Efficacy and Safety of Antibiotic Impregnated Microporous Nanohydroxyapatite Beads for Chronic Osteomyelitis Treatment: A Multicenter, Open-Label, Prospective Cohort Study

Jiamton, Chittawee; Apivatgaroon, Adinun; Aunaramwat, Saree; Chawalitrujiwong, Banchai; Chuaychoosakoon, Chaiwat; Suwannaphisit, Sitthiphong; Jirawison, Choen; Iamsumang, Chonlathan; Kongmalai, Pinkawas; Sukvanich, Pawaris; Nakorn, Pongtep Na; Ongbumrungphan, Worawit; Rattanasumrit, Pawin; Tharakulphan, Suthee; Thongtanworapat, Thanachai; Thammarakcharoen, Faungchat; Srion, Autcharaporn; Suwanprateeb, Jintamai; Chernchujit, Bancha

doi:10.3390/antibiotics12061049

Cited by 6 publications

(2 citation statements)

References 87 publications

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“…The selected antibiotic should contain a broad antibacterial spectrum, including water-soluble, non-allergenic, and thermostable [ 22 ]. The most commonly used antibiotics are cefazolin, moxalactam, cefotaxime, tobramycin, gentamycin, vancomycin, and ticarcillin [ 8 ]. The rate of methicillin resistance in S. aureus , the most common causative agent of osteomyelitis, is increasing day by day.…”

Section: Discussionmentioning

confidence: 99%

“…AIC beads are used to sterilize and temporarily fill the dead cavity and are usually removed within two to four weeks [ 7 ]. The most commonly used antibiotics in these beads are cefazolin, moxalactam, cefotaxime, tobramycin, gentamicin, vancomycin, and ticarcillin [ 8 ]. The disadvantage of this method is the need for repeated surgeries such as bone grafting or bone lengthening surgeries to remove the cement and fill the bone defects.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Therapeutic Efficacy of Antibiotic-Loaded Polymeric Tissue Scaffold and Bone Cement in the Regeneration of Infected Bone Tissue

Konya,

Yilmaz

et al. 2023

Cureus

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Background Local antibiotic applications have been used in chronic osteomyelitis and have been defined as an adjunctive treatment method. Biodegradable materials are also used for the same purpose by adding antibiotics. The fact that it does not require additional surgery to be removed is an important advantage. In this study, we intended to develop a new biodegradable drug-loaded polymeric scaffold with good antibiotic release and compare the microbiological results with antibiotic-impregnated bone cement. Methodology A tissue scaffold containing poly(2-hydroxyethyl methacrylate) (PHEMA) was prepared in our laboratory and loaded with ertapenem and daptomycin antibiotics. The surface morphology and pore geometries of drug-loaded and unloaded scaffolds were analyzed by a scanning electron microscope under vacuum. The dose-dependent antiproliferative effects of PHEMA scaffold, drug-loaded scaffold, cement, and drug-loaded cement on osteoblast cells were investigated. To evaluate drug release kinetics, the absorbance values of the scaffold loaded with ertapenem and daptomycin were measured with the spectrometer. For microbiological tests, ertapenem and daptomycin-impregnated cement and scaffold, as well as the control scaffold and cement samples, were investigated for their antibacterial activities on Staphylococcus aureus and Klebsiella pneumoniae strains using the disc diffusion method. These microorganisms are one of the most common microorganisms in osteomyelitis. Results The efficacy of antibiotic-impregnated scaffold and cement on both gram-negative and gram-positive microorganisms was investigated. The daptomycin zone diameter in S. aureus ATCC 29233 strain was 17 mm, whereas it was 24 mm for scaffold and 22 mm for cement. Scaffold was found to be more effective than cement against S. aureus strain. The K. pneumoniae ATCC BAA-2814 strain was found to be resistant to ertapenem, but the zone diameter was 21 mm for scaffold and 20 mm for cement. Ertapenem-loaded scaffold was found to be more effective than cement. It was found that the antimicrobial activity of the scaffold was higher than cement. When we evaluated the release profiles, for the daptomycin-loaded cement group, 98% of daptomycin was cumulatively released within 30 minutes, and for the daptomycin-loaded scaffold group, 100% of daptomycin was cumulatively released in six days. To compare ertapenem-loaded cement and scaffold, 98% of ertapenem was cumulatively released within 10 minutes in the cement group. For the scaffold group, 100% of ertapenem was cumulatively released in 17 days. We found that the scaffold released the antibiotic more slowly and for a longer duration. Therefore, it was thought that the scaffold would be more effective on biofilm and the treatment of osteomyelitis would be more successful. Conclusions The produced scaffold was compared...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the Therapeutic Efficacy of Antibiotic-Loaded Polymeric Tissue Scaffold and Bone Cement in the Regeneration of Infected Bone Tissue

