scholarly journals A novel technique for fabricating antibiotic-coated intramedullary nails using an antibiotic-loaded calcium sulphate hydroxyapatite bio-composite, Cerament-V

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
Anoop Anugraha ◽  
Luke D Hughes ◽  
Anand Pillai
Keyword(s):  
Deformity Correction ◽  
Calcium Sulphate ◽  
Stable Fixation ◽  
Intramedullary Nails ◽  
Novel Technique ◽  
Systemic Antibiotic Therapy ◽  
Antibiotic Release ◽  
Local Antibiotic ◽  
As Toxicity ◽  
Toxicity Effects

Abstract Deformity correction in the setting of osteomyelitis is a challenge for any orthopaedic surgeon. Principles of management are well described and include staged debridement, stable fixation and a combination of local and systemic antibiotic therapy. An antibiotic-coated nail (ACN) can prove a useful tool—stabilizing bone, whilst allowing for local antibiotic elution. Typically, the surgeon will prepare these implants in the operating room using materials that are routinely at hand. Most frequently, this will involve the use of antibiotic-loaded poly-methyl methacrylate (PMMA). This method of ACN fabrication has several disadvantages. PMMA is non-degradable and can be difficult to remove surgically. There are limitations with regard to antibiotic suitability, antibiotic release as well as toxicity effects. In this case report, we present a novel technique for the preparation of ACNs for use in hindfoot surgery, using a calcium sulphate/hydroxyapatite-based bio-composite—Cerament-V.

scholarly journals Evaluation of a bone filler scaffold for local antibiotic delivery to prevent Staphylococcus aureus infection in a contaminated bone defect

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Karen E. Beenken ◽  
Mara J. Campbell ◽  
Aura M. Ramirez ◽  
Karrar Alghazali ◽  
Christopher M. Walker ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Bone Defect ◽  
Rabbit Model ◽  
In Vivo Studies ◽  
Bovine Bone ◽  
Bone Filler ◽  
Antibiotic Release ◽  
Local Antibiotic ◽  
Antibiotic Delivery

AbstractWe previously reported the development of an osteogenic bone filler scaffold consisting of degradable polyurethane, hydroxyapatite, and decellularized bovine bone particles. The current study was aimed at evaluating the use of this scaffold as a means of local antibiotic delivery to prevent infection in a bone defect contaminated with Staphylococcus aureus. We evaluated two scaffold formulations with the same component ratios but differing overall porosity and surface area. Studies with vancomycin, daptomycin, and gentamicin confirmed that antibiotic uptake was concentration dependent and that increased porosity correlated with increased uptake and prolonged antibiotic release. We also demonstrate that vancomycin can be passively loaded into either formulation in sufficient concentration to prevent infection in a rabbit model of a contaminated segmental bone defect. Moreover, even in those few cases in which complete eradication was not achieved, the number of viable bacteria in the bone was significantly reduced by treatment and there was no radiographic evidence of osteomyelitis. Radiographs and microcomputed tomography (µCT) analysis from the in vivo studies also suggested that the addition of vancomycin did not have any significant effect on the scaffold itself. These results demonstrate the potential utility of our bone regeneration scaffold for local antibiotic delivery to prevent infection in contaminated bone defects.

Heparin-mediated antibiotic delivery from an electrochemically-aligned collagen sheet

2021 ◽  
pp. 1-12
Author(s):  
Olivia T. Cheng ◽  
Andrew P. Stein ◽  
Eric Babajanian ◽  
Kathryn R. Hoppe ◽  
Shawn Li ◽  
...  
Keyword(s):  
High Performance ◽  
Inhibitory Concentration ◽  
Medical Implants ◽  
Implantable Medical Devices ◽  
Antibiotic Solution ◽  
Inhibition Zones ◽  
Antibiotic Release ◽  
Local Antibiotic ◽  
Antibiotic Delivery

BACKGROUND: Implantable medical devices and hardware are prolific in medicine, but hardware associated infections remain a major issue. OBJECTIVE: To develop and evaluate a novel, biologic antimicrobial coating for medical implants. METHODS: Electrochemically compacted collagen sheets with and without crosslinked heparin were synthesized per protocol developed by our group. Sheets were incubated in antibiotic solution (gentamicin or moxifloxacin) overnight, and in vitro activity was assessed with five-day diffusion assays against Pseudomonas aeruginosa. Antibiotic release overtime from gentamicin infused sheets was determined using in vitro elution and high performance liquid chromatography (HPLC). RESULTS: Collagen-heparin-antibiotic sheets demonstrated larger growth inhibition zones against P. aeruginosa compared to collagen-antibiotic alone sheets. This activity persisted for five days and was not impacted by rinsing sheets prior to evaluation. Rinsed collagen-antibiotic sheets did not show any inhibition zones. Elution of gentamicin from collagen-heparin-gentamicin sheets was slow and remained above the minimal inhibitory concentration for gentamicin sensitive organisms for 29 days. Conversely, collagen-gentamicin sheets eluted their antibiotic payload within 24 hours. Overall, heparin associated sheets demonstrated larger inhibition zones against P. aeruginosa and prolonged elution profile via HPLC. CONCLUSION: We developed a novel, local antibiotic delivery system that could be used to coat medical implants/hardware in the future and reduce post-operative infections.

