Pre-sterilization of vancomycin-loaded cement spacers: impact on antibacterial efficacy against Staphylococcus aureus
Issued Date
2026-01-01
Resource Type
ISSN
03412695
eISSN
14325195
Scopus ID
2-s2.0-105039504573
Journal Title
International Orthopaedics
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SCOPUS
Bibliographic Citation
International Orthopaedics (2026)
Suggested Citation
Chulsomlee K., Pongchaikul P., Sadchaphaiboonkit R., Arunothai J., Mongkolsuk P., Sri-utenchai N. Pre-sterilization of vancomycin-loaded cement spacers: impact on antibacterial efficacy against Staphylococcus aureus. International Orthopaedics (2026). doi:10.1007/s00264-026-06829-9 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116953
Title
Pre-sterilization of vancomycin-loaded cement spacers: impact on antibacterial efficacy against Staphylococcus aureus
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Abstract
Background: Antibiotic-loaded polymethylmethacrylate (PMMA) cement spacers are widely used in periprosthetic joint infection and chronic osteomyelitis. Manual prefabrication and sterilisation of non-commercial antibiotic-loaded cement may reduce operative time and cost; however, the effects of sterilisation and storage on antimicrobial efficacy remain unclear. Methods: Manually prefabricated PMMA cement containing vancomycin (2 g or 4 g) underwent formaldehyde gas sterilisation (FO) and storage for one, four or seven days. Antibiotic elution was evaluated over 28 days. Antimicrobial activity against Staphylococcus aureus ATCC 25923 was assessed using minimum inhibitory dilution (MID) testing at predefined time points. Given the small number of specimens per subgroup, all comparisons should be interpreted as preliminary and hypothesis-generating. Results: FO sterilisation significantly reduced antimicrobial activity during the early elution phase. In the 4—g vancomycin group, Day 1 MID values were significantly higher in one day storage sterilised specimens than in specimens stored for four or seven days (1024 µg/mL vs. 213 µg/mL and 213 µg/mL, respectively; P < 0.001). Differences persisted at early time points but were no longer significant during the sustained elution phase (Days 14–28; P > 0.05). Overall, sterilised cement containing 4 g of vancomycin demonstrated higher MID values than 2 g cement during the early and mid-elution phases (Days 1–14; P < 0.01). MID values in all sterilised specimens remained several-fold above inhibitory thresholds for S. aureus throughout the 28-day period. Conclusions: FO sterilisation transiently reduces vancomycin antimicrobial activity during the early elution phase (Days 1–7) but does not affect sustained antimicrobial efficacy compared with non-sterilised cement. Based on these findings, vancomycin-loaded PMMA cement containing 4 g of antibiotic may be sterilised and stored for up to seven days while maintaining MIC values several-fold above inhibitory thresholds for Staphylococcus aureus throughout the 28-day elution period.