A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics

Abstract

Aims Local antibiotics are used in the surgical management of foot infection in diabetic patients. This systematic review analyzes the available evidence of the use of local antibiotic delivery systems as an adjunct to surgery. Materials and Methods Databases were searched to identify eligible studies and 13 were identified for inclusion. Results Overall, the quality of the studies was poor. A single trial suggested that wound healing is quicker when a gentamicin-impregnated collagen sponge was implanted at time of surgery, with no difference in length of stay or rate of amputation. Results from studies with high risk of bias indicated no change in wound healing when a gentamicin-impregnated sponge was implanted during transmetatarsal amputation, but a reduction in the incidence of wound breakdown (8% vs 25%, not statistically significant) was identified. A significant cost reduction was identified when using an antimicrobial gel to deliver antibiotics and anti-biofilm agents (quorum-sensing inhibitors) compared with routine dressings and systemic antibiotics. Analyses of case series identified 485 patients who were treated using local antibiotic delivery devices. The rates of wound healing, re-operation, and mortality were comparable to those that have been previously reported for the routine management of these infections. Conclusion There is a lack of good-quality evidence to support the use of local antibiotic delivery devices in the treatment of foot infections in patients with diabetes. Cite this article: Bone Joint J 2018;100-B:1409–15.

Collagen in Wound Healing

“…Collagen wound dressings contain collagen blended with natural and synthetic polymers such as polyethylene oxide, poly (L-lactic acid), hyaluronic acid, elastin and silk fibroin, alginate, chitosan, etc [ 73 , 81 , 82 , 83 , 84 , 85 ]. These blended fabrications have incorporated other additives such as insulin [ 86 ], antibiotics [ 87 , 88 , 89 , 90 , 91 , 92 ] or gold nanoparticles [ 93 , 94 , 95 ] and have been tested mostly in in vitro studies or small animal models of wound healing. An evidence-based review of clinical studies on antibacterial integrated collagen wound dressings indicated that most studies were limited by small sample sizes and mixed chronic wound etiologies [ 46 ].…”

“…Collagen is also used as a surface coating to enhance moisture retention and promote cell adhesion within scaffolds/matrices [ 73 , 81 , 82 , 83 , 84 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ]. Water retention is important to keep the wound bed moist.…”

Surgical management of the acute severely infected diabetic foot – The ‘infected diabetic foot attack’. An instructional review

“…A recent systematic review concluded there is little evidence to support routine local antibiotic delivery devices in the treatment of diabetic foot infections. 33 However, local antibiotic delivery yield very high local concentrations of antibiotics in targeted areas, especially in the presence of osteomyelitis: this approach maybe especially useful in poorly perfused tissues and 'hard-to-reach' locations. For example, the Silo technique, describes debridement delineated by MRI, drilling of bone tunnels and injection of antibiotic-loaded bio-ceramic, allowing infection control.…”

Gentamicin Sponge for Anti-infection, a Controversial Old Topic and Preliminary Exploration of the Solution, in Vitro and in Vivo Experiments

“…Gentamicin sponge, an implantable topical antibiotic agent, is approved for surgical implantation in 54 countries. Since 1985, more than 1 million patients have been treated with the sponges [1][2][3]. However, although gentamicin sponge has been studied for more than 30 years, the effectiveness of it still has been controversial [1,[4][5][6][7][8].…”