Coatings as the useful drug delivery system for the prevention of implant-related infections

Pan, Cunhong; Zhou, Zubin; Yu, Xiaowei

doi:10.1186/s13018-018-0930-y

Cited by 82 publications

(66 citation statements)

References 141 publications

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“…For such cases, a reliable implant coating should satisfy concomitantly three criteria: (i) stimulate a broad-spectrum antibacterial activity; (ii) elicit good stability and robustness over time; and (iii) possess a durable antimicrobial action, which can span for weeks or even months. In this context, several in vivo studies have already highlighted the merits of antibacterial HAp-based coatings and the persistence of their therapeutic effects in time [68][69][70]. Akiyama et al [69] inspected in vivo the antibacterial activity of flame-sprayed silver-containing HAp (Ag-HAp) implant coatings in the medullary cavity of rat tibiae.…”

Section: Resultsmentioning

confidence: 99%

Dextran-Thyme Magnesium-Doped Hydroxyapatite Composite Antimicrobial Coatings

et al. 2020

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The dextran-thyme magnesium-doped hydroxyapatite (10MgHAp-Dex-thyme) composite layers were prepared by a dip-coating procedure from stable suspensions and further analyzed for the first time. Different characterization techniques were employed to explore the physical-chemical features of the 10MgHAp-Dex-thyme suspensions and derived coatings. Information regarding the 10MgHAp-Dex-thyme suspensions was extracted on the basis of dynamic light scattering, zeta potential, and ultrasound measurements. The crystalline quality of the biocomposite powders—resulting after the centrifugation of suspensions—and the layers deposited on glass was assessed by X-ray diffraction in symmetric and grazing incidence geometries, respectively. The chemical structure and presence of functional groups were evaluated for both powder and coating by Fourier transform infrared spectroscopy in attenuated total reflectance mode. The extent of the antimicrobial effect range of the biocomposite suspensions and coatings was tested against different Gram-positive and Gram-negative bacteria (Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, and Pseudomonas aeruginosa) and fungus (Candida albicans) strains with promising results.

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Section: Resultsmentioning

confidence: 99%

Dextran-Thyme Magnesium-Doped Hydroxyapatite Composite Antimicrobial Coatings

et al. 2020

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“…This method did not seem to cause more infectious complications compared to external fixation, but more importantly, patients were comfortable and complications associated with external fixation were avoided. Thorough removal of infected bone and soft tissue is the prerequisite for the use of internal fixation, and it is also the core for bone infection treatment [23,24]. The goal of debridement is to achieve a viable vascularized environment and restore local immunity.…”

Section: Discussionmentioning

confidence: 99%

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

Jia

Xiao-hua

et al. 2020

J Orthop Surg Res

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Background: The induced membrane technique has achieved good clinical results in the treatment of infected bone defects, and external fixation is the main method, but it causes inconvenience and complications in patients. In this study, our objective was to investigate the outcomes of using an antibiotic cement-coated locking plate as a temporary internal fixation in the first stage of the surgical induced membrane technique for treating extremities with infected bone defects. Methods: We retrospectively analysed patients with lower extremity infected bone defects in our department between January 2013 and December 2017. All patients were treated with the induced membrane technique. In the first stage, the defects were stabilized with an antibiotic cement-coated locking plate as a temporary fixation after debridement, and polymethyl methacrylate cement was implanted to induce the formation of a membrane. In the second stage, bone grafting rebuilt the bone defects after infection control, and the temporary fixation was changed to a stronger fixation. Results: A total of 183 patients were enrolled, with an average follow-up duration of 32.0 (12-66) months. There were 154 males and 29 females with an average age of 42.8 (10-68) years. The infection sites included 81 femurs, 100 tibias and 2 fibulas. After the first stage of treatment (infection control), 16 (8.7%) patients had recurrence of infection. In terms of the incidence of complications, 4 patients had poor wound healing, 2 patients had fixation failure and 1 patient had femoral fracture due to a fall. After the second stage of treatment (bone reconstruction), there were 24 (13.1%) recurrences of infection, with a mean time of 9.9 months (range 0.5 to 36). Among them, 18 patients underwent bone grafting after re-debridement, 6 received permanent placement of antibiotic bone cement after debridement and 2 patients refused further treatment and chose amputation. Bone healing was achieved in 175 (95.9%) patients at the last follow-up, and the average time to bone union was 5.4 (4-12) months. Conclusions: Antibiotic cement-coated locking plates have good clinical effects in the control of bone infection, but attention must be paid to the possible difficulty of skin coverage when applied in calves.

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“…We first reported the application of this method in the humerus, and it significantly improved patients’ satisfaction and did not improve recurrence in our series (> 0.05). Recently, Pan et al [19] concluded that the local drug and barrier effect through antibiotic-impregnated cement may reduce subsequent bacterial colonization and the formation of biofilms. Although there are many advantages of this procedure and it is being used more frequently, we suggest that it may be especially suited for patients with better soft tissue envelopes (in the humerus).…”

Section: Discussionmentioning

confidence: 99%

Investigating clinical characteristics and prognostic factors in patients with chronic osteomyelitis of humerus

et al. 2019

Burns &Amp; Trauma

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BackgroundChronic osteomyelitis in the humerus, which has complex neuroanatomy and a good soft tissue envelope, represents a unique clinical challenge. However, there are relatively few related studies in the literature. This article retrospectively reviewed a large case series with the aims of sharing our management experiences and further determining factors associated with the outcomes.MethodsTwenty-eight consecutive adult patients with a mean age of 36 years were identified by reviewing the osteomyelitis database of our clinic centre. The database was used to prospectively identify all osteomyelitis cases between 2013 and 2017, and all data then was retrospectively analysed.ResultsThe mean follow-up period was 35 months (range 24–60). The aetiology was trauma in 43% (12) of the patients and haematogenous in 57% (16) of the patients, and Staphylococcus aureus was a solitary agent in 50% (14) of the patients. Host-type (Cierny’s classification) was IA in 8, IIIB in 11 and IVB in 9 patients. All patients required debridement followed by the placement of a temporary antibiotic-impregnated cement spacer (rod). Seventeen patients received a cement-coated plate for internal fixation after debridement, and 13 patients needed bone grafts when the spacer was staged removed. All patients attained an infection-free bone healing state at the final follow-up. The final average DASH (disabilities of the arm, shoulder and hand) score was 18.14 ± 5.39, while 6 patients (two developed traumatic olecranarthritis, four developed radial nerve injuries) showed the lowest levels of limb function (p = 0.000) and were unemployed. Three patients (type I; significant difference between type I versus type III and type IV patients, p < 0.05) experienced recurrence after debridement and underwent a second revision, which was not related to the bone graft (p = 0.226) or plate fixation (p = 0.050).ConclusionsHumeral chronic osteomyelitis can be treated with general surgery and anti-infective therapy; medullary (type I) infection presents a challenge, and the antibiotic-coated cement plate provides favourable fixation without increasing recurrence of infections. Clinicians should be aware of potential iatrogenic nerve injuries when treating these patients with complicated cases, and an experienced surgeon may improve the outcome.

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Coatings as the useful drug delivery system for the prevention of implant-related infections

Cited by 82 publications

References 141 publications

Dextran-Thyme Magnesium-Doped Hydroxyapatite Composite Antimicrobial Coatings

Dextran-Thyme Magnesium-Doped Hydroxyapatite Composite Antimicrobial Coatings

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

Investigating clinical characteristics and prognostic factors in patients with chronic osteomyelitis of humerus

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