Infection in Orthopaedics

Abstract

Infection in orthopaedic trauma patients is a common problem associated with significant financial and psychosocial costs, and increased morbidity. This review outlines technologies to diagnose and prevent orthopaedic infection, examines implant-related infection and its management, and discusses the treatment of post-traumatic osteomyelitis. The gold standard for diagnosing infection has a number of disadvantages, and thus new technologies to diagnose infection are being explored, including multilocus polymerase chain reaction with electrospray ionization-mass spectrometry and optical imaging. Numerous strategies have been employed to prevent orthopaedic infection, including use of antibiotic-impregnated implant coatings and cement; however, further research is required to optimize these technologies. Biofilm formation on orthopaedic implants is attributed to the glycocalyx-mediated surface mode of bacterial growth and is usually treated through a secondary surgery involving irrigation, debridement and the appropriate use of antibiotics, or complete removal of the infected implant. Research into the treatment of post-traumatic osteomyelitis has focused on developing an optimal local antibiotic delivery vehicle, such as antibiotic-impregnated polymethylmethacrylate (PMMA) cement beads or bioabsorbable bone substitute (BBS) delivery systems. As these new technologies to diagnose, prevent and treat orthopaedic infection advance, the incidence of infection will decrease and patient care will be optimized.

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

“…It remains challenging and expensive to treat IRIs, despite advances in antibiotics and new operative techniques. The traditional management of IRIs includes irrigation and debridement, obliteration of dead space, intravenous antibiotics, and removal of the hardware [3]. Each year, 750,000–1,000,000 IRIs occur in the USA, and the government needs to spend more than $1.6 billion to cover the expense of the excess hospital charges [4].…”

Osteomielitis, miembro inferior y PMMA.

“…una nueva tecnología está ganando importante relevancia: reacción en cadena de la polimerasa con electrospray espectrometría de ionización de masas (PCR/ESI-MS), emplea un único ensayo que amplifica y hace más precisa la identificación de muchas bacterias aisladas. Este sistema amplifica la mayoría de especies dentro de una muestra, determinando la masa molecular, y esto a su vez, permite una derivación inequívoca de las composiciones base, que se introducen en una base de datos para la identificación del organismo (29) .…”

Anin vitrobiofilm model ofStaphylococcus aureusinfection of bone

“…In its chronic form, bone necrosis and microbial biofilm formation limit delivery of antibiotics to, and within, the infection site (Cook et al . ). Relapse of infection is common and surgical debridement of the infected site (Tuchscherr et al .…”