Immobilized antibiotics to prevent orthopaedic implant infections.

Immobilized antibiotics to prevent orthopaedic implant infections.
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DOI:
10.1016/j.addr.2012.03.015
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发表时间:
2012-09
影响因子:
16.1
通讯作者:
Shapiro, Irving M.
Shapiro, Irving M.
中科院分区:
医学1区
文献类型:
--
作者:
Hickok, Noreen J.;Shapiro, Irving M.

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许多外科手术需要在体腔深处放置惰性或组织源性植入物。虽然大多数植入物不会被细菌定殖,但一小部分会形成含有侵入性微生物的生物膜层。在骨科手术中,未解决的假体周围感染可能导致植入物松动、关节融合术、截肢,有时甚至导致死亡。本综述的重点是描述植入物的开发,其中使用附着在金属表面的抗生素来防止细菌定植和生物膜形成。基于成熟的化学合成,研究表明抗生素可以通过硅氧基胺的自组装单层与钛连接。稳定的金属抗生素结构可抵抗细菌定植和生物膜形成,同时保持成骨细胞粘附和成熟的能力。在动物模型中,经过抗生素修饰的植入物可以抵抗假体周围感染中常见细菌的挑战。虽然长期功效和稳定性仍有待确定,但正在进行的研究支持这样一种观点,即这种新型生物活性表面具有减轻或预防骨科感染的破坏性后果的真正潜力。
Many surgical procedures require the placement of an inert or tissue-derived implant deep within the body cavity. While the majority of these implants do not become colonized by bacteria, a small percentage develops a biofilm layer that harbors invasive microorganisms. In orthopaedic surgery, unresolved periprosthetic infections can lead to implant loosening, arthrodeses, amputations and sometimes death. The focus of this review is to describe development of an implant in which an antibiotic tethered to the metal surface is used to prevent bacterial colonization and biofilm formation. Building on well-established chemical syntheses, studies show that antibiotics can be linked to titanium through a self-assembled monolayer of siloxy amines. The stable metal-antibiotic construct resists bacterial colonization and biofilm formation while remaining amenable to osteoblastic cell adhesion and maturation. In an animal model, the antibiotic modified implant resists challenges by bacteria that are commonly present in periprosthetic infections. While the long-term efficacy and stability is still to be established, ongoing studies support the view that this novel type of bioactive surface has a real potential to mitigate or prevent the devastating consequences of orthopaedic infection.
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