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Basic Science Investigations |
1 Service Hospitalier Frédéric Joliot, CEA, Orsay, France
2 INSERM EMI-U 99-33, Paris, France
3 Service de Médecine Nucléaire, Hôpital Bichat, Paris, France
Ciprofloxacin, a quinolone antibiotic drug, binds to DNA topoisomerase IV and DNA gyrase of various bacteria. Thus ciprofloxacin labeled with 99mTc could potentially act as a specific marker allowing discrimination between infection and sterile inflammation. We evaluated these properties on a rabbit model of prosthetic joint infection previously validated. We compared the images obtained in 2 groups of animals: rabbits with infected (G1; n = 6) and uninfected (G2; n = 7) prosthesis. Methods: Partial right-knee arthroplasty was performed on 13 New Zealand White female rabbits, with a tibial silicone-elastomer implant fitting into the intramedullary canal of the tibia. After the surgical wound was closed, 107 cfu of a clinical strain of methicillin-susceptible Staphylococcus aureus were injected into the joint in G1 rabbits. G2 rabbits were injected with sterile saline. No antibiotic therapy was given to the animals. 99mTc-ciprofloxacin planar imaging was performed on days 5, 12, and 19 after surgery, and after 3 mo in 1 uninfected rabbit. Images were obtained 1, 4, and 24 h after injection (147 ± 13 MBq). Results: In G1, increased right knee 99mTc-ciprofloxacin uptake was observed in 3 of 5 rabbits on day 5, and in all cases on days 12 and 19. Killing of the animals revealed purulent arthritis, osteitis, and tibial myelitis. In G2, significant right-knee uptake was found on days 12 and 19 in 5 of 6 rabbits, and after 3 mo in 1; all sets of images were negative in 1 animal. Bacteriologic studies after the animals were killed were negative in G2. Mean right/left knee uptake ratios on day 19 (4-h images) were 1.8 ± 0.4 in G1 versus 1.4 ± 0.3 in G2 (not significant). Late images did not discriminate between infected and uninfected arthroplasty. Conclusion: Results of 99mTc-ciprofloxacin imaging in rabbits with infected/uninfected knee prosthesis suggest good sensitivity but lack of specificity for the detection of S. aureus infection.
Key Words: radiolabeled quinolone • infection imaging • prosthetic joint
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