Bone graft substitutes in active or suspected infection. Contra-indicated or not? (original) (raw)
Related papers
Infections of Orthopaedic Implants and Devices
Springer Series on Biofilms, 2009
Prosthetic implantation is rising in popularity in the United States, and use of prostheses will only continue to increase with the aging of the Baby Boomer generation. A concurrent rise in the number of infections of these implants is also being seen. Prosthetic implant infection (PII) can be caused by direct inoculation of bacteria to the implant or by seeding from the blood (hematogenous). Because the implant is quickly coated by host connective tissue upon implantation, bacteria such as the staphylococcal species S. aureus and S. epidermidis are able to readily gain a foothold in the host. S. aureus is able to quickly develop antibiotic resistance and methicillin-resistant strains (MRSA) are considered endemic in hospitals. This bacterium features a myriad of virulence factors that allow it to colonize and damage the host, as well as avoid the host immune response. These virulence factors are largely regulated through population-based quorum sensing via the agr system. S. aureus is also able to form biofilms, microbial communities encased in a polysaccharide matrix, which allows the bacteria within to persist in the face of antimicrobial therapies and the host response. Diagnosis of PII is difficult with many false results and confusion with aseptic loosening of the implant. Because of ineffective means of diagnosis, combined with S. aureus' high incidence of antibiotic resistance and its ability to evade both antibiotics and the host response through biofilm formation, treatment for PII is often inadequate and infection can become chronic. Therefore, PII has a high rate of morbidity and mortality for patients, as well as an extreme economic burden on the US healthcare system.
Combating implant infections. Remarks by a women's team
International journal of …, 2008
and clinical expertises. An international group of women scientists is acting together in this field. The main research topics of the participants of this group are described. Formation of bacterial biofilms, antibiotic resistance and production of virulence factors like adhesins and toxins are investigated. New biomaterials, coatings and drugs designed to inhibit microbial adhesion are evaluated, and infection-resistant biomaterials are under study, such as a novel heparinizable polycarbonate-urethane (Bionate) or incorporation of diamino-diamide-diol (PIME) to reduce bacterial attachment. The correlation between biofilm production and the accessory-gene-regulator (agr) is investigated in Staphylococcus aureus. The ability to form biofilm has also been shown to be one of the important virulence factors of Enterococcus faecalis, favouring colonization of inert and biological surfaces. The study of quorum sensing has led to the discovery of a quorum sensing inhibitor termed RIP that suppresses staphylococcal biofilm and infections. The immune response and the local defence mechanisms of the host against implant-associated infections, activation and infiltration of immunocompetent cells into the sites of infection have been studied in patients with implant-associated osteomyelitis. Production of monoclonal antibodies (mAbs) as possible vaccines against the staphylococcal collagen-binding MSCRAMMs is in progress. (Int J Artif Organs 2008; 31: 858-64)
Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review
Injury, 2006
1 Implant-related infection is a feared complication in orthopedic and trauma surgery with tremendous consequences for the patient. To reduce this risk, administration of perioperative antibiotic prophylaxis is a routine procedure in orthopedic surgery. A local delivery system for antibiotics based on a polymer implant coating has been developed to optimize the prophylaxis. In an animal experiment, the efficacy of local prophylaxis of gentamicin was compared to a systemic single shot of gentamicin and to a combination of both administrations. The medullary cavities of rat tibiae were contaminated with Staphylococcus aureus and titanium K-wires were implanted into the medullary canals. For local antibiotic therapy, the implants were coated with poly(D,L-Lactide) (PDLLA) loaded with gentamicin. All the animals not treated with local and systemic application of the antibiotic developed osteomyelitis and all cultures of the implants tested positive for S. aureus. Onset of infection was prevented in 80−90% of animals treated with gentamicin-coated K-wires, with and without systemic prophylaxis. Gentamicin-coated intramedullary tibial nails are CE-certified for Europe and Canada and several patients have already been treated for implant-related infection. Up to now, eight patients with open tibia fractures have been treated with an unreamed tibial nail (UTN) coated with PDLLA and gentamicin. In the 1-year follow up, none of the patients developed an infection. A prospective randomized clinical documentation is currently in progress. So far, the results suggest that a local application of gentamicin from PDLLA-coated implants might support systemic antibiotic prophylaxis in preventing implant-associated osteomyelitis.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2013
Background: In spite of the decreasing incidence of orthopaedic device related infections to 1%, nowadays, device-related infections still remain a diagnostic, therapeutic and cost-related problem. Aims and Objective: To record the common causative organisms and the contributing risk factors for orthopaedic device-related infections in a tertiary care teaching hospital. Methods: In a prospective study, fifty patients who underwent orthopaedic device implantation from Jan 2009-June 2010 were enrolled; among them, 42 patients were complicated with infections. The demography, microbiological data, treatment and the outcome of each patient were recorded. Statistical Analysis: The data was analyzed in terms of frequency and percentage. Results: Of the 50 samples, 42(84%) were culture positive, while 8(16%) were cultures negative. The femur was the most commonly affected bone in both males (median age-37.1yrs) and females (median age-41.3 yrs). Staphylococcus aureus was the organism which was most commonly isolated and which caused biofilms, followed by non-fermenting, gram negative bacilli and Klebsiella spp. We reported the first case till date in the literature of Candida krusei PJI, to the best of our knowledge. No anaerobes were isolated. Tissue trauma, open fractures, post-operative surgical site infections and Diabetes mellitus were found to be the important risk factors. The biofilm forming organisms were commonly associated with polymicrobial infections and even an aggressive antibiotic therapy was often inadequate to eliminate the infections. A conservative surgical treatment was associated with treatment failures. Implant removal or replacement was required in most of the cases to eradicate the infection. Conclusion: The most common bacteria which were isolated included Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella. A majority of them are resistant to the commonly used antibiotics, leading to treatment failures which necessitated an implant removal.
