Antibiotic-laden bone cement for diabetic foot infected wounds: A systematic review and meta-analysis

Abstract

ObjectiveA large body of literature has demonstrated the significant efficacy of antibiotic bone cement in treating infected diabetic foot wounds, but there is less corresponding evidence-based medical evidence. Therefore, this article provides a meta-analysis of the effectiveness of antibiotic bone cement in treating infected diabetic foot wounds to provide a reference basis for clinical treatment.MethodsPubMed, Embase, Cochrane library, Scoup, China Knowledge Network (CNKI), Wanfang database, and the ClinicalTrials.gov were searched, and the search time was from the establishment of the database to October 2022, and two investigators independently. Two investigators independently screened eligible studies, evaluated the quality of the literature using the Cochrane Evaluation Manual, and performed statistical analysis of the data using RevMan 5.3 software.ResultsA total of nine randomized controlled studies (n=532) were included and, compared with the control group, antibiotic bone cement treatment reduced the time to wound healing (MD=-7.30 95% CI [-10.38, -4.23]), length of hospital stay (MD=-6.32, 95% CI [-10.15, -2.48]), time to bacterial conversion of the wound (MD=-5.15, 95% CI [-7.15,-2.19]), and the number of procedures (MD=-2.35, 95% CI [-3.68, -1.02]).ConclusionAntibiotic bone cement has significant advantages over traditional treatment of diabetic foot wound infection and is worthy of clinical promotion and application.Systematic review registrationPROSPERO identifier, CDR 362293.

Combining antibiotic‐loaded bone cement‐based free vastus lateralis muscle‐sparing flap with split‐thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non‐weight‐bearing areas

“… 28 Additionally, ALBC has been proven to rapidly control infection, promote ulcer healing, shorten hospital stays and lessen medical costs. 23 , 24 , 25 , 26 In our case series, the overall average hospital stay for patients was 18 days, which is lower than the 31 days (range: 12–51 days) reported in the systematic review by Bhat et al 29 Besides releasing antibiotics, the ALBC treatment for DFUs promotes the formation of the ‘induced membrane’ (Figure 2B ). 23 , 26 It can also cause the production of various cytokines, such as vascular endothelial growth factor (VEGF) and transforming growth factor‐β (TGF‐β).…”

“…Most DFU infections are polymicrobial, with Staphylococcus aureus , Pseudomonas aeruginosa and Escherichia coli being the primary pathogens. 21 , 22 In recent years, ALBC has been used to treat DFUs 23 , 24 , 25 , 26 as it is mixed with antibiotics such as gentamicin, tobramycin and vancomycin. 27 This mixture can continuously release antibiotics locally, slowly and effectively killing the bacteria commonly infecting DFUs, thus avoiding the systemic side effects of medications.…”

A meta‐analysis of the effectiveness of antibacterial bone cement in the treatment of diabetic foot skin wound infections

“…Systemic antibiotics are used to treat diabetic foot infections in subjects, but prolonged use of these drugs might have negative side effects and lead to bacterial resistance 29 . Sun Shujuan et al's analysis of the pathogenic bacteria associated with diabetic foot in Beijing revealed a 16.9% prevalence of bacteria that were multi‐drug resistant 30 . Diabetic foot infection subjects place a large strain on clinical care due to their lengthy hospital stays, lengthy recovery from trauma and expensive medical costs.…”

Composite Bone Cements with Enhanced Drug Elution

“…Polymethylmethacrylate (PMMA)-based antibiotic-loaded bone cement (ALBC) is widely employed in orthopedic surgery all over the world [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. As an antibiotic carrier, ALBC provides local drug delivery at the surgical site in concentrations sufficient for the successful suppression of the infection (e.g., periprosthetic joint infection (PJI)) [ 2 , 6 , 9 , 10 , 11 , 12 , 13 ].…”

“…Polymethylmethacrylate (PMMA)-based antibiotic-loaded bone cement (ALBC) is widely employed in orthopedic surgery all over the world [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. As an antibiotic carrier, ALBC provides local drug delivery at the surgical site in concentrations sufficient for the successful suppression of the infection (e.g., periprosthetic joint infection (PJI)) [ 2 , 6 , 9 , 10 , 11 , 12 , 13 ]. Moreover, ALBC application can be advantageous compared to systemic antibiotic administration since it provides higher local concentrations, lowers rates of antibiotic-associated adverse events, and decreases antimicrobial resistance via the preservation of the gastrointestinal microbiome [ 8 ].…”