Do Antibiotic-Loaded Calcium Sulfate Beads Improve Outcomes After Debridement, Antibiotics, and Implant Retention? A Matched Cohort Study

Tarity, T. David; Xiang, William; Jones, Christopher W.; Gkiatas, Ioannis; Nocon, Allina; Selemon, Nicolas A.; Carli, Alberto; Sculco, Peter K.

doi:10.1016/j.artd.2022.01.023

Cited by 11 publications

(9 citation statements)

References 31 publications

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“… 58 The addition of antibiotic-loaded CaSO 4 to standard of care did greatly improve outcomes in two studies examining debridement, antibiotics and implant retention procedures in hip 22 or knee 54 PJI, but had no effect in two other studies. 59 , 60 A potential explanation is insufficient quantities or concentrations. Another hypothetical explanation is the type of CaSO 4 used, as both studies with a positive effect used Osteoset, whereas the other two studies used Stimulan (Biocomposites, UK).…”

Section: Discussionmentioning

confidence: 99%

Wound fluid ceftriaxone concentrations after local application with calcium sulphate as carrier material in the treatment of orthopaedic device-associated hip infections

Wiesli

Livio

Achermann

et al. 2022

Bone & Joint Research

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Aims There is a considerable challenge in treating bone infections and orthopaedic device-associated infection (ODAI), partly due to impaired penetration of systemically administrated antibiotics at the site of infection. This may be circumvented by local drug administration. Knowledge of the release kinetics from any carrier material is essential for proper application. Ceftriaxone shows a particular constant release from calcium sulphate (CaSO4) in vitro, and is particularly effective against streptococci and a large portion of Gram-negative bacteria. We present the clinical release kinetics of ceftriaxone-loaded CaSO4 applied locally to treat ODAI. Methods A total of 30 operations with ceftriaxone-loaded CaSO4 had been performed in 28 patients. Ceftriaxone was applied as a single local antibiotic in 21 operations and combined with vancomycin in eight operations, and in an additional operation with vancomycin and amphotericin B. Sampling of wound fluid was performed from drains or aspirations. Ceftriaxone concentrations were measured by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Results A total of 37 wound fluid concentrations from 16 operations performed in 14 patients were collected. The ceftriaxone concentrations remained approximately within a range of 100 to 200 mg/l up to three weeks. The median concentration was 108.9 mg/l (interquartile range 98.8 to 142.5) within the first ten days. No systemic adverse reactions were observed. Conclusion Our study highlights new clinical data of locally administered ceftriaxone with CaSO4 as carrier material. The near-constant release of ceftriaxone from CaSO4 observed in vitro could be confirmed in vivo. The concentrations remained below known local toxicity thresholds. Cite this article: Bone Joint Res 2022;11(11):835–842.

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Section: Discussionmentioning

confidence: 99%

Wound fluid ceftriaxone concentrations after local application with calcium sulphate as carrier material in the treatment of orthopaedic device-associated hip infections

Wiesli

Livio

Achermann

et al. 2022

Bone & Joint Research

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“…DAIR continues to appear to be an acceptable treatment in management of early PJI (within 30 days) after revision arthroplasty; however, failure rates are increased in cases of antibiotic mismatches, multiple DAIR procedures, or a prolonged interval (>30 days) from the index procedure to the DAIR 28 . The addition of antibiotic-loaded calcium sulfate beads has not been shown to reduce the incidence of recurrent PJIs following DAIR 29 . A registry-based cohort study showed no difference in re-revision rates of an initial 2-stage exchange compared with a 2-stage exchange following a failed DAIR 30 .…”

Section: Surgical Treatmentmentioning

confidence: 99%

What’s New in Musculoskeletal Infection

Otero

Brown

Courtney

et al. 2023

Journal of Bone and Joint Surgery

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“…Unfortunately, the comparative studies assessing success rates are limited to case series or case-control studies in DAIR procedures. A matched case-control study of 40 DAIRs for acute hip or knee PJI demonstrated no significant improvement with the use of vancomycin and tobramycin CS beads at 90 days or two years [ 88 ]. This study reported a 45% failure rate, consistent with other smaller published case series of CS DAIRs [ 89 ].…”

Section: Local Antibiotic Carriersmentioning

confidence: 99%

Local Antibiotic Delivery Options in Prosthetic Joint Infection

et al. 2023

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Prosthetic Joint Infection (PJI) causes significant morbidity and mortality for patients globally. Delivery of antibiotics to the site of infection has potential to improve the treatment outcomes and enhance biofilm eradication. These antibiotics can be delivered using an intra-articular catheter or combined with a carrier substance to enhance pharmacokinetic properties. Carrier options include non-resorbable polymethylmethacrylate (PMMA) bone cement and resorbable calcium sulphate, hydroxyapatite, bioactive glass, and hydrogels. PMMA allows for creation of structural spacers used in multi-stage revision procedures, however it requires subsequent removal and antibiotic compatibility and the levels delivered are variable. Calcium sulphate is the most researched resorbable carrier in PJI, but is associated with wound leakage and hypercalcaemia, and clinical evidence for its effectiveness remains at the early stage. Hydrogels provide a versatile combability with antibiotics and adjustable elution profiles, but clinical usage is currently limited. Novel anti-biofilm therapies include bacteriophages which have been used successfully in small case series.

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Do Antibiotic-Loaded Calcium Sulfate Beads Improve Outcomes After Debridement, Antibiotics, and Implant Retention? A Matched Cohort Study

Cited by 11 publications

References 31 publications

Wound fluid ceftriaxone concentrations after local application with calcium sulphate as carrier material in the treatment of orthopaedic device-associated hip infections

Wound fluid ceftriaxone concentrations after local application with calcium sulphate as carrier material in the treatment of orthopaedic device-associated hip infections

What’s New in Musculoskeletal Infection

Local Antibiotic Delivery Options in Prosthetic Joint Infection

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