Antibiotic Beads and Osteomyelitis: Here Today, What's Coming Tomorrow?

Kent, Molly E; Rapp, Robert P.; Smith, Kelly M.

doi:10.3928/01477447-20060701-02

Cited by 34 publications

(14 citation statements)

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“…The antibiotics most commonly used to impregnate the PMMA are gentamycin, clindamycin, tobramycin, and vancomycin. Relative to other administration routes, antibiotic impregnation provides a higher antibiotic concentration at the defect site and a lower systemic concentration (Kent, Rapp, & Smith, 2006;Naal et al, 2008). Naal et al suggested that osteoblasts are induced to differentiate by low clindamycin concentrations but are killed at high concentrations (Naal et al, 2008).…”

Section: The Cement Spacer and Its Propertiesmentioning

confidence: 99%

The Masquelet technique: Current concepts, animal models, and perspectives

Klein

Monet

Barbier

et al. 2020

J Tissue Eng Regen Med

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Bone reconstruction within a critical‐sized defect remains a real challenge in orthopedic surgery. The Masquelet technique is an innovative, two‐step therapeutic approach for bone reconstruction in which the placement of a poly (methylmethacrylate) spacer into the bone defect induces the neo‐formation of a tissue called “induced membrane.” This surgical technique has many advantages and is often preferred to a vascularized bone flap or Ilizarov's technique. Although the Masquelet technique has achieved high clinical success rates since its development by Alain‐Charles Masquelet in the early 2000s, very little is known about how the process works, and few animal models of membrane induction have been developed. Our successful use of this technique in the clinic and our interest in the mechanisms of tissue regeneration (notably bone regeneration) prompted us to develop a surgical model of the Masquelet technique in rats. Here, we provide a comprehensive review of the literature on animal models of membrane induction, encompassing the defect site, the surgical procedure, and the histologic and osteogenic properties of the induced membrane. We also discuss the advantages and disadvantages of those models to facilitate efforts in characterizing the complex biological mechanisms that underlie membrane induction.

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Section: The Cement Spacer and Its Propertiesmentioning

confidence: 99%

The Masquelet technique: Current concepts, animal models, and perspectives

Klein

Monet

Barbier

et al. 2020

J Tissue Eng Regen Med

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“…9) or antibiotic-loaded cement also may be used to sterilize and temporarily maintain dead space. [68][69][70] The beads are usually removed after 2 to 4 weeks and replaced with a cancellous graft. The antibiotics used in the beads are most often vancomycin, tobramycin, and gentamicin.…”

Section: Surgerymentioning

confidence: 99%

Osteomyelitis of the Long Bones

Calhoun

Manring²,

Shirtliff³

2009

Seminars in Plastic Surgery

218

206

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Long bone osteomyelitis presents a variety of challenges to the physician. The severity of the disease is staged depending upon the infection's particular features, including its etiology, pathogenesis, extent of bone involvement, duration, and host factors particular to the individual patient (infant, child, adult, or immunocompromised). Long bone osteomyelitis may be either hematogenous or caused by a contiguous spread of infection. A single pathogenic organism is almost always recovered from the bone in hematogenous osteomyelitis; Staphylococcus aureus is the most common organism isolated. A variety of multidrugresistant organisms of bacteria continue to be a source of concern in arresting infection. The primary weapons to treat these infections are culture-specific antibiotics, aggressive debridement, muscle flaps, and bone grafts. This article offers a basic review of the classification, etiology, epidemiology, pathogenesis, and treatment of long bone osteomyelitis.

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“…In response, surgeons employ local antibiotic carriers as an adjunct to one-and two-stage revision protocols for infected total joint prosthetics [12][13][14][15][16][17]. The use of local delivery mechanisms provides high concentrations of drugs at the infection site with minimal serum concentrations [12,[18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Elution Profiles of Synthetic CaSO4 Hemihydrate Beads Loaded with Vancomycin and Tobramycin

Maale¹,

Eager²,

Mohammadi³

et al. 2020

Eur J Drug Metab Pharmacokinet

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Backgrounds and Objectives The use of local antibiotic delivery vehicles is common in the management of biofilm-related infections as they provide high concentrations of local antibiotics while simultaneously avoiding complications from systemic toxicity. We present a 100% pure synthetic calcium sulfate hemi-hydrate mixed with 240 mg tobramycin and 500 mg vancomycin per 10 cc mixture for use in revision surgeries of periprosthetic joint infections (PJIs). The purified carrier demonstrates bioabsorbablity, promotion of bone growth, a physiologically favorable pH, and hydrophilicity. These unique properties may alleviate persistent postoperative wound drainage seen in patients with PJI. Our questions consist of two parts: (1) does the novel calcium sulfate carrier provide therapeutic concentrations of antibiotic locally that can kill biofilm related infections? (2) Are serum concentrations of antibiotic significant to cause concern for systemic toxicity? Methods To address these questions, we assayed the elution of antibiotic concentrations obtained from surgical drains and serum among 50 patients in the first 5 postoperative days. Results The elution of vancomycin and tobramycin was greatest on day 1 compared with those concentrations obtained on days 2, 3, 4, and 5; serum concentrations were largely undetectable. Our findings demonstrate that this calcium sulfate preparation provides therapeutic delivery of vancomycin and tobramycin locally at log 2-3 above the minimum inhibitory concentration (MIC), while avoiding toxic serum concentrations. Conclusions When used in one-stage revision arthroplasties, the bioabsorbable, purified carrier delivers high concentrations of antibiotic while avoiding systemic toxicity.

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Antibiotic Beads and Osteomyelitis: Here Today, What's Coming Tomorrow?

Cited by 34 publications

References 0 publications

The Masquelet technique: Current concepts, animal models, and perspectives

The Masquelet technique: Current concepts, animal models, and perspectives

Osteomyelitis of the Long Bones

Elution Profiles of Synthetic CaSO4 Hemihydrate Beads Loaded with Vancomycin and Tobramycin

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