Local antibiotic therapy strategies in orthopaedic trauma: Practical tips and tricks and review of the literature

Hake, Mark E.; Young, Heather; Hak, David J.; Stahel, Philip F.; Hammerberg, E. Mark; Mauffrey, Cyril

doi:10.1016/j.injury.2015.05.008

Cited by 157 publications

(127 citation statements)

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“…Currently used antibiotic-loaded cement, beads, and spacers or powder do not confer tunable release of multiple antibiotics (18)(19)(20). This may compromise the treatment efficiency and it increases the likelihood of the development of antibiotic resistance while patients are on therapy (21,22), which has been seen in as high as 50% of patients with PJI treated with gentamicin or tobramycin spacers (43).…”

Section: Discussionmentioning

confidence: 99%

“…Because most biofilm-associated infections are caused by invading bacteria in the perioperative period, local antibiotic therapy has been clinically used, including antibiotic-loaded cement, beads, spacers, or powder in orthopedic surgery (18)(19)(20) and intraoperative lavage or application of antibiotics in CIED implantation (4,14). However, most of these approaches are only designed for single antibiotic release, which increases the likelihood of the development of antibiotic resistance while patients are on therapy (21,22).…”

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confidence: 99%

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Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

Ashbaugh

Jiang

Zheng

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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Bacterial biofilm formation is a major complication of implantable medical devices that results in therapeutically challenging chronic infections, especially in cases involving antibiotic-resistant bacteria.As an approach to prevent these infections, an electrospun composite coating comprised of poly(lactic-coglycolic acid) (PLGA) nanofibers embedded in a poly(e-caprolactone) (PCL) film was developed to locally codeliver combinatorial antibiotics from the implant surface. The release of each antibiotic could be adjusted by loading each drug into the different polymers or by varying PLGA:PCL polymer ratios. In a mouse model of biofilm-associated orthopedic-implant infection, three different combinations of antibiotic-loaded coatings were highly effective in preventing infection of the bone/joint tissue and implant biofilm formation and were biocompatible with enhanced osseointegration. This nanofiber composite-coating technology could be used to tailor the delivery of combinatorial antimicrobial agents from various metallic implantable devices or prostheses to effectively decrease biofilm-associated infections in patients.nanofiber | biofilm | infection | antibiotic | delivery

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

Ashbaugh

Jiang

Zheng

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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“…[1,2,11,12] Type and form of the antibiotic also change the properties of cement differently. [2,3] As already shown and explained in our study, the main variant in such an experiment is volumetric expansion.…”

Section: Discussionmentioning

confidence: 99%

“…as a knee spacer -help us to get higher intra-wound antibiotic concentrations without systemic toxicity. [1,2] Various methods were described to increase the elution of antibiotics from the cement spacers. Increasing the surface area is a solution as in septopal beads.…”

Section: öZmentioning

confidence: 99%

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Simple method for increasing drug elution from polymethylmethacrylate bone cement

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2017

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada sitrik asit ve sodyum bikarbonat karışımının polimetilmetakrilat kemik çimentosunda efervesan olarak kullanımının daha iyi ilaç elüsyonu açısından etkileri araştırıldı. Hastalar ve yöntemler: İçeriğinde 10'ar gram glikoz ve farklı miktarlarda efervesan (E) olan; parça sayıları (P), yüzey alanları, hacimleri ve poroziteleri farklı silindir çimento bloklar hazırlandı. Tüm blokların fiziksel özellikleri hesaplandı. Bloklar serum fizyolojik içeren kavanozlara konuldu ve sıvı içerisine salınan glikoz konsantrasyonları önceden belirlenen aralıklarda ölçüldü. Elüsyon hızı ve fiziksel özellikler arasındaki ilişkiler tanımlandı. Bulgular: Efervesanlı numunelerden elüsyon oranları anlamlı derecede daha yüksekti. Kırk beşinci günün sonunda E 0 P 1 glikoz içeriğinin ortalama %21'ini saldı. Bu değer E 0 P 2 , E 0 P 4 , E 2 P 1 ve E 4 P 1 için sırasıyla %38, %61, %82 ve %88 idi. Su absorbsiyon oranları, yüzey alanları, porozite ve glikoz elüsyonu oranları arasında güçlü korelasyonlar saptandı (r= 0,942, p<0,01; r= 0,894, p<0,05; r= 0,918, p<0,05). Sonuç: Sodyum bikarbonat ve sitrik asidin efervesan olarak kemik çimentosu içinde kullanılması, daha iyi antibiyotik elüsyonu için tatmin edici porozite oluşumunu sağlamaktadır. Yekpare bir spacer ve daha iyi lokal antibiyotik elüsyonu gereken durumlarda bu yöntem işe yarayabilir.Anahtar sözcükler: Antibiyotik, kemik çimentosu; çimento spacer; elüsyon; polimetilmetakrilat. ABSTRACT Objectives:This study aims to investigate the effects of the use of citric acid and sodium bicarbonate mixture as an effervescent in polymethylmethacrylate bone cement in terms of better drug elution. Patients and methods: Multiple cylinder cement blocks each containing 10 g of glucose and different amounts of effervescent (E), with different numbers of pieces (P), surface areas, volumes, and porosities were prepared. Physical properties of all blocks were calculated. Blocks were placed in jars containing saline solutions and the released glucose concentrations were measured at predefined intervals. Correlations between elution rate and physical properties were defined. Results: Elution rates were significantly higher in samples with effervescent. At the end of 45 th day, E 0 P 1 released mean 21% of its glucose content. This value was 38%, 61%, 82% and 88% for E 0 P 2 , E 0 P 4 , E 2 P 1 and E 4 P 1 , respectively. Strong correlations were detected between water absorption ratio, surface areas, porosity and glucose elution rates (r= 0.942, p<0.01; r= 0.894, p<0.05; r= 0.918, p<0.05). Conclusion: Using sodium bicarbonate and citric acid as effervescent in bone cement provides satisfactory porosity development for better antibiotic elution. This method may be useful when a monolithic spacer and better local antibiotic elution are required.

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Pre‐operative Planning and Preparation

Lischer

Mählmann

Kawcak

2022

Fractures in the Horse

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Local antibiotic therapy strategies in orthopaedic trauma: Practical tips and tricks and review of the literature

Cited by 157 publications

References 64 publications

Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

Simple method for increasing drug elution from polymethylmethacrylate bone cement

Pre‐operative Planning and Preparation

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