Antimicrobial delivery systems for local infection prophylaxis in orthopedic- and trauma surgery

Boo, Gert-Jan A. ter; Grijpma, Dirk W.; Moriarty, T. Fintan; Richards, R. Geoff; Eglin, David

doi:10.1016/j.biomaterials.2015.02.020

Cited by 172 publications

(138 citation statements)

References 128 publications

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“…Nonetheless, these implant coatings could be critical for treatment of established infections to help prevent colonization and biofilm formation on an exchanged implant or treat the biofilm on a retained implant. These technologies typically include hydrogel-based systems that can be coated onto an implant intraoperatively [30] or precoated devices, such as the Expert Tibial Nail PROtect from DePuy Synthes, as discussed in detail by a recent review on antimicrobial delivery systems for prophylaxis of orthopaedic infections [129]. …”

Section: Discussionmentioning

confidence: 99%

Biomaterials approaches to treating implant-associated osteomyelitis

et al. 2016

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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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Section: Discussionmentioning

confidence: 99%

Biomaterials approaches to treating implant-associated osteomyelitis

et al. 2016

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“…In a rabbit model, Alt et al [16] found that the gentamicin-HA composite provided a statistically significant reduction in infection rate when compared to uncoated total joint replacements. In patient trials, gentamicin-coated implants have displayed promising preliminary results ( Figure 1) [17][18][19][20] . Limitations of antibiotic coatings include the use of fixed, predetermined antibiotics; limited duration of drug elution; and the risk of developing drug resistance [21] .…”

Section: Antibiotic-based Coatingsmentioning

confidence: 99%

Antimicrobial technology in orthopedic and spinal implants

Eltorai

Haglin

Perera

et al. 2016

WJO

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Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines orthopedic implant antimicrobial technology, its current applications and supporting evidence, and clinically promising future directions.Key words: Antimicrobial; Coated implants; Antibiotic; Antiseptic; Nano-silver; Photoactive Core tip: Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines the latest orthopedic implant antimicrobial technologies-including updates on chitosan

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“…Currently used antibiotic-loaded cement, beads, and spacers or powder do not confer tunable release of multiple antibiotics (18)(19)(20). This may compromise the treatment efficiency and it increases the likelihood of the development of antibiotic resistance while patients are on therapy (21,22), which has been seen in as high as 50% of patients with PJI treated with gentamicin or tobramycin spacers (43). A recently approved dual antibiotic release mesh envelope impregnated with minocycline and rifampin has proven effective in preventing CIED infection in patients (44,45).…”

Section: Discussionmentioning

confidence: 99%

“…However, most of these approaches are only designed for single antibiotic release, which increases the likelihood of the development of antibiotic resistance while patients are on therapy (21,22). Therefore, we developed a conformal implant coating capable of local delivery of combinatorial antibiotics with tailored release profiles for each drug to effectively prevent biofilm formation and ensuing infectious complications.…”

mentioning

confidence: 99%

Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

Ashbaugh

Jiang

Zheng

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

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Bacterial biofilm formation is a major complication of implantable medical devices that results in therapeutically challenging chronic infections, especially in cases involving antibiotic-resistant bacteria.As an approach to prevent these infections, an electrospun composite coating comprised of poly(lactic-coglycolic acid) (PLGA) nanofibers embedded in a poly(e-caprolactone) (PCL) film was developed to locally codeliver combinatorial antibiotics from the implant surface. The release of each antibiotic could be adjusted by loading each drug into the different polymers or by varying PLGA:PCL polymer ratios. In a mouse model of biofilm-associated orthopedic-implant infection, three different combinations of antibiotic-loaded coatings were highly effective in preventing infection of the bone/joint tissue and implant biofilm formation and were biocompatible with enhanced osseointegration. This nanofiber composite-coating technology could be used to tailor the delivery of combinatorial antimicrobial agents from various metallic implantable devices or prostheses to effectively decrease biofilm-associated infections in patients.nanofiber | biofilm | infection | antibiotic | delivery

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Antimicrobial delivery systems for local infection prophylaxis in orthopedic- and trauma surgery

Cited by 172 publications

References 128 publications

Biomaterials approaches to treating implant-associated osteomyelitis

Biomaterials approaches to treating implant-associated osteomyelitis

Antimicrobial technology in orthopedic and spinal implants

Polymeric nanofiber coating with tunable combinatorial antibiotic delivery prevents biofilm-associated infection in vivo

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