Antibacterial bone adhesive cement for preventing sternal infections after cardiac surgery

Deep Sternal wound infection (Mediastinitis) after cardiac surgery can be potentially caused by both Gram-positive and Gram-negative bacteria. The incidence of sternal infection appears to be on the rise in current practice and is associated with increased hospital stay, cost of care, and mortality. Due to the unmet need for mediastinitis treatment or prevention, we developed and characterized an antibacterial, biocompatible bone adhesive cement composed of tetracalcium phosphate, phosphoserine, and the antibacterial drugs, amikacin and vancomycin (TPAV). Vancomycin and amikacin show a continuous release pattern from TPAV for up to 60 and 90 days, respectively. In vitro and ex vivo analysis of TPAV's antibacterial properties shows inhibitory activity against the growth of Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae) and Staphylococcus aureus (S. aureus), and their biofilm formation. TPAV is also capable of inhibiting the growth of E. coli, K. pneumoniae and S. aureus when grown together as co-culture. Furthermore, the in vivo studies are done in a rat sternotomy model infected with S. aureus and E. coli, and TPAV demonstrated significant inhibitory activity when compared to the infected control group. This study highlights the potential of the developed antibacterial bone adhesive cement for preventing mediastinitis in clinics.

Automated summary

Deep sternal wound infection (mediastinitis) after cardiac surgery can be caused by both Gram-positive and Gram-negative bacteria. The incidence of sternal infection is increasing in current practice and is associated with longer hospital stay, higher medical costs, and increased mortality. A new antibacterial bone adhesive cement called TPAV, composed of tetracalcium phosphate, phosphoserine, amikacin, and vancomycin, has been developed and characterized. TPAV exhibits effective antibacterial properties against various bacteria, inhibiting their growth and biofilm formation. In in vivo studies using a rat sternotomy model infected with Staphylococcus aureus and Escherichia coli, TPAV demonstrated significant inhibitory activity. This study highlights the potential of TPAV as a preventive treatment for mediastinitis in clinical settings.