Biomaterials approaches to treating implant-associated osteomyelitis.
Biomaterials approaches to treating implant-associated osteomyelitis.
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DOI：
10.1016/j.biomaterials.2015.12.012
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发表时间：
2016-03
期刊：
影响因子：
14
通讯作者：
Awad HA
中科院分区：
文献类型：
--
作者：
Inzana JA;Schwarz EM;Kates SL;Awad HA
骨科器械是与植入物相关感染最常见的手术器械，而金黄色葡萄球菌（S. aureus）是慢性骨感染（骨髓炎）中最常见的致病病原体。这些慢性骨感染的治疗通常涉及通过生物材料间隔剂全身和局部给药的抗生素组合。用于局部抗生素递送治疗骨髓炎的金标准生物材料聚甲基丙烯酸甲酯（PMMA）骨水泥有许多局限性。这些缺点包括抗生素释放有限，与许多抗菌剂不相容，以及在手术重建丢失的骨之前需要进行后续手术去除不可生物降解的水泥。因此，广泛的研究追求的目标是替代，可生物降解的材料，以取代PMMA在骨髓炎应用。在此，我们概述了主要的临床治疗策略和新兴的生物可降解材料，这些材料可能用于治疗种植体相关性骨髓炎。我们对实验生物材料系统进行了系统回顾，这些系统在动物模型中已被评估用于治疗已建立的金黄色葡萄球菌骨髓炎。许多实验生物材料在提供相同的抗生素时，对感染管理并不一定比PMMA更有效。然而，替代生物材料减少了后续手术的次数，通过输送与PMMA不相容的药物提高了抗菌效果，并在感染缺陷中再生了骨。了解每种生物材料的优势、局限性和临床转化的潜力，以及对其进行评估的条件（例如动物模型），对于外科医生和研究人员在大量的局部抗生素递送选择中进行导航至关重要。
Orthopaedic devices are the most common surgical devices associated with implant-related infections and Staphylococcus aureus (S. aureus) is the most common causative pathogen in chronic bone infections (osteomyelitis). Treatment of these chronic bone infections often involves combinations of antibiotics given systemically and locally to the affected site via a biomaterial spacer. The gold standard biomaterial for local antibiotic delivery against osteomyelitis, poly(methyl methacrylate) (PMMA) bone cement, bears many limitations. Such shortcomings include limited antibiotic release, incompatibility with many antimicrobial agents, and the need for follow-up surgeries to remove the non-biodegradable cement before surgical reconstruction of the lost bone. Therefore, extensive research pursuits are targeting alternative, biodegradable materials to replace PMMA in osteomyelitis applications. Herein, we provide an overview of the primary clinical treatment strategies and emerging biodegradable materials that may be employed for management of implant-related osteomyelitis. We performed a systematic review of experimental biomaterials systems that have been evaluated for treating established S. aureus osteomyelitis in an animal model. Many experimental biomaterials were not decisively more efficacious for infection management than PMMA when delivering the same antibiotic. However, alternative biomaterials have reduced the number of follow-up surgeries, enhanced the antimicrobial efficacy by delivering agents that are incompatible with PMMA, and regenerated bone in an infected defect. Understanding the advantages, limitations, and potential for clinical translation of each biomaterial, along with the conditions under which it was evaluated (e.g. animal model), is critical for surgeons and researchers to navigate the plethora of options for local antibiotic delivery.