Is coating of titanium implants effective at preventing Staphylococcus aureus infections? A meta-analysis of animal model studies

Tsikopoulos, Konstantinos; Sidiropoulos, Konstantinos; Kitridis, Dimitrios; Hassan, Anas Falah; Drago, Lorenzo; Mavrogenis, Andreas F.; McBride, Donald

doi:10.1007/s00264-020-04660-4

Cited by 10 publications

(9 citation statements)

References 60 publications

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“…23,27 There are only few systematic reviews and meta-analyses of animal studies of antimicrobial coated implants using various inorganic materials and organic compounds rather than the promising AMPs. 28,29 In this study, a systematic review has been undertaken to find out whether AMP-modified metallic implants showed antibacterial efficacy in in vivo induced infection models and if these AMP-coated implants may have potential in clinical applications. To this end, the different AMPs undergo comparisons, and where relevant, a metaanalysis has been performed to obtain effect size and heterogeneity.…”

Section: Introductionmentioning

confidence: 99%

In Vivo Antibacterial Efficacy of Antimicrobial Peptides Modified Metallic Implants─Systematic Review and Meta-Analysis

Sandhu

Yang

2022

ACS Biomater. Sci. Eng.

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Biomaterial-associated infection is difficult to detect and brings consequences that can lead to morbidity and mortality. Bacteria can adhere to the implant surface, grow, and form biofilms. Antimicrobial peptides (AMPs) can target and kill bacterial cells using a plethora of mechanisms of action such as rupturing the cell membrane by creating pores via depolarization with their cationic and amphipathic nature. AMPs can thus be coated onto metal implants to prevent microbial cell adhesion and growth. The aim of this systematic review was to determine the potential clinical applications of AMP-modified implants through in vivo induced infection models. Following a database search recently up to 22 January 2022 using PubMed, Web of Science and Cochrane databases, and abstract/title screening using the PRISMA framework, 24 studies remained, of which 18 were used in the random effects meta-analysis of standardized mean differences (SMD) to get effect sizes. Quality of studies was assessed using SYRCLE’s risk of bias tool. The data from these 18 studies showed that AMPs carry antibacterial effects, and the meta-analysis confirmed the favorited antibacterial efficacy of AMP-coated groups over controls (SMD −1.74, 95%CI [−2.26, −1.26], p < 0.00001). Subgroup analysis showed that the differences in effect size are random, and high heterogeneity values suggested the same. HHC36 and vancomycin were the most common AMPs for surface modification and Staphylococcus aureus , the most tested bacterium in vivo. Covalent binding with polymer brush coating and physical layer-by-layer incorporation of AMPs were recognized as key methods of incorporation to achieve desired densities. The use of fusion peptides seemed admirable to incorporate additional benefits such as osteointegration and wound healing and possibly targeting more microbe strains. Further investigation into the incorporation methods, AMP activity against different bacterial strains, and the number of AMPs used for metal implant surface modification is needed to progress toward potential clinical application.

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Section: Introductionmentioning

confidence: 99%

In Vivo Antibacterial Efficacy of Antimicrobial Peptides Modified Metallic Implants─Systematic Review and Meta-Analysis

Sandhu

Yang

2022

ACS Biomater. Sci. Eng.

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“…Antibiotics [11], antibacterial active metals (such as silver (Ag) [12][13][14], copper (Cu) [15], zinc (Zn) [16]), and metal oxides [17] are widely applied in the study of implant antimicrobial surfaces. In a meta-analysis of 23 studies, Tsikopoulos et al showed that a combination of active and passive antibacterial surfaces reduced the risk of IAIs [18].…”

