Department of Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster, Waldeyerstrasse 1, 48149, Muenster, Germany.
Department of Anesthesia, Hospital Lippe Detmold, Detmold, Germany.
Sci Rep. 2022 Mar 10;12(1):3979. doi: 10.1038/s41598-022-07673-8.
The increasing number of implant-associated infections and of multiresistant pathogens is a major problem in the daily routine. In the field of osteomyelitis, it is difficult to manage a valid clinical study because of multiple influencing factors. Therefore, models of osteomyelitis with a simulation of the pathophysiology to evaluate treatment options for implant-associated infections are necessary. The aim of this study is to develop a standardized and reproducible osteomyelitis model in-vivo to improve treatment options. This study analyses the influence of a post-infectious implant exchange one week after infection and the infection progress afterward in combination with a systemic versus a local antibiotic treatment in-vivo. Therefore, the implant exchange, the exchange to a local drug-delivery system with gentamicin, and the implant removal are examined. Furthermore, the influence of an additional systemic antibiotic therapy is evaluated. An in-vivo model concerning the implant exchange is established that analyzes clinic, radiologic, microbiologic, histologic, and immunohistochemical diagnostics to obtain detailed evaluation and clinical reproducibility. Our study shows a clear advantage of the combined local and systemic antibiotic treatment in contrast to the implant removal and to a non-combined antibiotic therapy. Group genta/syst. showed the lowest infection rate with a percentage of 62.5% concerning microbiologic analysis, which is in accordance with the immunohistochemical, cytochemical, histologic, and radiologic analysis. Our in-vivo rat model has shown valid and reproducible results, which will lead to further investigations regarding treatment options and influencing factors concerning the therapy of osteomyelitis and implant-associated infections.
植入物相关感染和多耐药病原体的数量不断增加是日常工作中的一个主要问题。在骨髓炎领域，由于多种影响因素，很难进行有效的临床研究。因此，需要建立一种模拟骨髓炎病理生理学的感染模型，以评估针对植入物相关感染的治疗选择。本研究旨在开发一种标准化且可重复的体内骨髓炎模型，以改善治疗选择。本研究分析了在感染后一周进行感染后植入物置换以及随后的感染进展的影响，同时结合了全身和局部抗生素治疗的影响。因此，研究了植入物置换、置换为局部庆大霉素药物输送系统以及植入物去除。此外，还评估了额外的全身抗生素治疗的影响。建立了一种涉及植入物置换的体内模型，该模型分析了临床、放射学、微生物学、组织学和免疫组织化学诊断，以获得详细的评估和临床可重复性。我们的研究表明，与植入物去除和非联合抗生素治疗相比，联合局部和全身抗生素治疗具有明显优势。局部联合全身使用庆大霉素组（group genta/syst.）的微生物学分析显示感染率最低，为 62.5%，这与免疫组织化学、细胞化学、组织学和放射学分析一致。我们的体内大鼠模型显示出有效的、可重复的结果，这将进一步研究骨髓炎和植入物相关感染的治疗选择和影响因素。
