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

Abstract

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.

Infections @ Trauma/Orthopedic Implants: Recent Advances on Materials, Methods, and Microbes—A Mini-Review

“…The review and meta-analysis performed by Tsikopoulos et al assessed the potential of stainless steel and its modifications to prevent S. aureus infection in animal models [ 34 ]. The analysis showed that passive or active coating of stainless-steel implants reduces MRSA or MSSA infections in various animal models using different antimicrobial substances.…”

Effect of Substrate Preparation and the Conversion Coating on the Corrosion Resistance in Ringer's Solution of 304L Stainless Steel Coated with Alumina Film

“…Using a protective coating may also increase the corrosion resistance of the stainless steel and promote more excellent compatibility with the surrounding human tissues, which is also indispensable 3,10,11 . Organic coatings can be used to enhance the antibacterial response of stainless steel orthopedic implants 12 . Composite coatings of chitosan and silver nanoparticles were applied to coat AISI 304L for orthopedic implants using galvanic deposition, showing improved corrosive protection in a simulated body fluid at 37 o C 13 .…”

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

“…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.…”