Antibiotic-Loaded Coatings to Reduce Fracture-Related Infections: Retrospective Case Series of Patients with Increased Infectious Risk

Abstract

Local antibiotic delivery strategies have been increasingly employed for the prevention of fracture-related infections (FRIs). The aim of this study is to evaluate the efficacy and safety of antibiotic-coated implants in the prevention of FRIs after surgical treatment in patients with increased infectious risk. A retrospective observational study has been conducted on patients with upper and lower limb fractures treated with internal fixation or prosthetic replacements, using a gentamicin coated nail (CN) and/or antibiotic-loaded hydrogel applied to the implant of choice (ALH). The study included 37 patients (20 M, 17 F), with a mean age of 63 years. The mean estimated preoperative infectious risk score was 6.4%. ALH was used in 27 cases, tibial CNs were implanted in 4 cases, and both were employed in 6 cases. The antibiotics used locally were gentamicin in 72.97% of cases (27 patients) and a combination of gentamicin + vancomycin in 27.03% of cases (10 patients). Mean follow-up was 32 months. Only one case (2.94%) showed onset of FRI at 5 months after surgery. Local antibiotic prophylaxis by coating resulted in a reduction in the incidence FRI, as compared to the estimated preoperative risk. The use of ALH allows for the choice of antibiotic; however, the application of antibiotics seems more nonuniform when applied to a nail.

The Intraoperative Use of Defensive Antibacterial Coating (DAC®) in the Form of a Gel to Prevent Peri-Implant Infections in Orthopaedic Surgery: A Clinical Narrative Review

“…Recently, De Meo et al [73] issued the results of an observational study confirming the efficacy, the safety, and clinical appropriateness of the use of a DAC ® antibiotic-loaded hydrogel in traumatology for the prevention of fracture-related infections (FRIs). A retrospective observational study was carried out on 37 patients with upper and lower limb fractures treated with internal fixation or prosthetic replacement, using a gentamicin-coated nail (CN) (n = 10) or antibiotic (gentamicin)-loaded DAC ® hydrogel (n = 27) applied to the implant of choice.…”

Nanoceramics-reinforced chitosan scaffolds in bone tissue engineering

“…The scaffold group containing 30 wt% CeO nanoparticle concentration demonstrated promising maximal antibacterial properties with an estimated 88% reduction in bacterial proliferation. 129 Dp nanoparticles are also widely used as bioactive ceramics in BTE. 130 The release of silicon and magnesium ions from the Dp lattice contributes to Dp nanoparticles' enhanced osteoblast proliferation, differentiation, and bone formation potential.…”

Hydrogel Coating versus Calcium Sulphate Beads as a Local Antibiotic Carrier for Debridement Procedures in Acute Periprosthetic Joint Infection: A Preliminary Study

“…Hydrogels are used as a tool to prevent biofilm adhesion in newly implanted hardware with a burst release of the surgeon’s chosen antibiotic, which undergoes complete reabsorption via hydrolytic degradation within 72 h and completely releases the antibiotic contained within it [ 18 ]. It is mainly used for prophylaxis [ 19 , 20 ]. Clinical use in PJI involves adding a targeted local antibiotic within the hydrogel during one- or two-stage exchanges, with encouraging results [ 21 , 22 , 23 ].…”