Systemic versus local application of gentamicin in prophylaxis of implant-related osteomyelitis in a rat model
Systemic versus local application of gentamicin in prophylaxis of implant-related osteomyelitis in a rat model
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DOI：
10.1016/j.bone.2005.01.008
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发表时间：
2005-05-01
期刊：
影响因子：
4.1
通讯作者：
Schmidmaier, G
中科院分区：
文献类型：
--
作者：
Lucke, M;Wildemann, B;Schmidmaier, G
围手术期抗生素预防性给药是骨科手术的常规程序。除了全身预防之外，只有少数技术可以用于局部应用抗生素以减少与骨科植入物相关的感染。本研究的目的是在大鼠模型中评估局部与全身应用庆大霉素的疗效（n = 60）。对于局部应用，抗生素从钛植入物的可生物降解聚（D，L-丙交酯）（PDLLA）涂层中释放。局部预防的有效性进行了比较，全身单次注射应用庆大霉素，以及两个administrations.Half的动物接受了体重通过单次注射应用庆大霉素手术前30分钟。手术时，胫骨髓腔被金黄色葡萄球菌污染（10（2）菌落形成单位/CFU），并将钛基克氏针植入髓腔内。植入物为无涂层、PDLLA涂层或PDLLA +10%w/w庆大霉素涂层，动物随访42天。处死动物后，通过组织学和微生物分析评估感染情况。所有使用无涂层或PDLLA涂层克氏针治疗但未全身应用抗生素的动物均发生骨髓炎，所有植入物培养物均检测为S阳性。在15%的动物中，通过预防全身应用庆大霉素可以预防植入物相关的骨髓炎。相比之下，局部应用PDLLA涂层递送的庆大霉素更有效。在90%接受庆大霉素涂层克氏针治疗的动物中，以及在80%接受局部和全身联合应用治疗的动物中，可以预防感染发作。PDLLA涂层种植体的局部应用可能支持预防种植体相关骨髓炎的全身抗生素预防。(c)2005年爱思唯尔公司All rights reserved.
Administration of perioperative antibiotic prophylaxis is a routine procedure in orthopedic surgery. Besides systemic prophylaxis, only few techniques are established for local application of antibiotics to reduce infection related to orthopedic implants.The aim of this study was to evaluate the efficacy of locally versus systemically applied gentamicin in a rat model (n = 60). For local application, the antibiotic was delivered from a biodegradable poly(D,L-lactide) (PDLLA) coating of titanium implants. The efficacy of local prophylaxis was compared to a systemic single shot application of gentamicin as well as a combination of both administrations.Half of the animals received a weight-adopted single shot application of gentamicin 30 min prior to surgery. At surgery, the medullary cavities of the tibiae were contaminated with Staphylococcus aureus (10(2) colony forming units /CFU) and titanium Kirschner wires were implanted into the medullary canals. The implants were either uncoated, PDLLA coated, or coated with PDLLA + 10% w/w gentamicin.The animals were followed up for 42 days. X-ray examinations were performed; body weight, temperature, and the clinical condition were determined.After sacrifice, infection was evaluated by histological and microbiological analysis.All animals treated with uncoated or PDLLA-coated Kirschner wires without systemic application of the antibiotic developed osteomyelitis and all cultures of implants were tested positive on S. aureus.Implant-related osteomyelitis could be prevented by prophylaxis of systemically applied gentamicin in 15% of animals. In contrast, local application of gentamicin delivered from a PDLLA coating was more effective. Onset of infection could be prevented in 90% of animals treated with gentamicin coated Kirschner wires, and in 80% of the animals that were treated with a combination of local and systemic application. The local application from PDLLA-coated implants might support systemic antibiotic prophylaxis in preventing implant-associated osteomyelitis. (c) 2005 Elsevier Inc. All rights reserved.