Antibiotic‐eluting orthopedic device to prevent early implant associated infections: Efficacy, biocompatibility and biodistribution studies in an ovine model

Abstract

Infection of orthopedic devices is a major complication in the postsurgical period generating important health issues and economic consequences. Prevention strategies could be based on local release of antibiotics from the orthopedic device itself to avoid adhesion and growth of bacteria. The purpose of this work is to demonstrate the efficiency to prevent these infections by a cefazolin-eluting, perforated stainless steel implant in an in vivo ovine model. The device was placed in the tibia of sheep, one group receiving cefazolin-loaded implants whereas the control group received empty implants. All implants were experimentally infected by direct inoculation of Staphylococcus aureus ATCC 6538. In vitro cytotoxicological studies were also performed to check the effect of antibiotic on cell viability, integrity, and cycle. Results showed that sheep receiving cefazolin-loaded devices were able to avoid implant-associated infections, with normal tissue healing process. The antibiotic release followed a local concentric pattern as demonstrated by high-performance liquid chromatography detection in tissues. The in vitro results indicate the lack of relevant cytotoxic effects for the maximum antibiotic concentration released by the device. These results demonstrate the efficiency and safety of cefazolin-eluting implants in an ovine model to prevent early postsurgical infections of orthopedic devices. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1976-1986, 2018.

Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

“…CERA-MENT™ is involved in the bone healing process in combination with vancomycin and gentamicin [144]. Gimeno et al (2018) demonstrated a high effectivity of cefazolin-loaded orthopedic implants [145]. Another important strategy is surface modification using anti-adhesive polymer, nanopatterned surface, hydrogels, biosurfactants, silver ions, and antimicrobial peptides either for the prevention of microbial attachment or the eradication of attached microorganisms [146].…”

Recent Advances in the Evaluation of Antimicrobial Materials for Resolution of Orthopedic Implant-Associated Infections In Vivo

“…Specifically, the antibiotic and metallic ions (e.g., silver, titanium) can be extracted from the serum and tissues and quantified using HPLC (for antibiotics) and inductively coupled plasma mass spectrometry (for metallic ions). 241,242,245 Models for the prevention of implant-associated infection included in Table 7 serve a variety of functions including those that evaluate systemic delivery of drugs, 188,223 evaluate the effect of the surface properties and topography of the implant, 38,232,237 and evaluate materials that provide both antimicrobial activity and promote osseointegration 97,112,113,122,186,187,190,225,[229][230][231]234,236,238 and those that evaluate intrinsic antimicrobial materials (e.g., without antibiotics). 112,122,150,157,227,230,233,234,238,245,246 5.2.…”

Implant Coating Manufactured by Micro-Arc Oxidation and Dip Coating in Resorbable Polylactide for Antimicrobial Applications in Orthopedics

“…In this condition, the porous structure of the MAO coating was mostly filled by the PLC, but a few pores remained and gave the implant a rough surface. The rough surface of implant with double coatings could help to stabilize the implant in the immediate post-operative period [10]. The porous MAO coating also permitted the PLC solution to integrate with the coating and increase the adhesive strength (Figures 4 and 6).…”

“…The internal bacteria will be protected by this biofilm, being free from phagocytosis and antibiotics, making it clinically difficult to treat [6,9]. Thus, prophylaxis and the treatment of implant-related infections has become a focal point for preventive medicine [1,2,7,10,11].…”