Section: Introductionmentioning

confidence: 99%

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

et al. 2021

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Implant-associated infections (IAIs) are among the most intractable and costly complications in implant surgery. They can lead to surgery failure, a high economic burden, and a decrease in patient quality of life. This manuscript is devoted to introducing current antimicrobial strategies for additively manufactured (AM) titanium (Ti) implants and fostering a better understanding in order to pave the way for potential modern high-throughput technologies. Most bactericidal strategies rely on implant structure design and surface modification. By means of rational structural design, the performance of AM Ti implants can be improved by maintaining a favorable balance between the mechanical, osteogenic, and antibacterial properties. This subject becomes even more important when working with complex geometries; therefore, it is necessary to select appropriate surface modification techniques, including both topological and chemical modification. Antibacterial active metal and antibiotic coatings are among the most commonly used chemical modifications in AM Ti implants. These surface modifications can successfully inhibit bacterial adhesion and biofilm formation, and bacterial apoptosis, leading to improved antibacterial properties. As a result of certain issues such as drug resistance and cytotoxicity, the development of novel and alternative antimicrobial strategies is urgently required. In this regard, the present review paper provides insights into the enhancement of bactericidal properties in AM Ti implants.

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“…A recent meta-analysis of animal model studies has investigated the infection prevention potential of various titanium coating options. 14 It is worthy of note that recent reviews have failed to show any significant difference in infection rates between stainless steel and titanium implants in the setting of fracture fixation. 15,16 However, given the higher propensity of Staphylococcus towards adherence to stainless steel, with an estimated 1.5-fold higher adherence with regard to Staphylococcus epidermidis, we felt it was important to discriminate between titanium and stainless steel implants.…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta‐analysis of animal model studies has investigated the infection prevention potential of various titanium coating options 14 . It is worthy of note that recent reviews have failed to show any significant difference in infection rates between stainless steel and titanium implants in the setting of fracture fixation 15,16 .…”

Section: Introductionmentioning

confidence: 99%

Preventing Staphylococcus aureus stainless steel‐associated infections in orthopedics. A systematic review and meta‐analysis of animal literature

Tsikopoulos

Sidiropoulos

Kitridis

et al. 2021

Journal Orthopaedic Research

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Surgical site infection in the presence of orthopedic implants poses significant healthcare and socioeconomic burden. To assess the potential of various prevention strategies against Staphylococcus-induced stainless steel-associated infections, a review of animal evidence was designed. The databases of PubMed, Embase, and CENTRAL were searched until March 10, 2020, for articles including animal models with stainless steel instrumentation and techniques to prevent Staphylococcus infection. We conducted a random-effects meta-analysis of standardized mean differences (SMD) with subgroup analysis linked to various protection strategies and we recorded complications. Quality was assessed with the SYRCLE's risk of bias tool. Twenty-five studies were included. Combined active coating (featuring organic antibacterial compound release) and degradable passive finishing (lipid-or polymerbased structure modification reducing bacterial adhesion) was favored over untreated controls (SMDs for methicillin-sensitive Staphylococcus aureus [MSSA] and methicillin-resistant Staphylococcus aureus [MRSA] were −3.46, 95% CI [−4.53 to −2.4], p < .001 [n = 4 head-to-head comparisons]; and −6.67, 95% CI [−10.53 to −3], p < .001 [n = 5 head-to-head comparisons], respectively). Systemic vitamin D supplementation and systemic antibiotic administration with or without local antibiotics demonstrated favorable outcomes against MSSA infection. On the contrary, no benefit was seen following vaccination. Of note, no side effects were documented.On the basis of data gathered from eight studies, which comprised 294 animals, a bioresorbable polymer-or lipid-based surface modification supplemented with organic coating yielded improved infection-related outcomes against MSSA and MRSA stainless steel infections, and therefore, this strategy could be further investigated in human research.

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Is coating of titanium implants effective at preventing Staphylococcus aureus infections? A meta-analysis of animal model studies

Cited by 10 publications

References 60 publications

In Vivo Antibacterial Efficacy of Antimicrobial Peptides Modified Metallic Implants─Systematic Review and Meta-Analysis

In Vivo Antibacterial Efficacy of Antimicrobial Peptides Modified Metallic Implants─Systematic Review and Meta-Analysis

Toward Bactericidal Enhancement of Additively Manufactured Titanium Implants

Preventing Staphylococcus aureus stainless steel‐associated infections in orthopedics. A systematic review and meta‐analysis of animal literature

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