Osteomyelitis: clinical update for practical guidelines.

Bone infections represent a diagnostic or therapeutic challenge for the infectivologist, orthopaedic surgeon, radiologist and nuclear medicine physician. Staphylococcus aureus is the major bacterium responsible for bone infections although Mycobacterium tuberculosis is emerging as an infectious agent in Italy because of immigration from Africa and Asia. Osteomyelitis requires long and expensive antibiotic treatment, including rifampicin administered parenterally for several weeks and the use of antimicrobial-impregnated cement in prosthesis substitution.

The in vitro elution characteristics of vancomycin combined with imipenem-cilastatin in acrylic bone-cements: a pharmacokinetic study.

The aim of this in vitro study was to compare the elution characteristics of vancomycin alone and in combination with imipenem-cilastatin from 3 acrylic bone-cements (CMW1 [DePuy International, Blackpool, UK], Palacos R [Schering-Plough, Wehrheim, Germany], and Simplex P [Howmedica International, London, UK]). Six groups of 3 antibiotic-loaded cement disks were prepared, incorporating 2 g of vancomycin (3 groups) and 2 g of vancomycin plus 2 g of imipenem-cilastatin (3 groups). The disks were placed in saline baths for 5 weeks, with the baths being sampled periodically and the elution rates calculated.

Mucoraceae infections of antibiotic-loaded cement spacers in the treatment of bacterial infections caused by knee arthroplasty.

Two clinical cases of mycotic infections secondary to knee spacers medicated with antibiotics against bacterial infections are presented. Care must be taken between the first and second stage (when the spacer is in place), and attention must be paid to the management of the surgical wound to avoid secondary contamination.