Revisiting the “race for the surface” in a pre-clinical model of implant infection
European Cells and Materials, 2020
Orthopaedic implant use increases infection risk. Implant infection risk can be explained by the "race for the surface" concept, where there is competition between host-cell integration and bacterial colonisation. Although generally accepted, the temporal dynamics have not been elucidated in vivo. Using a bilateral intramedullary rat model, Staphylococcus aureus was injected into the tail vein either immediately after or 1, 3 and 7 d following implant placement. This allowed assessment of the temporal interplay between bacterial colonisation and host-cell adhesion by uncoupling implant placement and bacterial challenge. 2 weeks following inoculation, animals were anaesthetised, euthanised and implants and tissues harvested for bacterial enumeration. To assess host participation in implant protection, additional animals were not inoculated but euthanised at 1, 3 or 7 d and the host cells adhered to the implant were evaluated by flow cytometry and microscopy. As time between implant placement and bacterial challenge increased, infection rate and bioburden decreased. All implants had measurable bioburden when challenged at day 1, but only two implants had recoverable bacteria when inoculated 7 d after implant placement. This protection against infection corresponded to a shift in host cell population surrounding the implant. Initially, cells present were primarily non-differentiated stem cells, such as bone marrow mesenchymal stem cells, or immature haematopoietic cells. At day 7, there was a mature monocyte/macrophage population. The present study illustrated a direct relationship between host immune cell attachment and decrease in bacterial colonisation, providing guidance for antimicrobial release devices to protect orthopaedic implants against bacterial colonisation.
Orthopaedic Implant Related Infection
International Journal of Research Publications, 2022
Implant is widely used to correct deformation, to stabilize fracture site, and promote bone healing in several orthopaedic surgeries. The use of implant is usually having a higher risk of developing infection. Although the use of antibiotic prophylaxis and antimicrobial impregnated biomaterial are used in cases of surgeries. But, the emerging superbugs which resistant to antibiotics, biofilms formation, and chronic immune suppressing diseases and lifestyles are challenging issues to make good osteosynthesis. Author use orthopaedic implant related infection to explain about the infection associated with the use of orthopaedic implants. This article attempts to discuss about infection associated with orthopaedic implant surgeries and treatment possible to treat the infection during implant placement.
Characteristics of bacterial biofilm associated with implant material in clinical practice
Polymer Journal, 2012
Colonization of bacteria around native host cells or polymeric implant surfaces results in a dense growth on the surface, which leads to infection. The change of a bacterium from a motile planktonic to a nonmotile long chain of growing cells is a complex, regulated process that depends on several factors. The probability of a biofilm-related infection occurrence is between 65 and 80%. This review critically evaluates the mode of biofilm formation on native tissues and orthopedics, dental, cardiac, and urological implants and vascular grafts. The combination of biochemical advancements with conventional microbiological techniques and the use of radio-labeled monoclonal antibodies in imaging techniques, with recent developments in the detection of these biofilm in vivo, would help in designing biomaterials that prevent bacterial adhesion and biofilm formation, and dislodge the formed biofilm, thereby accelerating the product development phase.
The influence of the chemical composition and surface of the implant on infection
Injury-international Journal of The Care of The Injured, 1996
The influence of the localization and size of orthopaedic implants on infection has been analyzed extensively, but the influence of implant shape and chemical composition has rarely been studied, and the influence of the surface has only been described in one single report.Several experimental studies have tried to compare the incidence of infection for different materials. PMMA usually appears as the implant material most prone to causing infection, while titanium (Ti) and cobalt-chromium (CoCr) are the materials most resistant to infection.On the polished surface of cylinders implanted in rabbit femora, it took 40 times more inoculum to produce a clinical infection than it took for porous CoCr implants. The polished surface implants required 2.5 times more inoculum than porous Ti to produce infection.
The significance of infection related to orthopedic devices and issues of antibiotic resistance
Biomaterials, 2006
Over the last 15 years, with the advent of modern standards in the control of sterility within the operating room environment and adequate protocols of peri-operative antibiotic prophylaxis, the incidence of infections associated to orthopedic implants has become very low. Nevertheless, the event of infection still represents one of the most serious and devastating complications which may involve prosthetic devices. It leads to complex revision procedures and, often, to the failure of the implant and the need for its complete removal. In orthopedics, for the enormous number of surgical procedures involving invasive implant materials, even if nowadays rare, infections have a huge impact in terms of morbidity, mortality, and medical costs. The difficult battle to prevent and fight bacterial infections associated to prosthetic materials must be played on different grounds. A winning strategy requires a clear view of the pathogenesis and the epidemiology of implant-related infections, with a special attention on the alarming phenomenon of antibiotic resistance. In this regard staphylococci are the prevalent and most important causative pathogens involved in orthopedic implant-related infections, and, thus, the main enemy to defeat. In this paper, we offer an overview of the complexity of this battleground and of the current and new, in our opinion most promising, strategies in the field of biomaterials to reduce the risks and counteract the establishment of implant infections.