Local Antibacterial Therapy for the Management of Orthopaedic Infections

Abstract

Bone infection has long been a formidable foe of orthopaedic surgeons. The standard method of treating osteomyelitis generally consists of irrigation and debridement supplemented by pre- and postoperative antibiotics and intraoperative antimicrobial solutions. In the 1970s, Buchholz introduced the concept of local antibacterial therapy in the form of antibiotic impregnated bone cement to treated infected arthroplasties. From this, antibiotic impregnated beads were developed to treat local infections of bone and soft tissue. The advantage of these beads compared with parenteral therapy is that they deliver a high concentration of antibacterial locally while avoiding high systemic concentrations, thus avoiding adverse effects that are often associated with parenteral antibacterial therapy. Additionally, methylmethacrylate bone cement does not significantly affect the immune response of the body. This makes the use of antibiotic-impregnated polymethylmethacrylate (PMMA) beads highly effective either as an alternative to, or in conjunction with, systemic antibiotic treatment of infected arthroplasties, and localised bone and soft tissue infection. This article explores the indications for the use of local therapy as well as any advantages or disadvantages it may have over systemic antibacterial treatment. Additionally, there are important pharmacokinetic considerations for the optimal use of antibacterial agents in the treatment of osteomyelitis.

RNAIII-Inhibiting-Peptide-Loaded Polymethylmethacrylate Prevents In Vivo Staphylococcus aureus Biofilm Formation

“…Polymethylmethacrylate (PMMA) is used in orthopedic surgery as a drug delivery system wherein antimicrobial agents are loaded into PMMA to deliver drugs to tissues with limited blood flow and to deliver high local antimicrobial concentrations (9).…”

Red man syndrome: an unusual complication of vancomycin beads

“…Hydroxizine) were given following which the patient revived. However, after about 15 minutes patient again went in hypotension In 1970s, Buchholz first started using antibiotic impregnated bone cement to treat infected arthroplasties 6 . Hence forth, antibiotic impregnated beads were developed to treat local infections of bone and soft tissue which is being continued to this day by many orthopaedic surgeons.…”

Local Antibiotic Therapy in the Treatment of Bone and Soft Tissue Infections

“…The use of antibioticimpregnated polymethylmethacrylate (PMMA) cement bead for the treatment of bone and soft tissue infections has many theoretical advantages. The beads, which release antibiotics by passive diffusion, combine with high local concentrations with low systemic levels of the antibiotic (Henry & Galloway, 1995), leading to more effective killing of the organisms and less risk of systemic toxicity. In addition, the beads can fill the dead space that may be left after debridement of infected tissue (Patzakis et al, 1993).…”

“…Since then antibiotic-loaded bone cement has been an effective method for providing sustained high concentrations of antibiotics locally when used in numerous types of bone and soft tissue infections (Calhoun & Mader, 1989;Josefsson et al, 1990). Polymethylmethacrylate (PMMA) exist in two forms: that of antibiotic-impregnated bone cement applied in arthroplasties and antibiotic-impregnated bead chains for musculoskeletal infections (Henry & Galloway, 1995). The success of these carriers depend on two factors: PMMA does not usually trigger any immune response from the host and the form of a bead confers a wide surface area, allowing rapid release of the antibiotic.…”