Induktion und Prophylaxe Implantat assoziierter Knocheninfektionen am Modell eines antiinfektiv beschichteten Marknagels
Beschreibung
vor 20 Jahren
Induction and prophylaxis of implant-related bone infections using
an antibacterial-coated intramedullary nail – an experimental
rabbit model Despite modern peri-operative antimicrobial
prophylaxis, bone infections still represent dangerous
complications in orthopedic and trauma surgery. Bacterial
colonization of implanted material is the first step in
pathogenesis of these infections. The objective of this study was
to evaluate the effectiveness from a new biodegradable, stable,
antibacterial gentamicin-loaded poly-(D,L-lactide) (PDLLA) coating
of orthopedic devices. In vitro, elution kinetics of gentamicin and
furthermore, biocompatibility and effectiveness in preventing
implant-related osteomyelitis should be studied in vivo. Coating of
commercial steel implants was performed by a so-called cold coating
technique under aseptic conditions. The carrier was the polymer
poly-(D,L-lactide) Resomer R 203 and gentamicin was incorporated in
a 10 % (w/w) concentration. Release kinetics of gentamicin were
tested in vitro for 96 hours. To study the biocompatibility, in a
group of eleven rabbits nails uncoated (n=5) or nails coated with
PDLLA and gentamicin (n=6) were implanted into the femur. Serum
gentamicin was determined after 12, 24, 48 hours and then weekly.
Follow-up was six weeks. After sacrifice the femora were examined
by histologic and radiologic means. In a second group of 20
rabbits, the medullary cavities of femora were contaminated with
105 CFU Staphylococcus aureus after implantation of uncoated (n=10)
or coated (n=10) nails. Serum gentamicin, blood samples and
clinical presentation were examined. Follow-up was eight weeks.
After sacrifice the femora were evaluated by microbiological,
histological and radiological analysis. The incorporated gentamicin
was released continuously over a period of at least 96 hours with
an initial peak of release in the first 24 hours. In the
biocompatibility group, radiological and histological studies
revealed no adverse effects on bone contributed to the PDLLA
coating. In the osteomyelitis group, all controls developed
abscesses and histological signs of osteomyelitis. In nine of ten
rabbits which had an implant coated with gentamicin abscesses were
not detected. Histological signs of infection were reduced. No
significant differences in clinical and radiological presentation
were observed between the groups. In our animal model with an
infective dosis of 105 CFU Staphylococcus aureus, local application
of nails coated with PDLLA and gentamicin significantly reduced
implant-related bone infections. The use of the
gentamicin-PDLLA-coating could be an effective supplement for
prophylaxis of implant-related infections in orthopedic and trauma
surgery.
an antibacterial-coated intramedullary nail – an experimental
rabbit model Despite modern peri-operative antimicrobial
prophylaxis, bone infections still represent dangerous
complications in orthopedic and trauma surgery. Bacterial
colonization of implanted material is the first step in
pathogenesis of these infections. The objective of this study was
to evaluate the effectiveness from a new biodegradable, stable,
antibacterial gentamicin-loaded poly-(D,L-lactide) (PDLLA) coating
of orthopedic devices. In vitro, elution kinetics of gentamicin and
furthermore, biocompatibility and effectiveness in preventing
implant-related osteomyelitis should be studied in vivo. Coating of
commercial steel implants was performed by a so-called cold coating
technique under aseptic conditions. The carrier was the polymer
poly-(D,L-lactide) Resomer R 203 and gentamicin was incorporated in
a 10 % (w/w) concentration. Release kinetics of gentamicin were
tested in vitro for 96 hours. To study the biocompatibility, in a
group of eleven rabbits nails uncoated (n=5) or nails coated with
PDLLA and gentamicin (n=6) were implanted into the femur. Serum
gentamicin was determined after 12, 24, 48 hours and then weekly.
Follow-up was six weeks. After sacrifice the femora were examined
by histologic and radiologic means. In a second group of 20
rabbits, the medullary cavities of femora were contaminated with
105 CFU Staphylococcus aureus after implantation of uncoated (n=10)
or coated (n=10) nails. Serum gentamicin, blood samples and
clinical presentation were examined. Follow-up was eight weeks.
After sacrifice the femora were evaluated by microbiological,
histological and radiological analysis. The incorporated gentamicin
was released continuously over a period of at least 96 hours with
an initial peak of release in the first 24 hours. In the
biocompatibility group, radiological and histological studies
revealed no adverse effects on bone contributed to the PDLLA
coating. In the osteomyelitis group, all controls developed
abscesses and histological signs of osteomyelitis. In nine of ten
rabbits which had an implant coated with gentamicin abscesses were
not detected. Histological signs of infection were reduced. No
significant differences in clinical and radiological presentation
were observed between the groups. In our animal model with an
infective dosis of 105 CFU Staphylococcus aureus, local application
of nails coated with PDLLA and gentamicin significantly reduced
implant-related bone infections. The use of the
gentamicin-PDLLA-coating could be an effective supplement for
prophylaxis of implant-related infections in orthopedic and trauma
surgery.
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