De Meo Daniele, Cera Gianluca, Pica Roberta, Perfetti Fabiano, Martini Paolo, Perciballi Beatrice, Ceccarelli Giancarlo, Persiani Pietro, Villani Ciro
Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital-Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy.
M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy.
Antibiotics (Basel). 2023 Feb 1;12(2):287. doi: 10.3390/antibiotics12020287.
Local antibiotic delivery strategies have been increasingly employed for the prevention of fracture-related infections (FRIs). The aim of this study is to evaluate the efficacy and safety of antibiotic-coated implants in the prevention of FRIs after surgical treatment in patients with increased infectious risk. A retrospective observational study has been conducted on patients with upper and lower limb fractures treated with internal fixation or prosthetic replacements, using a gentamicin coated nail (CN) and/or antibiotic-loaded hydrogel applied to the implant of choice (ALH). The study included 37 patients (20 M, 17 F), with a mean age of 63 years. The mean estimated preoperative infectious risk score was 6.4%. ALH was used in 27 cases, tibial CNs were implanted in 4 cases, and both were employed in 6 cases. The antibiotics used locally were gentamicin in 72.97% of cases (27 patients) and a combination of gentamicin + vancomycin in 27.03% of cases (10 patients). Mean follow-up was 32 months. Only one case (2.94%) showed onset of FRI at 5 months after surgery. Local antibiotic prophylaxis by coating resulted in a reduction in the incidence FRI, as compared to the estimated preoperative risk. The use of ALH allows for the choice of antibiotic; however, the application of antibiotics seems more nonuniform when applied to a nail.
局部抗生素递送策略已越来越多地用于预防骨折相关感染（FRI）。本研究的目的是评估抗生素涂层植入物在预防感染风险增加患者手术治疗后发生FRI的有效性和安全性。对接受内固定或假体置换治疗的上肢和下肢骨折患者进行了一项回顾性观察研究，使用庆大霉素涂层钉（CN）和/或应用于所选植入物的载抗生素水凝胶（ALH）。该研究纳入了37例患者（男性20例，女性17例），平均年龄63岁。术前估计的平均感染风险评分为6.4%。27例使用了ALH，4例植入了胫骨CN，6例同时使用了两者。局部使用的抗生素在72.97%的病例（27例患者）中为庆大霉素，在27.03%的病例（10例患者）中为庆大霉素+万古霉素联合使用。平均随访32个月。仅1例（2.94%）在术后5个月出现FRI。与术前估计风险相比，通过涂层进行局部抗生素预防可降低FRI的发生率。使用ALH可选择抗生素；然而，当应用于髓内钉时，抗生素的应用似乎更不统一。
