Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review
Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review
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DOI：
10.1016/j.injury.2006.04.016
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发表时间：
2006-05-01
影响因子：
2.5
通讯作者：
Raschke, Michael
中科院分区：
文献类型：
--
作者：
Schmidmaier, Gerhard;Lucke, Martin;Raschke, Michael
植入物相关感染是骨科和创伤手术中令人担忧的并发症，会给患者带来严重后果。为了降低这种风险，围手术期抗生素预防性给药是骨科手术的常规程序。一种基于聚合物植入涂层的抗生素局部给药系统已经开发出来，以优化prophylaxis.In动物实验中，局部预防庆大霉素的效果进行了比较，全身单次注射庆大霉素和两种管理的组合。用金黄色葡萄球菌污染大鼠胫骨髓腔，将钛克氏针植入髓腔内。对于局部抗生素治疗，植入物涂有载有庆大霉素的聚（D，L-丙交酯）（PDLLA）。所有未局部和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。金黄色。80-90%接受庆大霉素涂层克氏针治疗的动物（有或无全身预防）的感染发生得到预防。庆大霉素涂层胫骨髓内钉。髓内钉在欧洲和加拿大获得了CE认证，一些患者已经接受了与植入物相关的感染治疗。到目前为止，有8例开放性胫骨骨折患者接受了胫骨不扩髓治疗。涂有PDLLA和庆大霉素的髓内钉（UTN）。在1年的随访中，没有患者发生感染。目前正在进行一项前瞻性随机临床研究，结果表明，局部应用PDLLA涂层种植体上的庆大霉素可能有助于预防种植体相关性骨髓炎的全身抗生素预防。
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.