The use of high-dose dual-impregnated antibiotic-laden cement with hemiarthroplasty for the treatment of a fracture of the hip

Sprowson, Andrew P.; Jensen, Cyrus D.; Chambers, S; Parsons, Nicholas R.; Aradhyula, N.M.; Carluke, I; Inman, Dominic; Reed, Mike

doi:10.1302/0301-620x.98b11.34693

Cited by 67 publications

(50 citation statements)

References 43 publications

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“…This period includes patients recruited into the quasi-randomised controlled trial. 6 This trial ran from April 2008 to May 2012 and randomised patients to receive LDSAC or HDDAC for their hip hemiarthroplasty. Following completion of the trial the trust switched to HDDAC as the standard of care for hip hemiarthroplasty.…”

Section: Methodsmentioning

confidence: 99%

“… 5 A quasi-randomised controlled trial conducted by Sprowson et al recently demonstrated that high dose dual-antibiotic cement (HDDAC) (Copal G+C, Heraeus Medical, UK) reduces rates of deep SSI when compared to the standard low dose single-antibiotic cement (LDSAC) (Palacos R+G, Heraeus Medical, UK). 6 Palacos R+G contains 0.5 grams of gentamicin whilst Copal G+C contains 1 gram of gentamicin and 1 gram of clindamycin per mix. The addition of clindamycin to gentamicin-loaded bone cement is known to work synergistically to yield higher antibiotic release in vivo as well as providing a wider antibiotic coverage.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic resistance profiles of deep surgical site infections in hip hemiarthroplasty; comparing low dose single antibiotic versus high dose dual antibiotic impregnated cement

Tyas

Marsh

Oswald

et al. 2018

J. Bone Joint Infect.

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Objectives: The incidence of fractured neck of femur (FNOF) is increasing yearly. Many of these patients undergo hip hemiarthroplasty. High dose dual-antibiotic cement (HDDAC) has been shown to reduce rates of deep surgical site infection (SSI) when compared to the current standard low dose single-antibiotic cement (LDSAC) in a quasi-randomised controlled trial. Some concerns exist regarding the use of HDDAC and the development of antibiotic resistance. We reviewed cases of infection in LDSAC and HDDAC bone cement with regard to causative organism and resistance profile.Methods: A retrospective analysis was undertaken of all hemiarthroplasties within our trust from April 2008 to December 2014. We identified all patients in this time period who acquired a deep SSI. The infecting organisms and susceptibility patterns were collated for each cement.Results: We identified 1941 hemiarthroplasties. There were 38 deep surgical site infections representing an infection rate of 3.4% in LDSAC patients and 1.2% in HDDAC patients. The majority of infections were polymicrobial. Staphylococcus epidermidis was the most commonly isolated organism. It accounted for a larger proportion of HDDAC than LDSAC infections (p<0.05). Infection with Corynebacterium species and S. aureus, including MRSA, was eradicated completely with the use of HDDAC. There was no significant change in the proportion of Gram negative and Gram positive infections between the two cements. In Gram positive organisms, there was no significant change in resistance to most antibiotics. Although fewer resistant infections overall, there were significant increases in the proportion of resistance to ciprofloxacin and clindamycin with HDDAC. We observed no resistance to daptomycin or linezolid in either cement and levels of resistance remained low to rifampicin and teicoplanin. In Gram negative organisms, no significant change in resistance was observed.Conclusions: We observed a significantly lower infection rate with the use of HDDAC compared to LDSAC. Such was this reduced infection rate that there was a trend to a lower rate of resistance with the use of HDDAC. However, there were increases in the proportion of resistant cases, most notably to clindamycin and ciprofloxacin in Gram positive organisms, possibly reflecting the higher number of S. epidermidis in the HDDAC group. Whilst the differences in our study were not found to be statistically significant, it is reassuring for teams using HDDAC to prevent SSI in hip hemiarthroplasty.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibiotic resistance profiles of deep surgical site infections in hip hemiarthroplasty; comparing low dose single antibiotic versus high dose dual antibiotic impregnated cement

Tyas

Marsh

Oswald

et al. 2018

J. Bone Joint Infect.

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“…To decrease postoperative deep infection, preventive care, including drainage and the administration of prophylactic antibiotics, is needed after bone tumor surgeries. Recently, several new techniques, including antibiotic-impregnated cement and an implant with silver coating or iodine coating, have been used to prevent deep infection after orthopaedic surgery [ 31 – 34 ]. More efforts should be made to decrease postoperative deep infection in patients with a high risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative deep infection in bone tumors

et al. 2017

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BackgroundPostoperative deep infection after bone tumor surgery remains a serious complication. Although there are numerous reports about risk factors for postoperative deep infection in general surgery, there is only a small number of reports about those for bone tumor surgery. This retrospective study aimed to identify risk factors for postoperative deep infection after bone tumor resection.MethodsWe reviewed data of 681 patients (844 bone tumors) who underwent surgery. Associations between variables, including age, recurrent tumor, pathological fracture, surgical site (pelvis/other), chemotherapy, biological reconstruction, augmentation of artificial bone or bone cement, the use of an implant, intraoperative blood loss, operative time, additional surgery for complications, and postoperative deep infection were evaluated.ResultsThe rate of postoperative deep infection was 3.2% (27/844 tumors). A pelvic tumor (odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.0–11.3) and use of an implant (OR: 9.3, 95% CI: 1.9–45.5) were associated with an increased risk of deep infection.ConclusionsThis retrospective study showed that pelvic tumor and use of an implant were independent risk factors for deep infection. This information will help surgeons prepare an adequate surgical plan for patients with bone tumors.

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“…There was 1 level I study comparing single antibiotics to dual antibiotics in ALC (Table 1). Sprowson et al [10] performed a quasirandomized controlled trial treating 848 hip fracture patients with cemented hemiarthroplasty, randomizing patients to receive either low-dose single antibiotic impregnated or high-dose dual antibiotic impregnated cement. There were 448 patients who received single antibiotic cement mixed with 0.5 g of gentamicin and 400 patients who received dual antibiotic cement mixed with 1 g of clindamycin and 1 g of gentamicin.…”

Section: Level I Studiesmentioning

confidence: 99%

“…The mechanism behind this effect may be due to "passive opportunism," where the second antibiotic appears to act as a soluble passive additive, increasing the porosity and available surface area for elution [8]. The advantage of enhanced elution is the ability to maintain intra-articular antibiotic concentrations above the minimal inhibitory concentration for a longer period of time, thereby preventing polymicrobial pathogen colonization [6,10,11]. However, several concerns have been raised regarding antibiotic utilization in ALCs.…”

mentioning

confidence: 99%