Schwarz, Edward M. and McLaren, Alex C. and Sculco, Thomas P. and Brause, Barry and Bostrom, Mathias and Kates, Stephen L. and Parvizi, Javad and Alt, Volker and Arnold, William V. and Carli, Alberto and Chen, Antonia F. and Choe, Hyonmin and Coraca-Huber, Debora C. and Cross, Michael and Ghert, Michelle and Hickok, Noreen and Jennings, Jessica Amber and Joshi, Manjari and Metsemakers, Willem-Jan and Ninomiya, Mark and Nishitani, Kohei and Oh, Irvin and Padgett, Douglas and Ricciardi, Benjamin and Saeed, Kordo and Sendi, Parham and Springer, Bryan and Stoodley, Paul and Wenke, Joseph C. (2021) Adjuvant antibiotic-loaded bone cement: Concerns with current use and research to make it work. JOURNAL OF ORTHOPAEDIC RESEARCH, 39 (2). pp. 227-239. ISSN 0736-0266, 1554-527X
Full text not available from this repository. (Request a copy)Abstract
Antibiotic-loaded bone cement (ALBC) is broadly used to treat orthopaedic infections based on the rationale that high-dose local delivery is essential to eradicate biofilm-associated bacteria. However, ALBC formulations are empirically based on drug susceptibility from routine laboratory testing, which is known to have limited clinical relevance for biofilms. There are also dosing concerns with nonstandardized, surgeon-directed, hand-mixed formulations, which have unknown release kinetics. On the basis of our knowledge of in vivo biofilms, pathogen virulence, safety issues with nonstandardized ALBC formulations, and questions about the cost-effectiveness of ALBC, there is a need to evaluate the evidence for this clinical practice. To this end, thought leaders in the field of musculoskeletal infection (MSKI) met on 1 August 2019 to review and debate published and anecdotal information, which highlighted four major concerns about current ALBC use: (a) substantial lack of level 1 evidence to demonstrate efficacy; (b) ALBC formulations become subtherapeutic following early release, which risks induction of antibiotic resistance, and exacerbated infection from microbial colonization of the carrier; (c) the absence of standardized formulation protocols, and Food and Drug Administration-approved high-dose ALBC products to use following resection in MSKI treatment; and (d) absence of a validated assay to determine the minimum biofilm eradication concentration to predict ALBC efficacy against patient specific micro-organisms. Here, we describe these concerns in detail, and propose areas in need of research.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | TOTAL KNEE ARTHROPLASTY; SMALL COLONY VARIANTS; ELUTION KINETICS; JOINT INFECTION; LOCAL-DELIVERY; CASE SERIES; IN-VITRO; VANCOMYCIN; OSTEOMYELITIS; TOBRAMYCIN; antibiotic-loaded bone cement (ALBC); Biofilm Meeting; local antibiotics; musculoskeletal infection (MSKI) |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Unfallchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 28 Feb 2022 06:23 |
| Last Modified: | 28 Feb 2022 06:23 |
| URI: | https://pred.uni-regensburg.de/id/eprint/44972 |
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