İbrahim KAYA, İbrahim SUNGUR, Murat YİLMAZ, Filiz PEHLİVANOGLU, Kadriye KARTYASAR, Gonul SENGOZ

Farklı antibiyotik içeren yıkama solüsyonlarının Staphylococcus aureus ile kirletilmiş allogreftlerin dekontaminasyonundaki etkinliğinin karşılaştırılması

Amaç: Bu çalışmanın amacı Staphylococcus aureus ile kontamine edilmiş allogreftlerin dekontaminasyonunda serum fizyolojik, rifampisin, gentamisin, düşük ve yüksek konsantrasyonlu fusidik asit içeren yıkama solüsyonlarının lokal antibakteriyel etkinliğinin araştırılması idi. Çalışma planı: Kemik bankasından sterilite kontrolü yapılarak elde edilmiş, taze dondurulmuş 55 femur başı metisiline duyarlı ATCC 25923 Staphylococcus aureus ile kontamine edilip gruplara ayrıldıktan sonra, yüksek basınçlı (80 psi) pulse lavaj kullanılarak serum fizyolojik, rifampisinli yıkama solüsyonu (50 mg/l), gentamisinli yıkama solüsyonu (50 mg/l), düşük (50 mg/l) ve yüksek konsantrasyonlu (500 mg/l) fusidik asitli yıkama solüsyonu ile 10 cm’lik mesafeden 30 saniye süreyle yıkandı. Yıkama sonrası allogreftler kültüre ekilerek koloni sayımı yapıldı. Ortalama±standart sapma değerleri (minimum-maksimum) hesaplandı. Dört yıkama grubu arasındaki farklılıklar Kruskal-Wallis varyans analizi ile değerlendirilerek, post-hoc Mann-Whitney U testi ile ikili gruplar halinde karşılaştırıldı. Bulgular: Rifampisinli yıkama solüsyonu ile yapılan yıkamada bir allogreft haricinde kolonizasyona rastlanmadı. Gentamisinli yıkama solüsyonu ile yıkamadan elde edilen sonuçlar, düşük konsantrasyonlu fusidik asit içeren yıkama solüsyonu ve serum fizyolojikten üstünken (sırasıyla, p=0.010 ve 0.004), yüksek konsantrasyonlu fusidik asit içeren yıkama solüsyon grubundakiler ile benzerlik göstermekteydi. Düşük ve yüksek konsantrasyonlu fusidik asit içeren yıkama solüsyonları ile elde edilen sonuçlar birbirine benzer iken, serum fizyolojikle yapılan yıkamaya göre bir üstünlükleri saptanmadı. Çıkarımlar: Staphylococcus aureus ile kontamine edilmiş allogreftlerin dekontaminasyonunda rifampisinli yıkama solüsyonunun en fazla etkili olduğu saptanırken, etkinlik sıralamasına göre gentamisinli, yüksek konsantrasyonlu fusidik asitli, düşük konsantrasyonlu fusidik asitli ve son olarak serum fizyolojikli yıkama solüsyonunun etkili olduğu gösterilmiştir.

Anahtar Kelimeler:

Fusidik asit; irrigasyon; kontamine kemik; Staphylococcus aureus

Comparison of the efficiency of different antibiotic irrigation solutions in decontamination of allografts contaminated with Staphylococcus aureus

Objective: The purpose of this study was to investigate the local antibacterial efficacy of saline, rifampicin, gentamicin, high-concentration fusidic acid and low-concentration fusidic acid in thedecontamination of allografts contaminated with Staphylococcus aureus.Methods: Fifty-five sterile, fresh-frozen femoral heads obtained from the bone bank were contaminated with methicillin-sensitive ATCC 25923 Staphylococcus aureus. Samples were divided into groups and debrided with high-pressure (80 psi) pulse lavage using a saline, rifampicin irrigation solution (50 mg/l), gentamicin irrigation solution (50 mg/l) and low- (50 mg/l) or high concentration (500 mg/l) fusidic acid irrigation solution for 30 seconds from a distance of 10 cm. After irrigation, allografts were incubated in the culture and developed colonies were counted. Mean±standard deviation (min-max) values were calculated. The differences between the four irrigation groups were evaluated using the Kruskal-Wallis variance analysis and groups were compared two at a time using the post-hoc MannWhitney U test.Results: No colonization was detected with the exception of one allograft in the rifampicin irrigation group. The gentamicin irrigation group had similar results as the high-concentration fusidic acid irrigation group and both results were superior to those of the saline and low-concentration fusidic acid irrigation groups (p=0.010 and 0.004, respectively). The low- and high-concentration fusidic acid irrigation groups were similar and were not shown to have superior results than saline irrigation group.Conclusion: Rifampicin irrigation solution was the most effective in the decontamination of allografts previously contaminated with Staphylococcus aureus. Gentamicin, high-concentration fusidic acid, lowconcentration fusidic and saline irrigation solutions may also be used respectively, according to their effectiveness.

Keywords:

Contaminated bone, fusidic acid, irrigation Staphylococcus aureus,

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