High local concentrations without systemic adverse effects after impaction of netilmicin-impregnated bone

Witsø, Eivind; Persen, Leif N.; Benum, Pål; Aamodt, Arild; Husby, Otto Schnell; Bergh, Kåre

doi:10.1080/00016470410001295

Cited by 37 publications

(30 citation statements)

References 32 publications

(27 reference statements)

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“…In vitro studies have shown that a high level of tobramycin (400 mg/L) impairs cell replication (Miclau et al 1995). However, no systemic adverse effects were observed in patients operated with impaction of netilimicinimpregnated cancellous bone (Witsø et al 2004). In an experimental study in rats, Gray and Elves (1981) observed that topically applied antibiotic powder was detrimental to the osteogenesis in fresh corticocancellous isograft.…”

Section: Discussionmentioning

confidence: 99%

Cortical allograft as a vehicle for antibiotic delivery

et al. 2005

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Background Infection can be a devastating complication after implantation of a cortical bone allograft. The allograft could act as a vehicle for local antibiotic prophylaxis.Material and methods We studied the release of antibiotics in vitro from cortical bone allografts impregnated with antibiotics for different periods of time. We also studied whether cortical allografts impregnated with antibiotics could eradicate Staphylococcus aureus from an experimentally infected graft in vivo. In the in vitro study, pieces of cortical bone were impregnated with netilmicin, vancomycin, ciprofloxacin and rifampicin for 1 h, 10 h and 100 h. The antibiotics were eluted into phosphate-buffered saline (PBS) for 7 days, with daily transfer of the bone into fresh PBS. In the in vivo study, cortical allografts impregnated with antibiotics were placed in rats intramuscularly. 10 µL of an S. aureus suspension (0.6 × 10 5 CFU) was placed in the intramedullary cavity. After 15 days, the allografts were removed and examined for bacterial growth.Results The amount of antibiotics released in vitro was influenced by the time used for antibiotic impregnation of the bone. Allografts impregnated with netilmicin, vancomycin and rifampicin effectively eradicated perioperative contamination with S. aureus in vivo.Interpretation This study shows that a cortical bone allograft would be an effective vehicle for local antibiotic delivery.

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Section: Discussionmentioning

confidence: 99%

Cortical allograft as a vehicle for antibiotic delivery

et al. 2005

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“…Witso et al used netilmicin-impregnated allografts for reconstruction in revision hip and knee surgery and found no adverse effects (22). Buttaro et al (23) favorably used vancomycin supplemented cancellous grafts for reconstruction after infected THA (20,23 (24,25).…”

Section: Justificationmentioning

confidence: 99%

Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): Literature Review and World Consensus (Part Six)

Parvızı¹,

Ghazavi²,

Meeting³

2016

Shafa Ortho J

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Context: There is a need to find the recommended perioperative antibiotic prophylaxis for current MRSA carriers and to determine if patients with prior history of MRSA should be re-screened and what should the choice of perioperative prophylactic antibiotics be in these patients. There is also a need to determine the recommended prophylaxis in patients undergoing major orthopaedic reconstructions for either tumor or non-neoplastic conditions using megaprosthesis or allograft. Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. 30 of 221 articles were relevant to the 4 following questions regarding perioperative antibiotic prophylaxis to prevent PJI. Results: For current MRSA carriers, vancomycin or teicoplanin is the recommended perioperative antibiotic prophylaxis. Patients with prior history of MRSA should be re-screened preoperatively. If patients are found to be negative for MRSA, we recommend routine perioperative antibiotic prophylaxis. Until the emergence of further evidence, we recommend the use of routine antibiotic prophylaxis for patients undergoing major reconstructions such as allograft or megaprostheses. Conclusions: Based on evidences in the literature and consensus of expert delegates from consensus meeting recommendations for type of antibiotic prophylaxis in patients who are current MRSA carriers, the protocol for screening and type of prophylactic antibiotics for patients with prior history of MRSA and antibiotic prophylaxis for patients undergoing major reconstructions such as megaprosthesis and allograft were provided.

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“…One hour is an acceptable period for antibiotic impregnation allowing the procedure to be done during surgery. Studies in the related literature have shown that one hour antibiotic impregnation provides effective antibiotic impregnation to bone [3,4]. Our model was the establishment of early deep implant related infection; thus, it is not prerequisite to remove a stable implant which would inevitably increase the morbidity in clinical applications.…”

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confidence: 99%