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      Current Insights in the Application of Bone Grafts for Local Antibiotic Delivery in Bone Reconstruction Surgery

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          Abstract

          Introduction: Bone implant related infection is still one of the biggest challenges in bone and joint surgery. Antibiotic impregnated bone grafts seem to be promising in both treatment and prevention of these infections. However, great variance in methodology predominates this field of research. This paper gives an overview of the published literature.

          Methods: The PRISMA-flowchart was used as protocol for article selection. Medline was searched and articles were selected in accordance with predetermined exclusion criteria.

          Results: Forty-eight articles were included in the synthesis. Topics including bone graft type, manipulations of the graft, elution profile, bacterial inhibition, osteotoxicity, incorporation, special impregnation methods, clinical use and storage were investigated.

          Therapeutically, high initial levels seem appropriate for biofilm eradication. A single stage procedure in the treatment of bone implant related infection seems feasible. Prophylactically, the literature indicates a reduction of postoperative infections when using antibiotic impregnated bone grafts.

          Conclusion: Bone grafts are a suitable carrier for local antibiotic application both therapeutically and prophylactically.

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          Antimicrobial susceptibility testing in biofilm-growing bacteria.

          M Macià, E Rojo-Molinero, Thomas Oliver (2014)
          Biofilms are organized bacterial communities embedded in an extracellular polymeric matrix attached to living or abiotic surfaces. The development of biofilms is currently recognized as one of the most relevant drivers of persistent infections. Among them, chronic respiratory infection by Pseudomonas aeruginosa in cystic fibrosis patients is probably the most intensively studied. The lack of correlation between conventional susceptibility test results and therapeutic success in chronic infections is probably a consequence of the use of planktonically growing instead of biofilm-growing bacteria. Therefore, several in vitro models to evaluate antimicrobial activity on biofilms have been implemented over the last decade. Microtitre plate-based assays, the Calgary device, substratum suspending reactors and the flow cell system are some of the most used in vitro biofilm models for susceptibility studies. Likewise, new pharmacodynamic parameters, including minimal biofilm inhibitory concentration, minimal biofilm-eradication concentration, biofilm bactericidal concentration, and biofilm-prevention concentration, have been defined in recent years to quantify antibiotic activity in biofilms. Using these parameters, several studies have shown very significant quantitative and qualitative differences for the effects of most antibiotics when acting on planktonic or biofilm bacteria. Nevertheless, standardization of the procedures, parameters and breakpoints, by official agencies, is needed before they are implemented in clinical microbiology laboratories for routine susceptibility testing. Research efforts should also be directed to obtaining a deeper understanding of biofilm resistance mechanisms, the evaluation of optimal pharmacokinetic/pharmacodynamic models for biofilm growth, and correlation with clinical outcome.
          Article 0 comments Cited 167 times – based on 0 reviews     Review now
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            Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to 2013

            Chukwuweike U. Gwam, Jaydev Mistry, Nequesha Mohamed … (2017)
            Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continues to burden the healthcare system. THA failure has evolved and displays variability throughout the literature. In order to understand how THAs are failing and how to reduce this burden, it is essential to assess modes of implant failure on a large scale. Thus, we report: (1) etiologies for revision THA; (2) frequencies of revision THA procedures; (3) patient demographics, payor type, and US Census region of revision THA patients; and (4) the length of stay and total costs based on the type of revision THA procedure.
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              Biomaterials approaches to treating implant-associated osteomyelitis.

              Jason Inzana, Edward M. Schwarz, Stephen L Kates … (2016)
              Orthopaedic devices are the most common surgical devices associated with implant-related infections and Staphylococcus aureus (S. aureus) is the most common causative pathogen in chronic bone infections (osteomyelitis). Treatment of these chronic bone infections often involves combinations of antibiotics given systemically and locally to the affected site via a biomaterial spacer. The gold standard biomaterial for local antibiotic delivery against osteomyelitis, poly(methyl methacrylate) (PMMA) bone cement, bears many limitations. Such shortcomings include limited antibiotic release, incompatibility with many antimicrobial agents, and the need for follow-up surgeries to remove the non-biodegradable cement before surgical reconstruction of the lost bone. Therefore, extensive research pursuits are targeting alternative, biodegradable materials to replace PMMA in osteomyelitis applications. Herein, we provide an overview of the primary clinical treatment strategies and emerging biodegradable materials that may be employed for management of implant-related osteomyelitis. We performed a systematic review of experimental biomaterials systems that have been evaluated for treating established S. aureus osteomyelitis in an animal model. Many experimental biomaterials were not decisively more efficacious for infection management than PMMA when delivering the same antibiotic. However, alternative biomaterials have reduced the number of follow-up surgeries, enhanced the antimicrobial efficacy by delivering agents that are incompatible with PMMA, and regenerated bone in an infected defect. Understanding the advantages, limitations, and potential for clinical translation of each biomaterial, along with the conditions under which it was evaluated (e.g. animal model), is critical for surgeons and researchers to navigate the plethora of options for local antibiotic delivery.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Bone Jt Infect
                Journal ID (iso-abbrev): J Bone Jt Infect
                Journal ID (publisher-id): jbji
                Title: Journal of Bone and Joint Infection
                Publisher: Ivyspring International Publisher (Sydney )
                ISSN (Electronic): 2206-3552
                Publication date Collection: 2019
                Publication date (Electronic): 15 October 2019
                Volume: 4
                Issue: 5
                Pages: 245-253
                Affiliations
                [1 ]Faculty of Medicine, KU Leuven, Leuven, Belgium
                [2 ]Orthopedic Centre, AZ Groeninge, Kortrijk, Belgium
                [3 ]Department of Development and Regeneration, KU Leuven, Kortrijk, Belgium
                Author notes
                ✉ Corresponding author: lieven.thorrez@ 123456kuleuven.be , +32 56 24 62 31

                Competing Interests: The authors have declared that no competing interest exists.

                Article
                Publisher ID: jbjiv04p0245
                DOI: 10.7150/jbji.38373
                PMC ID: 6831806
                PubMed ID: 31700774
                SO-VID: 4a9e3d85-537f-4510-8585-cd714939754c
                Copyright © © The author(s)
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.

                History
                Date received : 12 July 2019
                Date accepted : 27 August 2019
                Categories
                Subject: Review

                Keywords: bone grafts,impregnation,antibiotic delivery,infection
                Data availability:
                Keywords: bone grafts, impregnation, antibiotic delivery, infection

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