A Study on Electrospun Nanofibrous Mats for Local Antibiotic Delivery

2013 ◽  
Vol 829 ◽  
pp. 510-514 ◽  
Author(s):  
Mahboubeh Maleki ◽  
Mohammad Amani-Tehran ◽  
Masoud Latifi ◽  
Sanjay Mathur
Keyword(s):  
Structural Characteristics ◽  
Electrospun Nanofibers ◽  
Electrospinning Process ◽  
Static System ◽  
Antibiotic Drug ◽  
Paper Fabrication ◽  
Antibiotic Release ◽  
Reduced Toxicity ◽  
Local Antibiotic ◽  
Antibiotic Delivery

The demand for novel antibiotic-loaded electrospun nanofibrous structures has increased extremely in the recent years and has engaged the interests of scientists and engineers into a blend configuration of antibiotic drug and biocompatible polymers due to their unique applications in future of better therapeutic effect, reduced toxicity and sustained local antibiotic release over a period of time. One method to produce these antibiotic-loaded networks is by electrospinning process. However, it is very important to know structural characteristics and morphology of nanofibers for controlling the performance of the yields. In this paper, fabrication of electrospun nanofibers suited for antibiotic delivery system is investigated based on tetracycline hydrochloride as the antibiotic drug and poly (lactic-co-glycolic acid) as the biodegradable polymeric matrix. Furthermore, the effect of material and process parameters on morphology and release behavior of produced nonwovens is investigated. The efficacy of the medicated scaffolds using a static system for bacterial growth on agar plates was also proved.

Local Antibiotic Delivery with Bovine Cancellous Chips

2010 ◽  
Vol 26 (4) ◽  
pp. 491-506 ◽  
Author(s):  
Christine S. Lewis ◽  
Jordan Katz ◽  
Maribel I. Baker ◽  
Peter R. Supronowicz ◽  
Elise Gill ◽  
...  
Keyword(s):  
Standard Of Care ◽  
Secondary Surgery ◽  
Primary Osteoblast ◽  
Systemic Antibiotic Therapy ◽  
Bone Void Filler ◽  
Orthopedic Applications ◽  
Local Antibiotic ◽  
Bone Void ◽  
Antibiotic Delivery

Infected bone defects and osteomyelitis are encountered frequently in trauma cases. Currently, the standard of care for osteomyelitis cases is prolonged systemic antibiotic therapy and implantation of antibiotic carrier beads. However, this method requires a secondary surgery to remove the beads after the infection has cleared. In the present study a common bone void filler was investigated for its ability to be infused with an antibiotic. This study demonstrates that the xenograft material tested can be loaded with gentamicin and release clinically relevant levels of the drug for at least 14 days in vitro allowing for the inhibition of bacterial growth on the graft. This study also demonstrates that the levels of gentamicin released did not have an adverse effect on primary osteoblast cell proliferation or ability to generate alkaline phosphatase. This bone void filler may represent a viable alternative to current methods of local antibiotic delivery in orthopedic applications.

scholarly journals Short or Long Antibiotic Regimes in Orthopaedics (SOLARIO): a randomised controlled open-label non-inferiority trial of duration of systemic antibiotics in adults with orthopaedic infection treated operatively with local antibiotic therapy

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Dudareva ◽  
Michelle Kümin ◽  
Werner Vach ◽  
Klaus Kaier ◽  
Jamie Ferguson ◽  
...  
Keyword(s):  
Side Effects ◽  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Open Label ◽  
Systemic Antibiotic ◽  
Systemic Antibiotic Therapy ◽  
Randomised Controlled ◽  
Systemic Antibiotics ◽  
Local Antibiotic ◽  
Local Antibiotic Therapy

Abstract Background Orthopaedic infections, such as osteomyelitis, diabetic foot infection and prosthetic joint infection, are most commonly treated by a combination of surgical debridement and a prolonged course of systemic antibiotics, usually for at least 4–6 weeks. Use of local antibiotics, implanted directly into the site of infection at the time of surgery, may improve antibiotic delivery and allow us to shorten the duration of systemic antibiotic therapy, thereby limiting the frequency of side effects, cost and selection pressure for antimicrobial resistance. Methods SOLARIO is a multicentre open-label randomised controlled non-inferiority trial comparing short and long systemic antibiotic therapy alongside local antibiotic therapy. Adult patients with orthopaedic infection, who have given informed consent, will be eligible to participate in the study provided that no micro-organisms identified from deep tissue samples are resistant to locally implanted antibiotics. Participants will be randomised in a 1:1 ratio to receive either a short course (≤ 7 days) or currently recommended long course (≥ 4 weeks) of systemic antibiotics. The primary outcome will be treatment failure by 12 months after surgery, as ascertained by an independent Endpoint Committee blinded to treatment allocation. An absolute non-inferiority margin of 10% will be used for both per-protocol and intention-to-treat populations. Secondary outcomes will include probable and definite treatment failure, serious adverse events, treatment side effects, quality of life scores and cost analysis. Discussion This study aims to assess a treatment strategy that may enable the reduction of systemic antibiotic use for patients with orthopaedic infection. If this strategy is non-inferior, this will be to the advantage of patients and contribute to antimicrobial stewardship. Trial registration Clinicaltrials.gov, NCT03806166. Registered on 11 November 2019.

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