Analysis of Antibacterial Activity of Graded Concentrations of Teicoplanin Mixed With Acrylic Bone Cement in Staphylococcal (Methicillin-resistant Staphylococcus aureus) Infections and to Compare itwith Vancomycin: An In Vitro Study

Background: Orthopedic infections by methicillin-resistant Staphylococcus aureus (MRSA) are becoming more frequent afterdevice implantation, and often resistant to many commonly used antibiotics. The new line of antibiotics such as vancomycin,meropenem, and teicoplanin is being used for the treatment of such infections intravenously. However, these antibiotics canalso be used along with bone cement as a local antibiotic spacer.Aims: The aim of the study was to compare in vitro antibacterial activity of vancomycin and teicoplanin and to know the optimumconcentration of teicoplanin at which there is maximum inhibition of bacteria.Materials and Methods: Three different brands of bone cement discs (Palacos-R + G, surgical Simplex P, and CMW1) withvancomycin and teicoplanin of different concentration used. Inoculating media with bacterial isolates of Staphylococcus aureus(Methicillin-resistant) of strain ATCC 2593 with known minimum inhibitory concentration were used. In each media two discs ofone formulation were placed and labeled accordingly. Readings were taken at 24 h, 48 h, and 6 days.Results: All the cement brands eluted vancomycin equally well, but the zone of inhibition for palacos was marginally highercompared to the other two. Teicoplanin when increased from 400 mg to 1200 mg concentration showed a dose-dependentinhibition of MRSA with an increase in the zone of inhibition in all cements, with palacos being highest.Conclusion: Teicoplanin in higher concentration is a better alternative to vancomycin in MRSA bone infection.

Novel CHD7 and FBN1 mutations in an infant with multiple congenital anamolies.

The first case of an infant with a dual genetic diagnosis of CHARGE and Marfan syndrome is reported here. The patient had multiple congenital anamolies, many of them consistent with CHARGE syndrome and genetic testing identified a heterozygous mutation c.3806_11del6insA in the CHD7 gene. In addition, his father had physical features consistent with Marfan syndrome. Fibrillin-1 (FBN1) mutation screening identified a heterozygous c.3990insC mutation in both father and the patient.