Prevention of Staphylococcus aureus biofilm formation on metallic surgical implants via controlled release of gentamicin

Implant associated infections are a critical health concern following orthopaedic surgery. Sustained local delivery of antibiotics has been suggested as a means of preventing these infections. Poly(D,L-lactide) (PDLLA) is a biodegradable polymer that has been used to coat implants for the delivery of antibiotics and other bioactive molecules. While effective, these studies show that antibiotics are released in a burst profile. Here we evaluated a method for controlled release of gentamicin from implant surfaces using the palmitate alkyl salt to decrease its solubility in aqueous solution. Steel Kirschner wires (K-wires) were coated with Gentamicin-palmitate (GP)-PDLLA, gentamicin sulphate (GS)-PDLLA or vancomycin sulphate (VS)-PDLLA, and elution of antibiotics from coated K-wires investigated using HPLC/MS/MS. In contrast to burst antibiotic release from the GS-PDLLA and VS-PDLLA groups, GP was released in a slower sustained manner. Colonisation and initial attachment of Staphylococcus aureus Xen29 to gentamicin-coated K-wires was reduced by 90% when compared to the non-coated control group. However there was no statistical difference in recovery of bacteria from GS or GP groups. Bacteria recovered from VS-PDLLA coated K-wires decreased by 36%. Bioluminescence emitted by S. aureus Xen29 was also reduced over seven days in the antibiotic control groups, demonstrating that growth and biofilm development over the longer term was impaired by antibiotic-PDLLA coating. These results indicate that using alkyl salts of antibiotics may be an effective strategy for controlling the release of antibiotics from implants