N‐acetylcysteine use as an adjuvant to bone cement to fight periprosthetic joint infections: A preliminary in vitro efficacy and biocompatibility study. Issue 2 (25th November 2020)

• Record Type: Journal Article
• Authors: Sukhonthamarn, Kamolsak; Cho, Jeongeun; Chisari, Emanuele; Goswami, Karan; Arnold, William V.; Parvizi, Javad
• Other Names: Schwarz Edward guestEditor.; Chen Antonia guestEditor.; Arts Jacobus J.C. guestEditor.
• Is Part Of: Journal of orthopaedic research. Volume 39:Issue 2(2021)
• Page Start: 356
• Page End: 364
• Publication Date: 2020-11-25
• Subjects: infection -- pathophysiology -- reconstruction -- therapeutics; Orthopedics -- Periodicals; Musculoskeletal system -- Periodicals; 616.7
• DOI: 10.1002/jor.24910
• Languages: English
• ISSNs: 0736-0266

Abstract

Abstract: When antibiotic laden bone cement is used to manage periprosthetic joint infection (PJI), failure still occurs with its use in up to 30% of cases. Therefore, we designed an in vitro study to assess the bactericidal effect of N ‐acetylcysteine (NAC), an antibacterial adjuvant, in cement against planktonic and biofilm forms of common PJI pathogens. NAC (10%, 20%, 30%, 40%, and 50% w/v) added to polymethyl methacrylate (PMMA) and incubated in broth at 36°C. PMMA‐alone and/or culture bacteria alone were used as a negative control. Aliquots of cement elution from each group were taken at 1 day and 1 week and then were investigated for antimicrobial efficacy against the planktonic‐form and the biofilm‐form of Staphylococcus aureus and Escherichia coli . The primary outcome was the residual colony‐forming unit count. The cytotoxicity and mechanical properties of the NAC–PMMA cement‐blocks were also assessed. NAC–PMMA efficacy against the planktonic bacteria was demonstrated at a minimum of 30% at Day 1 and a minimum of 20% at 1 week after ( p < .001). NAC–PMMA cement was effective against biofilm at a minimum of 30% of NAC at 1 day and 1 week of cement immersion ( p < .001). The PMMA alone group was identified as having the highest cytotoxicity ( p < .001). NAC decreased the stiffness ( p = .004) and maximum load breaking point of the cement ( p = .029). NAC is an effective and biocompatible adjuvant to PMMA in terms of antibacterial activity against Staphylococcus aureus and Escherichia coli . The broad antibacterial spectrum of NAC, its low expense, and minimal cytotoxicity makes it an ideal agent for addition to PMMA cement.