Antibiotic-loaded bone graft for reduction of surgical site infection in spinal fusion

Shiels, Stefanie M.; Raut, Vivek; Patterson, Patrick B.; Barnes, Brian R.; Wenke, Joseph C.

doi:10.1016/j.spinee.2017.06.039

Cited by 20 publications

(14 citation statements)

References 21 publications

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“…This results in a much higher local concentration when using DBM as a carrier instead of cement. Using allografts, attenuated healing was also seen in spinal fusion where DBM was mixed with vancomycin [21], whereas DBM with gentamicin or DBM/bioactive glass with tobramycin had no negative effect on osteoinductivity or femur defect healing, respectively [22,23]. Coraca-Huber et al published detailed studies investigating the effect of e.g., processing, storage, and freezing on antibiotic-loaded allogeneic bone and found promising in vitro results; however, no in vivo study has been published investigating biocompatibility until now [11,24,25,26,27].…”

Section: Discussionmentioning

confidence: 99%

Impact of Gentamicin-Loaded Bone Graft on Defect Healing in a Sheep Model

et al. 2019

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Infections of bone are severe complications, and an optimization of grafting material with antimicrobial drugs might be useful for prevention and treatment. This study aimed to investigate the influence of gentamicin-loaded bone graft on the healing of bone defects in a sheep model. Metaphyseal and diaphyseal drill hole defects (diameter: 6 mm, depth: 15 mm) were filled with graft or gentamicin-loaded graft (50 mg/g graft) or were left untreated. Analysis of regeneration after three and nine weeks, micro-computed tomography (μCT), and histology revealed a significant increase in bone formation in the drill hole defects, which began at the edges of the holes and grew over time into the defect center. The amount of graft decreased over time due to active resorption by osteoclasts, while osteoblasts formed new bone. No difference between the groups was seen after three weeks. After nine weeks, significantly less mineralized tissue was formed in the gentamicin-loaded graft group. Signs of inflammatory reactions were seen in all three groups. Even though the applied gentamicin concentration was based on the concentration of gentamicin mixed with cement, the healing process was impaired. When using local gentamicin, a dose-dependent, compromising effect on bone healing should be considered.

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Section: Discussionmentioning

confidence: 99%

Impact of Gentamicin-Loaded Bone Graft on Defect Healing in a Sheep Model

et al. 2019

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“…6 An in vivo study demonstrated that the addition of vancomycin to demineralized bone matrix (DBM) reduced the fusion capability of the DBM graft in posterolateral fusion. 27 Currently, little is known about the impact of intrawound vancomycin powder on the true risk for pseudarthrosis. Existing retrospective studies fail to report compelling data on the subject and show no significant differences in pseudoarthrosis rates in patients treated with or without intrawound vancomycin powder due to small patient numbers, shortterm follow-up, or insufficient radiological study.…”

Section: Vancomycin-related Adverse Drug Reactionsmentioning

confidence: 99%

“…33 The toxic impact of subfascial administration of vancomycin powder on bone healing with increased risk of nonunion is controversial but remains a serious concern. 6,27 To date no studies have evaluated the efficacy and safety of solely suprafascial administration of vancomycin powder. With suprafascial distribution of vancomycin powder, there might be a potential reduction not only in SSIs but also in drug-related complications, which have been reported with subfascial administration.…”

mentioning

confidence: 99%

Reduction in surgical site infection with suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion: a retrospective case-control study

Haimoto

Schär

Nishimura

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVERecent studies have demonstrated the efficacy of subfascial intrawound application of vancomycin powder in spine surgery in reducing the rate of surgical site infections (SSIs). However, to date no study has evaluated the efficacy and safety of suprafascial application of vancomycin powder in spine surgery. The purpose of this study was to quantify the rate of SSIs after open instrumented posterior spinal fusion with and without application of suprafascial vancomycin powder and to evaluate the rate of vancomycin powder–related local adverse effects.METHODSThe authors conducted a single-center retrospective case-control study of adult patients undergoing open instrumented posterior fusion of the cervical, thoracic, or lumbar spine performed by a single surgeon from January 2010 through December 2016. In March 2013, routine application of 1 g of suprafascial vancomycin powder was started for all cases in addition to standard systemic antibiotic prophylaxis. Baseline demographics and operative data as well as the SSI rates were compared between the study groups. The incidence of vancomycin powder–related adverse effects was analyzed.RESULTSA total of 515 patients (268 in the untreated group and 247 in the treated group) were included in the study. The mean age was significantly higher in the treated group than in the untreated group (58.4 vs 54.4 years, p < 0.01). Operative variables were similar between the study groups. Patients receiving vancomycin powder had a significantly lower infection rate (5.6% in the untreated group vs 0% in the treated group, p < 0.001). No vancomycin powder–related adverse effects were identified in the treated group.CONCLUSIONSRoutine application of suprafascial intrawound vancomycin powder in addition to systemic antibiotic prophylaxis is an easy-to-use, safe, and effective strategy for preventing SSIs after instrumented posterior spinal fusion. Suprafascial application of vancomycin powder could be a valuable alternative to previously reported subfascial distribution, minimizing the risk of local adverse drug reactions.

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“…When calcium sulfate is used as a carrier for gentamycin, it prolonged the hydration of calcium sulfate and adhered to the whole crystal-forming process [11]. In vivo experiments proved that gentamycin or vancomycin-coated human bone graft application in a bone defect model caused decreased healing rate and less mineralization [37,38]. Although a study combining in vivo and in vitro approaches claimed that there is no adverse effect of gentamycin on bone-forming cells and remodeling when human bone graft is coated [39].…”

Section: Discussionmentioning

confidence: 99%

Alveolar Preservation with Albumin and Gentamycin-Coated Allograft after Third Molar Tooth Removal: A Randomized Clinical Trial

et al. 2021

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Alveolar preservation can minimize bone resorption after tooth removal and additional topical antibiotics might also be considered. The goal of this study was to observe alveolar preservation with albumin and gentamycin-coated allograft compared to unfilled control sockets after mandibular third molar removal. Twenty-two patients were involved, 11 in the control group and 11 in the test group. CBCT analysis and micromorphometric analysis were performed. After one year, graft integration was observed with remaining graft particles. Micromorphometric analysis showed increased density and lower trabeculae formation in the grafted group. The buccal height reduction of the alveolar ridge was significantly lower when alveolar preservation was applied (control: 2.54 ± 2.01 mm, graft: 1.37 ± 1.04 mm, p < 0.05). Horizontal bone loss prevention was not significant. At the distal site of the second molar, the marginal bone level (MBL) was significantly lower in the control group. At the control group, five pockets persisted from the eight initial and all healed in the graft group. Alveolar preservation improves bone formation, helps to preserve the buccal bone crest, and minimizes MBL loss and pocket formation on the adjacent teeth. Thus, it needs to be also considered after third molar surgical removal.

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Antibiotic-loaded bone graft for reduction of surgical site infection in spinal fusion

Cited by 20 publications

References 21 publications

Impact of Gentamicin-Loaded Bone Graft on Defect Healing in a Sheep Model

Impact of Gentamicin-Loaded Bone Graft on Defect Healing in a Sheep Model

Reduction in surgical site infection with suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion: a retrospective case-control study

Alveolar Preservation with Albumin and Gentamycin-Coated Allograft after Third Molar Tooth Removal: A Randomized Clinical Trial

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