Gallarate Marina, Chirio Daniela, Chindamo Giulia, Peira Elena, Sapino Simona
Department of Drug Science and Technology, University of Turin, via P. Giuria 9, Turin, 10125, Italy.
Curr Drug Deliv. 2021;18(5):532-545. doi: 10.2174/1567201817666200915093224.
Osteomyelitis is a bone marrow infection which generally involves cortical plates and which may occur after bone trauma, orthopedic/maxillofacial surgery or after vascular insufficiency episodes. It mostly affects people from the Third World Countries, the elderly and patients affected by systemic diseases e.g. autoimmune disorders, AIDS, osteoporosis and microvascular disease. The highest percentage of osteomyelitis cases (almost 75%) is caused by Staphylococcus spp., and in particular by Staphylococcus aureus (more than 50%). The ideal classification and the diagnosis of osteomyelitis are two important tools which help the physicians to choose the best therapeutic strategies. Currently, common therapies provide an extensive debridement in association with intravenous administration of antibiotics (penicillin or clindamycin, vancomycin and fluoroquinolones among all for resistant microorganisms), to avoid the formation of sequestra. However, conventional therapeutic approach involves several drawbacks like low concentration of antibiotics in the infected site, leading to resistance and adverse effects due to the intravenous administration. For these reasons, in the last years several studies have been focused on the development of drug delivery systems such as cements, beads, scaffolds and ceramics made of hydroxyapatite (HA), calcium phosphate (CaP) and β-tricalcium phosphate (β-TCP) which demonstrated to be biocompatible, poorly toxic and capable to allow osteointegration and a prolonged drug release. The aim of this review is to provide a focus on current therapies and latest developed drug delivery systems with particular attention on those based on CaP and its derivatives, hoping that this work could allow further direction in the field of osteomyelitis.
骨髓炎是一种骨髓感染，通常累及骨皮质板，可发生于骨创伤、骨科/颌面外科手术后或血管功能不全发作后。它主要影响来自第三世界国家的人群、老年人以及患有全身性疾病（如自身免疫性疾病、艾滋病、骨质疏松症和微血管疾病）的患者。骨髓炎病例中最高比例（近75%）由葡萄球菌属引起，尤其是金黄色葡萄球菌（超过50%）。骨髓炎的理想分类和诊断是帮助医生选择最佳治疗策略的两个重要工具。目前，常见的治疗方法是在静脉注射抗生素（对耐药微生物使用的所有抗生素中包括青霉素或克林霉素、万古霉素和氟喹诺酮类）的同时进行广泛清创，以避免死骨形成。然而，传统治疗方法存在几个缺点，如感染部位抗生素浓度低，导致耐药性以及静脉给药引起的不良反应。由于这些原因，近年来多项研究集中在药物递送系统的开发上，如由羟基磷灰石（HA）、磷酸钙（CaP）和β - 磷酸三钙（β - TCP）制成的骨水泥、珠子、支架和陶瓷，这些材料已证明具有生物相容性、低毒性，能够实现骨整合和延长药物释放。本综述的目的是聚焦当前的治疗方法和最新开发的药物递送系统，特别关注基于CaP及其衍生物的系统，希望这项工作能为骨髓炎领域提供进一步的指导方向。
