Antibiotic Bead Chains

Klemm, Klaus

doi:10.1097/00003086-199310000-00011

Cited by 151 publications

(101 citation statements)

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“…High local levels of antibiotics provide sufficient antibiotic levels in avascular areas by diffusion, and in many circumstances the organisms that are resistant to drug concentrations achieved by systemic antibiotics are susceptible to the extremely high local drug concentrations provided by local antibiotic delivery [10]. Most of the data reported in the literature supports the safe usage of antibiotic-impregnated beads [4,7,10,11,15,18,20,22]. This system is superior in terms of antibiotic concentration to suction-antibiotic irrigation systems, more convenient to the patient and not associated with the risks of superinfection and blood loss by drains [1].…”

Section: Discussionmentioning

confidence: 99%

“…Radical debridement, copious irrigation and systemic and local antibiotic therapy are essential to avoid recurrent infection [3,4,12,14,19,20,22], with the quality of the surgical debridement being the most important parameter for long-term success in its management. Dead space management by means of antibiotic beads has lowered the failure rates and also enables a staged reconstruction, if needed [7,8,11,21,23]. The Cierny-Mader (C-M) classification provides prognostic data and assists in the planning of the treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

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Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Kınık

Karaduman

2007

International Orthopaedics (SICO

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Cierny-Mader (C-M) Type III osteomyelitis is defined as a localised lesion with both medullary and cortical involvement that is stable mechanically after debridement. The treatment of C-M Type III osteomyelitisis is difficult and requires a precise protocol to achieve a disease-free longterm follow-up. We report here the results of our study on 26 patients (19 men and 7 women; average age: 34.7 years) with C-M Type III osteomylelitis who were treated with radical debridement, irrigation, vancomycin-impregnated custom-made beads and culture-specific systemic antibiotics. Those patients with metaphyseal involvement were treated with deroofing of the cortex and debridement by means of a "trough" (16 patients); those with diaphyseal involvement were treated with both intramedullary reaming and debridement from a trough (ten patients). Antibiotic cement rods were used as an additional therapy in five patients with diaphyseal involvement. Recurrence developed in three patients and was attributed to inadequate debridement; all three patients were treated again in the same manner with success. The mean follow-up is currently 3.6 years (range: 2-6 years). All of the patients have normal clinical, radiographic and laboratory parameters, and all are ambulatory and have returned to their pretreatment level of activity or better. We conclude that C-M Type III chronic osteomyelitis can be safely treated with this protocol.Résumé L'ostéomyélite de type III Cierny-Mader (C-M) peut se définir comme une localisation de lésions localisées à la fois sur la médullaire et la corticale et qui reste stable sur le plan mécanique après mise à plat. Son traitement est difficile et demande un protocole précis. Pour cette étude, nous avons suivi les résultats de 26 patients (19 hommes et 7 femmes) dont l'âge moyen était de 34.7 ans, traités par mise à plat, irrigation, et billes de vancomycine. Dans les lésions métaphysaires, la mise à plat est réalisée à travers une fenêtre (16 patients), dans les lésions diaphysaires on réalise à la fois un alésage des lésions et une mise à plat par la fenêtre (10 patients). En addition aux billes de vancomycine, un ciment aux antibiotiques a été utilisé chez 5 patients avec lésions diaphysaires. Trois patients ont présenté une récidive secondaire à une mise à plat insuffisante. Tous ces patients ont été à nouveau traités de la même manière et avec succès. Le suivi moyen a été de 3.6 ans (2 à 6 ans) et aucun patient n'a présenté d'anomalie post-opératoire des différents paramètres clinique, radiographique et biologique. Les patients peuvent marcher et ont retrouvé leur activité d'avant le traitement. L'ostéomyé-lite chronique de type III de CM peut être traitée avec succès selon ce protocole.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Kınık

Karaduman

2007

International Orthopaedics (SICO

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“…Local drug delivery systems offer obvious advantages over parenteral antibiotic treatment by providing high local concentrations of antibiotic directly to the wound, while maintaining low systemic levels. However, because PMMA implants generally elute therapeutic levels of antibiotic for only two to four weeks, parenteral antibiotic therapy is still a necessary adjunct [24,7,10,11,14,17,.…”

Section: Introductionmentioning

confidence: 99%

An articulated antibiotic spacer used for infected total knee arthroplasty: A comparative in vitro elution study of Simplex® and Palacos® bone cements

Stevens

Tetsworth

Calhoun

et al. 2005

Journal Orthopaedic Research

137

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For the staged management of infected total knee arthroplasty (TKA), antibiotic laden polymethylmethacrylate (PMMA) spacers have been recommended. Antibiotic-impregnated PMMA spacers target drug delivery, achieving high local levels while limiting the potential for host toxicity associated with parenteral antimicrobial therapy. This study examined the elution characteristics of an articulating PMMA TKA spacer that has been useful clinically. Tobramycin and vancomycin are both active against many organisms leading to joint infections. We used various combined antibiotic concentrations (maintaining a relative ratio of 55% tobramycin to 45% vancomycin w/w), and then assayed the elution profile of the TKA spacer in vitro. Additionally, the elution qualities of two brands of bone cement, Simplexm and Palaces@, were compared. Briefly, three groups of PMMA spacers, impregnated with different antibiotic loads, were fashioned from a mold replicating a femoral TKA component. The entire spacer surface area was immersed in sterile phosphate buffered saline (PBS) in a 1.6 ratio of grams of cement to milliliters of PBS and incubated at 37 "C for 24 h. After 24 h, aliquot eluates were taken, the PBS discarded, and replaced with fresh, sterile PBS. PBS was changed daily and an aliquot was taken at least weekly for nine weeks. Eluate samples were stored at -70 "C until assayed. Each spacer eluate sample's antibiotic concentration was determined by disc diffusion bioassay against Bacillus subtilis. Mean zone inhibition diameters were extrapolated from the standard curve to yield micrograms per milliliter of antibiotic in PBS. In all groups the Palaces@ spacers demonstrated higher elution levels, above the MIC for the organism used, for a longer period of time than those made with Simplexa. Based on the observed elution profiles, antibiotic-impregnated Palaces@ bone cement may offer a more effective vehicle for local drug delivery during staged treatment of infected TKA.

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“…Auch in der Unfallchirurgie wurde eine signifikante Reduktion der Inzidenz akuter Knocheninfektionen und Osteomyelitisfälle bei offenen Brüchen mit erheblicher Schädigung des Weichteilgewebes (Gustilo-Typ-IIIB-und -IIICFrakturen) beschrieben, wenn zusätzlich zum chirurgischen Débridement und zur systemischen Antibiotikaprophylaxe antibiotikabeladene Knochenzementketten vor Ort eingesetzt wurden [34,35,53,58].…”

Section: Hintergrundunclassified