Analytical Evaluation of a Vancomycin Immunoassay in Synovial Fluid

Abstract

In clinical laboratories performing routine activities, the need to answer the burning clinical question in emerging field may be limited by lack of technology support or assays accessibility. Commercially available methods, although originally validated for specific biological matrices, may be employed for other matrices, following appropriate guidelines such as Clinical and Laboratory Standards Institute (CLSI) EP 19. We investigated the use of a vancomycin assay with synovial fluid samples, in view of a possible employment in vancomycin release study. The standard of care of periprosthetic joint infection is a two-stage revision surgery with antibiotic-loaded bone cement implantation. Vancomycin, for its activity against gram-positive bacteria even multidrug-resistant staphylococci, is the most widely used antibiotic. Despite the widespread use of such devices, little is known about the in vivo elution in the joint space. Clinical laboratories equipped with a validated, affordable method to quantify vancomycin in synovial fluid, may support clinical research, and give an important contribution to the study of the pharmacokinetics of antibiotic release from bone cement matrix.

Keywords

vancomycin - clinical laboratory services - immunoassay synovial fluid - antibacterial agents

• References

• 1 Bertazzoni Minelli E, Benini A, Samaila E, Bondi M, Magnan B. Antimicrobial activity of gentamicin and vancomycin combination in joint fluids after antibiotic-loaded cement spacer implantation in two-stage revision surgery. J Chemother 2015; 27 (01) 17-24
• 2 Del Pozo JL, Patel R. Clinical practice. Infection associated with prosthetic joints. N Engl J Med 2009; 361 (08) 787-794
• 3 Leone JM, Hanssen AD. Management of infection at the site of a total knee arthroplasty. J Bone Joint Surg Am 2005; 87 (10) 2335-2348
• 4 Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ. Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 2007; 89 (04) 871-882
• 5 Iarikov D, Demian H, Rubin D, Alexander J, Nambiar S. Choice and doses of antibacterial agents for cement spacers in treatment of prosthetic joint infections: review of published studies. Clin Infect Dis 2012; 55 (11) 1474-1480
• 6 Balato G, Ascione T, Rosa D. , et al. Release of gentamycin from cement spacers in two-stages procedure for hip and knee prosthetic infection: an in vivo pharmacokinetic study with clinical follow-up. J Biol Regul Homeost Agents 2015; 29 (4, Suppl): 63-72
• 7 Anagnostakos K, Kelm J. Enhancement of antibiotic elution from acrylic bone cement. J Biomed Mater Res B Appl Biomater 2009; 90 (01) 467-475
• 8 Sterling GJ, Crawford S, Potter JH, Koerbin G, Crawford R. The pharmacokinetics of Simplex-tobramycin bone cement. J Bone Joint Surg Br 2003; 85 (05) 646-649