Joint fluid concentrations of amphotericin B after local application with calcium sulphate-report of 2 cases.
Details
State: Public
Version: Final published version
License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_1F0B7B1DD6C4
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Joint fluid concentrations of amphotericin B after local application with calcium sulphate-report of 2 cases.
Journal
APMIS
ISSN
1600-0463 (Electronic)
ISSN-L
0903-4641
Publication state
Published
Issued date
11/2023
Peer-reviewed
Oui
Volume
131
Number
11
Pages
567-573
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
Fungal periprosthetic joint infections (PJI) are difficult to treat, due to important biofilm formation and limited local penetration of systemically administered antifungals. Calcium sulphate (CaSO <sub>4</sub> ) might be a promising carrier to increase local concentration of antifungals. We hypothesized that local amphotericin B release from CaSO <sub>4</sub> is high enough to significantly contribute to treatment of fungal PJI. We report joint fluid and serum concentrations of amphotericin B after local application with CaSO <sub>4</sub> as an implanted resorbable carrier material as adjunct to standard surgical and systemic antifungal treatment in two cases of PJI with Candida spp. Maximal joint fluid amphotericin B concentration was 14.01 mg/L 5 days after the second local administration of liposomal amphotericin in Case One and 25.77 mg/L 14 days after the second local administration in Case Two. Concentrations higher than minimal inhibitory concentrations (MIC) could be measured for 21 days and 17 days after local administration in Case One and Two, respectively. In Case Two, serum concentration of amphotericin B was <0.01 mg/L 3 days after local administration of 450 mg liposomal amphotericin B. No local or systemic adverse reaction was observed. Fungal PJI was successfully eradicated in both cases with a follow-up of 12 months in Case One and 20 months in Case Two. Application of amphotericin B-loaded CaSO <sub>4</sub> was associated with joint fluid concentrations higher than minimal inhibitory concentrations for Candida spp. for approximately 3 weeks, with the advantage that the carrier material dissolves spontaneously and does not require secondary removal. Relapse of fungal infections did not occur in these two patients.
Keywords
Periprosthetic joint infection, amphotericin B, calcium sulphate, fungi, joint fluid
Pubmed
Web of science
Open Access
Yes
Create date
13/01/2023 17:39
Last modification date
24/10/2023 7:09