Clinical Application of Antibacterial Hydrogel and Coating in Orthopaedic and Traumatology Surgery

Abstract

Implant related infection is one of the most frequent complications in orthopaedic and trauma surgery. Local antibiotic treatment strategies are becoming part of the prevention and treatment methodology for this fearful complication. To date, there are two coatings available on the market, both with a polylactic acid base. Current evidence supports the use of these types of coatings in the prophylaxis of periprosthetic infections and fracture-related infections. However, their therapeutic use has been less investigated. The purpose of this article is to summarise recent evidence relating to the clinical application of antibacterial hydrogels and coatings in orthopaedic and traumatology surgery and indicating which future applications may benefit from it.

A clinical prediction model for predicting the surgical site infection after an open reduction and internal fixation procedure considering the NHSN/SIR risk model: a multicenter case–control study

“…According to guidelines, preventive measures such as hand hygiene of personnel and instrument sterilization, skin preparation (methicillin-resistant Staphylococcus aureus decolonization, hair removal, skin antiseptic), wound classification, preoperative antibiotic prophylaxis (selecting the best timing, dosing, and type of antibiotic) ( 32 ), and use of innovative device such as gentamicin bone substitutes and the application of antibacterial hydrogel and coating could be effective prophylactic tools in orthopedic surgery combined with other preventive measures ( 33 , 34 ). Although implementations such as methicillin-resistant Staphylococcus aureus screening via swabs of the anterior nares in elective surgery is not commonly used and is institution-dependent, this implementation with other preventive measures may affect the detection of high-risk patients and, ultimately, help to reduce the risk of SSI, particularly for patients with a history of methicillin-resistant Staphylococcus aureus infection or a current positive screening test, as well as for patients residing in nursing homes, dorm, or prisons ( 32 , 35 ).…”

Orthopaedic Implant-Associated Staphylococcal Infections: A Critical Reappraisal of Unmet Clinical Needs Associated with the Implementation of the Best Antibiotic Choice

“…In this scenario, the implant of antibiotic-loaded carrier material may ensure the achievement of high antibiotic concentrations locally, thus overcoming the poor vascularity and biofilm formation potentially involved in the failure of a systemic antibiotic approach [151]. Although polymethylmethacrylate (PMMA) was initially used as an antibiotic carrier, its undesirable features (the need for subsequent removal, potential biofilm formation on surface) caused it to be replaced by other absorbable materials (calcium sulphate beads, hydrogel) [151,152]. Vancomycin, gentamycin, and tobramycin are the most broadly used agents for local delivery [151][152][153].…”

“…Although polymethylmethacrylate (PMMA) was initially used as an antibiotic carrier, its undesirable features (the need for subsequent removal, potential biofilm formation on surface) caused it to be replaced by other absorbable materials (calcium sulphate beads, hydrogel) [151,152]. Vancomycin, gentamycin, and tobramycin are the most broadly used agents for local delivery [151][152][153]. The delivery of local rifampicin has raised concerns about the development of rapid resistance when used as a single agent [150].…”

“…Although the use of local antibiotic delivery seems to be promising, there is still a lack of level 1 evidence to demonstrate the efficacy of this strategy [150]. Currently, the evidence supports the implementation of local antibiotic treatments mainly in the prophylaxis of periprosthetic or fracture-related infections, while therapeutic use remains an unmet clinical need [152,155].…”

Local Antibiotic Delivery Options in Prosthetic Joint Infection

“…Clinical studies are limited to the use of Defensive Antibacterial Coating (DAC®, Novagenit Srl, Mezzo Lombardo, Italy), which is the most studied and is already commercially available ( Figure 4 ). DAC® is recommended as a prophylactic implant coating, as it changes the implant surface from hydrophobic to hydrophilic, to impair bacterial adhesion, but is completely resorbed in 72 h [ 128 ]. It can also carry antibiotics to improve its capacity for infection prevention or for PJI treatment.…”