Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review

Schmidmaier, Gerhard; Lücke, Martin; Wildemann, Britt; Haas, Norbert; Raschke, Michael J.

doi:10.1016/j.injury.2006.04.016

Cited by 287 publications

(243 citation statements)

References 32 publications

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“…Because systemic antibiotics often do not provide effective treatment for implant infections due to the phenomenon of drug resistance, it is important that the coating of the implant exhibit local antibacterial activity. In order to reduce the incidence of implant-associated infections, several biomaterial surface treatments have been proposed [18][19][20][21][22][23][24][25][26][27][28][29][30]. In particular, silver has raised the interest of many investigators because of its good antimicrobial action and low toxicity [30,[40][41][42][43].…”

Section: Discussionmentioning

confidence: 99%

“…Several biomaterial surface treatments have been proposed as a means of reducing the incidence of implant-associated infections. There has been investigation into the covalent attachment of polycationic groups [18,19]; ion implantation, such as F+ [20]; impregnating or loading chitosan nanoparticles with antimicrobial agents [21,22]; coating implant surfaces with polymers drug-loaded [23,24]; and coating implant surfaces with either quaternary ammonium compounds, human serum albumin, or silver ions [25][26][27][28][29][30]. However, there are several shortcomings of these proposed techniques including limited chemical stability, local inflammatory reactions due to material composition, and a lack of controlled release kinetics from the coatings.…”

Section: Introductionmentioning

confidence: 99%

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Antibacterial iodine-supported titanium implants

et al. 2011

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Deep infection remains a serious complication in orthopedic implant surgery. In order to reduce the incidence of implant-associated infections, several biomaterial surface treatments have been proposed. This study focused on evaluating the antibacterial activity of iodine-supported titanium (Ti-I 2 ) and impact on post-implant infection, as well as determining the potential suitability of Ti-I 2 as a biomaterial.External fixation pins were used in this experiment as trial implants because it was easy to make the septic models.The antibacterial activity of the metal was measured using a modification of the Japanese Industrial Standards method. Activity was evaluated by exposing the implants to Staphylococcus aureus or Escherichia coli and comparing reaction of pathogens to the Ti-I 2 versus the stainless steel and titanium controls. The Ti-I 2 clearly inhibited bacterial colonization more than the control metals. In addition, cytocompatibility was assessed by counting the number of colonies that formed on the metals. The three metals showed the same amount of fibroblast colony formation.Japanese white rabbits were used as an in vivo model. Three pins were inserted into both femora of six rabbits for histological analysis. Pin sites were inspected and graded for infection and inflammation. Fewer signs of infection and inflammatory changes were observed in conjunction with the Ti-I 2 pins. Furthermore, osteoconductivity of the implant was evaluated with osteoid formation surface of the pin. Consecutive bone formation was observed around the Ti-I 2 and titanium pins, while little osteoid formation was found around the stainless steel pins. These findings suggest that Ti-I 2 has antimicrobial activity and cytocompatibility.Therefore, Ti-I 2 substantially reduces the incidence of implant infection and shows particular promise as a biomaterial.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibacterial iodine-supported titanium implants

et al. 2011

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“…However, failure or peeling of the coating could potentially be detrimental to bone repair. Nonetheless, antibiotic-coated intramedullar nails implanted in eight patients with open tibia fractures have been shown to be effective in preventing infection (Schmidmaier et al, 2006). A step further would be a fully degradable device with controlled surface topography and chemistry and with an antibiotic load to decrease infection.…”

Section: Eglin and M Alinimentioning

confidence: 99%

Degradable polymeric materials for osteosynthesis: Tutorial

Eglin

Alini²

2008

eCM

111

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This report summarizes the state of the art and recent developments and advances in the use of degradable polymers devices for osteosynthesis. The current generation of biodegradable polymeric implants for bone repair utilising designs copied from metal implants, originates from the concept that devices should be supportive and as "inert" substitute to bone tissue. Today degradable polymeric devices for osteosynthesis are successful in low or mild load bearing applications. However, the lack of carefully controlled randomized prospective trials that document their efficacy in treating a particular fracture pattern is still an issue. Then, the choice between degradable and non-degradable devices must be carefully weighed and depends on many factors such as the patient age and condition, the type of fracture, the risk of infection, etc. The improvement of the biodegradable devices mechanical properties and their degradation behaviour will have to be achieved to broaden their use. The next generation of biodegradable implants will probably see the implementation of the recent gained knowledge in cellmaterial interactions and cells therapy, with a better control of the spatial and temporal interfaces between the material and the surrounding bone tissue.

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“…1,2 Currently, osteomyelitis treatment is conceived to limit and resolve the infective process and stabilize the infection site (i.e., fracture fixation, one or two-stage joint revision, etc.) and requires a multidisciplinary approach: removal of all implanted devices by the surgical debridement of all infected tissue followed by a specific systemic antibiotic therapy for at least 4-6 weeks.…”

mentioning

confidence: 99%

“…[3][4][5][6][7] To reduce the risk of infection, the administration of perioperative systemic antibiotic prophylaxis is also a routine procedure. 2 After systemic administration the degree of penetration of antibiotics into the bone is irregular, thus determining variable concentrations that are not always inhibitory and effective. 8 Therefore, a therapy offering high local drug concentrations for a determined period of time is appealing.…”

mentioning

confidence: 99%

Microbiological and pharmacological tests on new antibiotic‐loaded PMMA‐based composites for the treatment of osteomyelitis

Giavaresi

Minelli

Sartori

et al. 2011

Journal Orthopaedic Research

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Local antibiotic diffusion in rabbit femurs from two new PMMA-based and nail-shaped composites, enriched with btricalcium phosphate (P-TCP) and BaSO 4 or only with BaSO 4 (P-BaSO 4 ), and soaked in a solution of gentamicin (G) and vancomycin (V) was studied. Nails were implanted into the intramedullary cavity of healthy and osteomyelitic femurs to study the resolution of infection and to quantify the antibiotic penetration into bone by microbiological, pharmacological, and histological tests. A significant progression of osteomyelitis was recorded 7 weeks after MRSA inoculation, whereas no bacteria were found in animals treated with antibiotic-loaded nails as confirmed by microbiology and histology (Smeltzer score). The release of both antibiotics from composites was high and prompt both in healthy and infected bone; the amount of V was higher than that of G in all bone samples. Antibiotics of both composites were still present in bone 3 weeks after nail implantation. The P-BaSO4 composite released a lower amount of antibiotics than did P-TCP. The G-V combination in vivo exerted a synergistic bactericidal effect, which was confirmed by microbiological, histological, and clinical results (no infection). These new porous PMMA composites, soaked in G-V solution in the operating room, might be an effective and useful drug delivery system for osteomyelitis treatment. ß

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Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review

Cited by 287 publications

References 32 publications

Antibacterial iodine-supported titanium implants

Antibacterial iodine-supported titanium implants

Degradable polymeric materials for osteosynthesis: Tutorial

Microbiological and pharmacological tests on new antibiotic‐loaded PMMA‐based composites for the treatment of osteomyelitis

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