Poor Outcomes of Irrigation and Debridement in Acute Periprosthetic Joint Infection With Antibiotic-Impregnated Calcium Sulfate Beads

Flierl, Michael A.; Culp, Brian M.; Okroj, Kamil; Springer, Bryan D.; Levine, Brett R.; Valle, Craig J. Della

doi:10.1016/j.arth.2017.03.051

Cited by 57 publications

(48 citation statements)

References 22 publications

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“…Clinically, antibiotic loaded resorbable calcium sulphate based beads have shown good potential in the treatment of PJIs, and osteomyelitis . However, antibiotic loaded calcium sulfate beads were not shown to improve outcomes over I&D alone in treating knee and hip PJI with implant retention . The study found that at a mean follow‐up of 13 months, there was a 48% failure rate, as a result of recurrence or failure to eradicate infection.…”

Section: Discussionmentioning

confidence: 98%

Antibiotic loaded calcium sulfate bead and pulse lavage eradicates biofilms on metal implant materials in vitro

Knecht

Moley

McGrath

et al. 2018

Journal Orthopaedic Research

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Pulse lavage (PL) debridement and antibiotic loaded calcium sulfate beads (CS-B) are both used for the treatment of biofilm related periprosthetic joint infection (PJI). However, the efficacy of these alone and in combination for eradicating biofilm from orthopaedic metal implant surfaces is unclear. The purpose of the study was to understand the efficacy of PL and antibiotic loaded CS-B in eradicating bacterial biofilms on 316L stainless steel (SS) alone and in combination in vitro. Biofilms of bioluminescent strains of Pseudomonas aeruginosa Xen41 and a USA300 MRSA Staphylococcus aureus SAP231 were grown on SS coupons for 3 days. The coupons were either, (i) debrided for 3 s with PL, (ii) exposed to tobramycin (TOB) and vancomycin (VAN) loaded CS-B for 24 h, or (iii) exposed to both. An untreated biofilm served as a control. The amount of biofilm was measured by bioluminescence, viable plate count and confocal microscopy using live/dead staining. PL alone reduced the CFU count of both strains of biofilms by approximately 2 orders of magnitude, from an initial cell count on metal surface of approximately 10 CFU/cm . The antibiotic loaded CS-B caused an approximate six log reduction and the combination completely eradicated viable biofilm bacteria. Bioluminescence and confocal imaging corroborated the CFU data. While PL and antibiotic loaded CS-B both significantly reduced biofilm, the combination of two was more effective than alone in removing biofilms from SS implant surfaces. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2349-2354, 2018.

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Section: Discussionmentioning

confidence: 98%

Antibiotic loaded calcium sulfate bead and pulse lavage eradicates biofilms on metal implant materials in vitro

Knecht

Moley

McGrath

et al. 2018

Journal Orthopaedic Research

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“…Care should also be taken when extrapolating the results of studies based on osteomyelitis, to other contexts. It has recently been shown that antibiotic-impregnated calcium sulfate beads do not improve outcomes in periprosthetic joint infections, for example [71].…”

Section: Calcium Phosphatesmentioning

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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“…Additionally, a 3% acetic acid soak inhibits bacterial growth in vitro and may be safe as an irrigation solution, based on a level-IV study 65 . In a different study, poorer outcomes were reported when antimicrobial-impregnated calcium sulfate beads were utilized for treating acute hematogenous or acute postoperative PJI 66 .…”

Section: Treatmentmentioning

confidence: 99%