Eluting antibiotic bone graft substitutes for the treatment of osteomyelitis in long bones. A review: evidence for their use?

Schlickewei, Carsten; Yarar, S.; Rueger, Johannes M.

doi:10.2147/orr.s44747

Cited by 19 publications

(22 citation statements)

References 81 publications

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“…Local delivery of antibiotics from degradable combination devices represents potentially promising advantages over current methods utilized to treat these infections. 9,15,17,18,20,24,30,32 A previous in vivo study evaluating the group 1 device 20 reported that this device did not degrade in situ. Furthermore, the glassy surface of the device provoked a foreign body response resulting in the fibrous encapsulation of the device.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of PJI following total knee arthroplasty continues to challenge clinicians despite advancements in surgical and antimicrobial techniques. Local delivery of antibiotics from degradable combination devices represents potentially promising advantages over current methods utilized to treat these infections . A previous in vivo study evaluating the group 1 device reported that this device did not degrade in situ .…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, the work described characterized the devices in vitro : bactericidal activity, antibiotic elution kinetics, and degradation; as well as a pilot in vivo assessment of the device's osteoconductivity. It was hypothesized that these devices would elute the antibiotic, tobramycin, at or above the minimum inhibitory concentration of >2 µg/mL for a period of 6 to 8 weeks and would demonstrate bactericidal activity over the same, 6‐ to 8‐week period of time in vitro . The second hypothesis was that these devices would exhibit significant signs of degradation in isotonic phosphate‐buffered saline (PBS) within 90 days.…”

Section: Introductionmentioning

confidence: 99%

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A resorbable antibiotic eluting bone void filler for periprosthetic joint infection prevention

et al. 2015

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Periprosthetic joint infection (PJI) following total knee arthroplasty is a globally increasing procedural complication. These infections are difficult to treat and typically require revision surgery. Antibiotic-loaded bone cement is frequently utilized to deliver antibiotics to the site of infection; however, bone cement is a nondegrading foreign body and known to leach its antibiotic load, after an initial burst release, at subtherapeutic concentrations for months. This work characterized a resorbable, antibiotic-eluting bone void filler designed to restore bone volume and prevent PJI. Three device formulations were fabricated, consisting of different combinations of synthetic inorganic bone graft material, degradable polymer matrices, salt porogens, and antibiotic tobramycin. These formulations were examined to determine the antibiotic's elution kinetics and bactericidal potential, the device's degradation in vitro, as well as osteoconductivity and device resorption in vivo using a pilot rabbit bone implant model. Kirby-Bauer antibiotic susceptibility tests assessed bactericidal activity. Liquid chromatography with tandem mass spectrometry measured antibiotic elution kinetics, and scanning electron microscopy was used to qualitatively assess degradation. Results indicated sustained antibiotic release from all three formulations above the Staphylococcus aureus minimum inhibitory concentration for a period of 5 to 8 weeks. Extensive degradation was observed with the Group 3 formulation after 90 days in phosphate-buffered saline, with a lesser degree of degradation observed in the other two formulations. Results from the pilot rabbit study showed the Group 3 device to be biocompatible, with minimal inflammatory response and no fibrous encapsulation in bone. The device was also highly osteoconductive-exhibiting an accelerated mineral apposition rate. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1632-1642, 2016.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A resorbable antibiotic eluting bone void filler for periprosthetic joint infection prevention

et al. 2015

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“…Other desirable properties of scaffolds include osteoconduction, osteoinduction and osteogenesis [25,39,40]. Osteoconduction is the ability to guide reparative bone growth.…”

Section: Bone Growthmentioning

confidence: 99%

Developments in Antibiotic-Eluting Scaffolds for the Treatment of Osteomyelitis

2020

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Osteomyelitis is a devastating disease caused by the infection of bone tissue and is associated with significant morbidity and mortality. It is treated with antibiotic therapy and surgical debridement. A high dose of systemic antibiotics is often required due to poor bone penetration and this is often associated with unacceptable side-effects. To overcome this, local, implantable antibiotic carriers such as polymethyl methacrylate have been developed. However, this is a non-biodegradable material that requires a second surgery to be removed. Attention has therefore shifted to new antibiotic-eluting scaffolds which can be created with a range of unique properties. The purpose of this review is to assess the level of evidence that exists for these novel local treatments. Although this field is still developing, these strategies seem promising and provide hope for the future treatment of chronic osteomyelitis.

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“…Over time, the result can be destruction of the bone itself. 1 Ciprofloxacin is a broad-spectrum fluoroquinolone antibacterial agent used in the treatment of osteomyelitis caused by pathogens like Staphylococcus aureus and Pseudomonas aeruginosa. 2 A high concentration of the drug is required for 5 weeks to several months to cure the bone infection.…”

Section: Introductionmentioning

confidence: 99%

Biodegradation and cytotoxicity of ciprofloxacin-loaded hydroxyapatite-polycaprolactone nanocomposite film for sustainable bone implants

Nithya¹,

Sundaram²

2015

IJN

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Introduction In recent years there has been a steep increase in the number of orthopedic patients for many reasons. One major reason is osteomyelitis, caused by pyrogenic bacteria, with progressive infection of the bone or bone marrow and surrounding tissues. So antibiotics must be introduced during bone implantation to avoid prolonged infection. Aim The objective of the study reported here was to prepare a composite film of nanocrystalline hydroxyapatite (HAp) and polycaprolactone (PCL) polymer loaded with ciprofloxacin, a frequently used antibiotic agent for bone infections. Methods Nanocrystalline HAp was synthesized by precipitation method using the precursor obtained from eggshell. The nanocomposite film (HAp-PCL-ciprofloxacin) was prepared by solvent evaporation. Drug-release and biodegradation studies were undertaken by immersing the composite film in phosphate-buffered saline solution, while a cytotoxicity test was performed using the fibroblast cell line NIH-3T3 and osteoblast cell line MG-63. Results The pure PCL film had quite a low dissolution rate after an initial sharp weight loss, whereas the ciprofloxacin-loaded HAp-PCL nanocomposite film had a large weight loss due to its fast drug release. The composite film had higher water absorption than the pure PCL, and increasing the concentration of the HAp increased the water absorption. The in vitro cell-line study showed a good biocompatibility and bioactivity of the developed nanocomposite film. Conclusion The prepared film will act as a sustainable bone implant in addition to controlled drug delivery.

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Eluting antibiotic bone graft substitutes for the treatment of osteomyelitis in long bones. A review: evidence for their use?

Cited by 19 publications

References 81 publications

A resorbable antibiotic eluting bone void filler for periprosthetic joint infection prevention

A resorbable antibiotic eluting bone void filler for periprosthetic joint infection prevention

Developments in Antibiotic-Eluting Scaffolds for the Treatment of Osteomyelitis

Biodegradation and cytotoxicity of ciprofloxacin-loaded hydroxyapatite-polycaprolactone nanocomposite film for sustainable bone implants

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