Fölsch Christian, Federmann Maike, Lakemeier Stefan, Kuehn Klaus D, Kittinger Clemens, Kerwat Martina, Fuchs-Winkelmann Susanne, Paletta Jürgen R J, Roessler Philip P
Department of Orthopaedic Surgery, University Hospital Gießen, Marburg, Germany.
Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany.
Arch Orthop Trauma Surg. 2016 Apr;136(4):585-92. doi: 10.1007/s00402-016-2419-7. Epub 2016 Feb 12.
Treatment of implant-associated osteomyelitis regularly involves the use of systemic antibiotics in addition to surgical intervention. However, it remains unclear if perioperative systemic application of bactericide substances can improve overall outcome in models of severe intramedullary infection. The present study investigated the use of systemic gentamicin in addition to a controlled local release from a highly lipophilic gentamicinpalmitate compound while the previous study showed efficacy of sole antibiotic implant-coating.
Forty male Sprague-Dawley rats were divided into two groups receiving an intramedullary femoral injection of 10(2) CFU of a common methicillin susceptible Staphylococcus aureus strain (MSSA Rosenbach). Group I received an uncoated implant whereas group II received a coated implant. All animals received a single shot intraperitoneal application of gentamicinsulfate directly after wound closure while the historical control group III (n = 20) had no antibiotic treatment at all. Animals were observed for 28 and 42 days. Serum haptoglobin and relative weight gain were assessed as well as roll over cultures of explanted femur nails and histological scores of periprosthetic infection in dissected femora.
Systemic application of gentamicin combined with antibiotic-coated implant did not further reduce bacterial growth significantly compared with systemic or local antibiotic application alone. Combined local and systemic therapy reduced serum haptoglobin significantly after day 7, 28 and 42 whereas systemic application alone did not compare to controls.
Systemic perioperative and implant-associated application of antibiotics were both comparably effective to treat implant-associated infections whereas the combined antibiotic therapy further reduced systemic signs of infection time dependent.
植入物相关骨髓炎的治疗通常除了手术干预外，还需要使用全身性抗生素。然而，围手术期全身性应用杀菌物质是否能改善严重髓内感染模型的总体预后仍不清楚。本研究调查了全身性庆大霉素的使用，以及一种高度亲脂性庆大霉素棕榈酸酯化合物的可控局部释放，而先前的研究表明单纯抗生素植入物涂层具有疗效。
40只雄性Sprague-Dawley大鼠被分为两组，接受股骨骨髓腔内注射10²CFU常见的甲氧西林敏感金黄色葡萄球菌菌株（MSSA Rosenbach）。第一组接受未涂层植入物，而第二组接受涂层植入物。所有动物在伤口闭合后立即腹腔内单次注射硫酸庆大霉素，而历史对照组III（n = 20）根本没有接受抗生素治疗。对动物进行28天和42天的观察。评估血清触珠蛋白和相对体重增加，以及取出的股骨钉的翻转培养物和解剖的股骨中假体周围感染的组织学评分。
与单独全身性或局部应用抗生素相比，全身性应用庆大霉素联合抗生素涂层植入物并没有进一步显著降低细菌生长。联合局部和全身性治疗在第7天、28天和42天后显著降低了血清触珠蛋白，而单独全身性应用与对照组相比则没有。
围手术期全身性和与植入物相关的抗生素应用在治疗植入物相关感染方面同样有效，而联合抗生素治疗进一步依时间降低了感染的全身症状。
