Current Concepts of Fracture-Related Infection

He, Siying; Yu, Bin; Jiang, Nan

doi:10.1155/2023/4839701

Cited by 14 publications

(5 citation statements)

References 114 publications

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“…Implant-associated infections (IAI) remain one of the greatest challenges in orthopedic and trauma surgery, despite major advances that have been achieved regarding their diagnosis and treatment. Currently, the most important treatment principles for IAI include surgical debridement, implant handling, long-term systemic antibiotics, reconstruction defects of bone and soft tissues, and functional recovery [ 25 ]. Fundamental research in vitro and in vivo should be performed to uncover the pathogenesis of this disorder more comprehensively.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of lysostaphin-coated titanium plates on implant-associated MRSA osteitis in minipigs

Jaekel,

Windolf,

Bieler

et al. 2024

Eur J Trauma Emerg Surg

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Purpose The growing incidence of implant-associated infections (IAIs) caused by biofilm-forming Staphylococcus aureus in combination with an increasing resistance to antibiotics requires new therapeutic strategies. Lysostaphin has been shown to eliminate this biofilm. Own studies confirm the effectiveness in a murine model. The current study characterizes the effects of lysostaphin-coated plates in an IAI minipig model. Methods The femur of 30 minipigs was stabilized with a five-hole plate, a bone defect was created, and in 20 cases methicillin-resistant Staphylococcus aureus was applied. Ten animals served as control group. After 14 days, local debridement, lavage, and plate exchange (seven-hole plate) were performed. Ten of the infected minipigs received an uncoated plate and 10 a lysostaphin-coated plate. On day 84, the minipigs were again lavaged, followed by euthanasia. Bacterial load was quantified by colony-forming units (CFU). Immunological response was determined by neutrophils, as well as interleukins. Fracture healing was assessed radiologically. Results CFU showed significant difference between infected minipigs with an uncoated plate and minipigs with a lysostaphin-coated plate (p = 0.0411). The infection-related excessive callus formation and calcification was significantly greater in the infected animals with an uncoated plate than in animals with a lysostaphin-coated plate (p = 0.0164/p = 0.0033). The analysis of polymorphonuclear neutrophils and interleukins did not reveal any pioneering findings. Conclusion This study confirms the minipig model for examining IAI. Furthermore, coating of plates using lysostaphin could be a promising tool in the therapeutic strategies of IAI. Future studies should focus on coating technology of implants and on translation into a clinical model.

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Section: Discussionmentioning

confidence: 99%

Efficacy of lysostaphin-coated titanium plates on implant-associated MRSA osteitis in minipigs

Jaekel,

Windolf,

Bieler

et al. 2024

Eur J Trauma Emerg Surg

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“…He et al, 16 in their review article on current concepts of treatment of fracture related infection recommended the “Oxford group” protocol for local implantation of calcium sulfate with antibiotics for intramedullary (type I), localized (type III), and diffuse (type IV) infections, while soft-tissue coverage is recommended for superficial infection (type II).…”

Section: Discussionmentioning

confidence: 99%

The use of Stimulan in bone and joint infections

Mereddy,

Nallamilli,

Gowda

et al. 2023

Bone Jt Open

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AimsMusculoskeletal infection is a devastating complication in both trauma and elective orthopaedic surgeries that can result in significant morbidity. Aim of this study was to assess the effectiveness and complications of local antibiotic impregnated dissolvable synthetic calcium sulphate beads (Stimulan Rapid Cure) in the hands of different surgeons from multiple centres in surgically managed bone and joint infections.MethodsBetween January 2019 and December 2022, 106 patients with bone and joint infections were treated by five surgeons in five hospitals. Surgical debridement and calcium sulphate bead insertion was performed for local elution of antibiotics in high concentration. In all, 100 patients were available for follow-up at regular intervals. Choice of antibiotic was tailor made for each patient in consultation with microbiologist based on the organism grown on culture and the sensitivity. In majority of our cases, we used a combination of vancomycin and culture sensitive heat stable antibiotic after a thorough debridement of the site. Primary wound closure was achieved in 99 patients and a split skin graft closure was done in one patient. Mean follow-up was 20 months (12 to 30).ResultsOverall, six out of 106 patients (5.6%) presented with sepsis and poorly controlled comorbid conditions, and died in the hospital within few days of index surgery. Out of the remaining 100 patients, control of infection was achieved in 95 patients (95%). Persistence of infection was noted in five (5%) patients. Out of these 95 patients that had good control of infection, four patients (4.2%) with gap nonunion needed Masquelet procedure to achieve union.ConclusionOur multicentre experience confirmed that surgical debridement along with calcium sulphate bead insertion was effective in treating bone and joint infections without any side effects and complications.Cite this article: Bone Jt Open 2023;4(7):516–522.

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“…Implant-associated infections (IAI) remain one of the greatest challenges in orthopaedic and trauma surgery, despite major advances that have been achieved regarding their diagnosis and treatment. Currently, the most important treatment principles for IAI include surgical debridement, implant handling, long-term systemic antibiotics, reconstruction defects of bone and soft tissues, and functional recovery [25]. Fundamental research in vitro and in vivo should be performed to uncover the pathogenesis of this disorder more comprehensively.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of lysostaphin-coated titanium plates on implant- associated MRSA osteitis in minipigs

Jaekel,

Windolf,

Bieler

et al. 2023

Preprint

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Purpose. The growing incidence of implant-associated infections (IAIs) caused by biofilm-forming Staphylococcus aureus in combination with an increasing resistance to antibiotics requires new therapeutic strategies. Lysostaphin has been shown to eliminate this biofilm. Own studies confirm the effectiveness in a murine model. The current study characterizes the effects of lysostaphin-coated plates in an IAI minipig model. Methods. The femur of 30 minipigs was stabilized with a 5-hole plate, a bone defect was created, and in 20 cases methicillin-resistantStaphylococcus aureus was applied. 10 animals served as control group. After 14 days, local debridement, lavage, and plate exchange (7-hole plate) were performed. 10 of the infected minipigs received an uncoated plate and 10 a lysostaphin-coated plate. On day 84, the minipigs were again lavaged, followed by euthanasia. Bacterial load was quantified by colony-forming units (CFU). Immunological response was determined by neutrophils, as well as interleukins. Fracture healing was assessed radiologically. Results. CFU showed significant difference between infected minipigs with uncoated plate and minipigs with lysostaphin-coated plate (p=0.0411). The infection-related, excessive callus formation and calcification was significantly greater in the infected animals with uncoated plate than in animals with lysostaphin-coated plate (p=0.0164 / p=0.0033). The analysis of polymorphonuclear neutrophils and interleukins did not reveal any pioneering findings. Conclusion. This study confirms the minipig model for examining IAI. Furthermore, coating of plates using lysostaphin could be a promising tool in the therapeutic strategies of IAI. Future studies should focus on coating technology of implants and on translation into a clinical model.

show abstract

Current Concepts of Fracture-Related Infection

Cited by 14 publications

References 114 publications

Efficacy of lysostaphin-coated titanium plates on implant-associated MRSA osteitis in minipigs

Efficacy of lysostaphin-coated titanium plates on implant-associated MRSA osteitis in minipigs

The use of Stimulan in bone and joint infections

Efficacy of lysostaphin-coated titanium plates on implant- associated MRSA osteitis in minipigs

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