Konya,

Yilmaz

et al. 2023

Cureus

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Role of STIMULAN in chronic osteomyelitis-A randomised blinded study on 95 patients comparing 3 antibiotic compositions, bead quality, forming & absorption time

Palo,

Ray,

Lakhanpal

et al. 2024

Journal of Clinical Orthopaedics and Trauma

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Comparison of the therapeutic efficacy of antibiotic-loaded polymeric tissue scaffold and bone cement in the regeneration of infected bone tissue

Konya,

Yılmaz

et al. 2023

Preprint

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Osteomyelitis is a progressive disease characterized by damage to bone tissue by microorganisms through infectious and inflammatory processes. Local antibiotic applications have been used in chronic osteomyelitis and have been defined as an adjunctive treatment method.Biodegradable materials are also used for the same purpose by adding antibiotics. The fact that it does not require additional surgery to be removed is an important advantage. The current study is therefore intended to develop a biodegradable drug-loaded polymeric scaffold with good antibiotic release that can be an alternative to antibiotic-impregnated bone cement. Methods Tissue scaffold containing poly (2-hydroxyethyl methacrylate) (PHEMA) was prepared in our laboratory and loaded with Ertapenem and Daptomycin antibiotics. The surface morphology and pore geometries of drug-loaded and unloaded scaffolds were analyzed by SEM (scanning electron microscope) under vacuum. The dose-dependent antiproliferative effects of PHEMA scaffold, drug-loaded scaffold, cement, and drug-loaded cement on osteoblast cells were investigated. To evaluate drug release kinetics, the absorbance values of the scaffold loaded with Ertapenem and Daptomycin were measured with the spectrometer. For microbiological tests, Ertapenem and Daptomycin impregnated cement and scaffold, as well as the control scaffold and cement samples were investigated for their antibacterial activities on Staphylococcus aureusand Klebsiella pneumoniae strains using the disc diffusion method. Results The efficacy of antibiotic-impregnated scaffold and cement on both gram negative and gram positive microorganisms was investigated. Daptomycin zone diameter in S. aureus ATCC strain was 17 mm, whereas this value was 24 mm for scaffold and 22 mm for cement. Scaffold was found to be more effective than cement against S. aureus strain. On K. pneumoniae ATCC strain, it was found that this strain was resistant to Ertapenem, but the zone diameter was 21 mm for scaffold and 20 mm for cement.Ertapenem-loaded scaffold was found to be more effective than cement. It was found that the antimicrobial activity of the scaffold was higher than cement. When we evaluated the release profiles, for the Daptomycin-loaded cement group, 98%of Daptomycin was cumulatively released within 30 min and for the Daptomycin-loaded scaffold group, 100%of Daptomycin was cumulatively released in 6 days. To compare Ertapenem-loaded cement and scaffold, 98% of Ertapenem was cumulatively released within 10 min in the cement group. For the scaffold group, 100% of Ertapenem was cumulatively released in 17 days. We found that the scaffold released the antibiotic more slowly and during a longer duration. Therefore, it was thought that scaffold would be more effective on biofilm and treatment of osteomyelitis would be more successful. Conclusions The scaffold produced was compared with cement, and it was concluded that the scaffold has better release and antimicrobial efficacy.Scaffold is more advantageous than cement because it is bioeliminable. Thus, there will be no need for a second surgical intervention and possible mortality and morbidities will be prevented. Because of all these features, scaffold seems promising in the local treatment of osteomyelitis.

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Efficacy and Safety of Antibiotic Impregnated Microporous Nanohydroxyapatite Beads for Chronic Osteomyelitis Treatment: A Multicenter, Open-Label, Prospective Cohort Study

Cited by 6 publications

References 87 publications

Comparison of the Therapeutic Efficacy of Antibiotic-Loaded Polymeric Tissue Scaffold and Bone Cement in the Regeneration of Infected Bone Tissue

Comparison of the Therapeutic Efficacy of Antibiotic-Loaded Polymeric Tissue Scaffold and Bone Cement in the Regeneration of Infected Bone Tissue

Role of STIMULAN in chronic osteomyelitis-A randomised blinded study on 95 patients comparing 3 antibiotic compositions, bead quality, forming & absorption time

Comparison of the therapeutic efficacy of antibiotic-loaded polymeric tissue scaffold and bone cement in the regeneration of infected bone tissue

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