her right shoulder. The staff in the residential home where she lived had called the general practitioner who had prescribed a three-day course of trimethoprim for a suspected urinary tract infection.
On examination, she was pyrexia with a temperature of 39.5°C. She was drowsy but reusable. Pulse was 125 beats per minute and regular. Blood pressure was 90/55 mmHg. Heart sounds were normal with no added sounds or murmurs. The chest was clear. Her abdomen was soft and non-tender with no palpable masses or organs. The skin overlying the right shoulder was warm to touch and erythematous. She was unable to tolerate any passive movement of the joint. An plain x ray of her shoulder shows lucent defects in the head of the humerus with loss of the normally well-corticated surface. This is consistent with osteomyelitis. Two of 2-blood cultures and numerous operative cultures grew MRSA. His subsequent treatment consisted of intravenous vancomycin, achieving plasma drug levels approximating 24 μg/mL. This treatment was extended for 8 weeks, given the clinical concern for possible osteomyelitis in an area. Treatment was complicated by significant a decline in hearing. Biodegradable drug delivery systems provide a method for local delivery of drugs in deeper tissues, obviating parenteral or enteral usage; in some situations. A significant advantage is that much higher doses and/or strengths of the drug can be delivered locally than can be tolerated if the drug is delivered systemically. In this case report, we discussed the use of Biodegradable Antibiotic Delivery Systems in treatment chronic osteomyelitis.
Key words: Biodegradable Antibiotic Delivery Systems, MRSA, Osteomyelitis
1. Böstman OM. Osteolytic changes accompanying degradation of absorbable fracture fixation implants. J Bone Joint Surg (Br) 1991;73((4)):679–82. [PubMed]
2. Böstman OM, Laitinen OM, Tynninen O, Salminen ST, Pihlajamäki HK. Tissue restoration after resorption of polyglycolide and poly-laevo-lactic acid screws. J Bone Joint Surg (Br) 2005;87(11):1575–80. [PubMed]
3. Haleem AA, Rouse MS, Lewallen DG, Hanssen AD, Steckelberg JM, Patel R. Gentamicin and vancomycin do not impair experimental fracture healing. Clin Orthop 2004;(427):22–4. [PubMed]
4. Lin SS, Ueng SW, Liu SJ, Chan EC, Chao EK, Tsai CH, Chen KT, Wei FC, Shih CH. Development of a biodegradable antibiotic delivery system. Clin Orthop 1999;(362):240–50. [PubMed]
5. Naraharisetti PK, Guan Lee HC, Fu YC, Lee DJ, Wang CH. In vitro and in vivo release of gentamicin from biodegradable discs. J Biomed Mater Res B Appl Biomater 2006;77((2)):329–37. [PubMed]
6. Zhang Z, Kuijer R, Bulstra SK, Grijpma DW, Feijen J. The in vivo and in vitro degradation behavior of poly(trimethylene carbonate) Biomaterials 2006;27(9):1741–8. [PubMed]
7. Goldstein N. Planktonics or Biofilms infections? American journal of BioMedicine 2013;1(1): 1-3. [Abstract/Full-text]
8. Cevher E, Orhan Z, Sensoy D, Ahiskali R, Kan PL, Sağirli O, Mülazimoğlu L. Sodium fusidate-poly(D,L-lactide-co-glycolide) microspheres: preparation, characterisation and in vivo evaluation of their effectiveness in the treatment of chronic osteomyelitis. J Microencapsul 2007;24(6):577-95. [PubMed]
9. Cevher E1, Orhan Z, Mülazimoğlu L, Sensoy D, Alper M, Yildiz A, Ozsoy Y. Characterization of biodegradable chitosan microspheres containing vancomycin and treatment of experimental osteomyelitis caused by methicillin-resistant Staphylococcus aureus with prepared microspheres. Int J Pharm 2006;317(2):127-35. [PubMed]
10. Solky BA, Pincus L, Horan RF. Vancomycin-induced linear IgA bullous dermatosis: morphology is a key to diagnosis. Cutis 2004; 73: 65–7. [Medline]
11. Hanssen AD, Spangehl MJ. Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements. Clin Orthop 2004;1: 9–85.
13. Luu QN, Buxton TB, Nelson DR et al. Treatment of chronic experimental Staphylococcus aureus osteomyelitis with LY146032 and vancomycin. Eur J Clin Microbiol Infect Dis 1989;8:562–3. [CrossRef]
14. Perry AC, Rouse MS, Khaliq Y et al. Antimicrobial release kinetics from polymethylmethacrylate in a novel continuous flow chamber. Clin Orthop Relat Res 2002; 403: 49–53.
15. Liu SJ, Wen-Neng Ueng S, Lin SS et al. In vivo release of vancomycin from biodegradable beads. J Biomed Mater Res 2002; 63: 807–13. [CrossRef]