Persistence of bacterial growth on antibiotic-loaded beads - Is it actually a problem?

Background and purpose Implantation of antibiotic-loaded beads is used for orthopedic infections. However, recent in vitro reports have emphasized that bacteria can persist on-or even colonize-antibiotic-impregnated bone cement. We therefore assessed whether bacterial adherence and growth could be determined on gentamicin- and gentamicin-vancomycin-loaded beads that had been removed after eradication of infection. Material and methods We bacteriologically examined 18 chains of antibiotic-loaded beads (11 gentamicin-loaded, 7 gentamicin-vancomycin-loaded) that had been implanted because of orthopedic infections. Among the causative agents, Staphylococcus epidermidis, Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) were the most frequent organisms identified. Results In 4 cases (3 with S. epidermidis and one with MRSA), we found that there was persistence of bacterial growth on the beads. S. epidermidis strains persisted only on gentamicin-loaded beads, while MRSA could grow on gentamicin-vancomycin-impregnated cement. In one case, the emergence of a gentamicin-resistant S. epidermidis strain was observed despite the fact that preoperative samples of S. epidermidis from this patient had been susceptible to the antibiotic. Interpretation Persistence of bacterial growth on bone cement remains a hazardous problem in orthopedic surgery. Adherence of bacteria to cement can lead to emergence of bacterial resistance to antibiotics and might result in clinical recurrence of infection.