Objective: 

Cefazolin is a heat-labile antibiotic that is not usually added to polymethylmethacrylate (PMMA) cement spacers because it is believed to be inactivated by the high polymerization temperatures. The purpose of this study was to compare cefazolin versus vancomycin high-dose antibiotic cement spacers.

Methods: 

High-dose antibiotic PMMA spacers with either cefazolin or vancomycin were fabricated. Setting time, compressive strength, and compression modulus of spacers were measured. Spacers were emerged in saline, and the eluent was tested on days 1, 2, 3, 7, 14, and 30 to determine the zone of inhibition of methicillin-sensitive Staphylococcus aureus and estimate the cumulative antibiotic released.

Results: 

Cefazolin, compared with vancomycin-loaded spacers, had significantly shorter setting time [mean difference (MD) −1.8 minutes, 95% confidence interval (CI), −0.6 to −3.0], greater compressive strength (MD 20.1 megapascal, CI, 15.8 to 24.5), and compression modulus (MD 0.15 megapascal, CI, 0.06 to 0.23). The zone of inhibition of eluent from PMMA-C spacers was significantly greater than PMMA-V spacers at all time points, an average of 11.7 ± 0.8 mm greater across time points. The estimated cumulative antibiotic released from cefazolin spacers was significantly greater at all time points (P < 0.0001).

Conclusions: 

Cefazolin was not inactivated by PMMA polymerization and resulted in spacers with superior antimicrobial and biomechanical properties than those made with vancomycin, suggesting that cefazolin could play a role in the treatment of infected bone defects with high-dose antibiotic PMMA spacers.

中文翻译：

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头孢唑啉与万古霉素抗生素骨水泥间隔物的疗效

客观的： 

头孢唑林是一种热不稳定的抗生素，通常不添加到聚甲基丙烯酸甲酯 (PMMA) 水泥间隔物中，因为据信它会被高聚合温度失活。本研究的目的是比较头孢唑林与万古霉素高剂量抗生素骨水泥间隔物。

方法： 

制造了含有头孢唑啉或万古霉素的高剂量抗生素 PMMA 间隔物。测量垫片的凝固时间、抗压强度和压缩模量。间隔物出现在盐水中，并在第 1、2、3、7、14 和 30 天测试洗脱液，以确定对甲氧西林敏感的金黄色葡萄球菌的抑菌圈并估计抗生素的累积释放量。

结果： 

与装载万古霉素的间隔物相比，头孢唑啉具有显着更短的凝固时间 [平均差 (MD) -1.8 分钟，95% 置信区间 (CI)，-0.6 至 -3.0]，抗压强度更高（MD 20.1 兆帕，CI，15.8至 24.5）和压缩模量（MD 0.15 兆帕，CI，0.06 至 0.23）。PMMA-C 间隔物的洗脱液抑制区在所有时间点均显着大于 PMMA-V 间隔物，跨时间点平均大 11.7 ± 0.8 mm。从头孢唑啉间隔物释放的估计累积抗生素在所有时间点都显着更高（P <0.0001）。

结论： 

头孢唑啉不会因 PMMA 聚合而失活，产生的间隔物比用万古霉素制成的间隔物具有更好的抗菌和生物力学特性，这表明头孢唑啉可以在使用高剂量抗生素 PMMA 间隔物治疗感染性骨缺损中发挥作用。