Department of Orthopedics, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Mail Stop B202, Aurora, CO, 80045, USA.
Eur J Orthop Surg Traumatol. 2024 Nov 25;35(1):25. doi: 10.1007/s00590-024-04132-0.
Implants in orthopedic trauma and arthroplasty surgery establish a milieu conducive to biofilm formation. Antimicrobial-loaded cements (ABCs) and beads have become popular in treating acute and chronic orthopedic surgery-related infections. The growing incidence of antimicrobial resistance has necessitated the exploration of alternative antibiotic medications. This review aims to demonstrate meaningful clinical decision-making guidance for orthopedic surgeons in approaching the management of these complex infections.
This study protocol was conducted following the PRISMA checklist and guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. PubMed, Ovid MEDLINE, Web of Science, and other databases were queried using applicable search terms. Relevant dosing, efficacy, and elution profiles were reviewed and compiled from 74 articles published between 1976 and 2019. First-line and targeted therapies were identified against rare and resistant bacteria. Drug therapies not recommended due to excessive cytotoxicity or poor delivery kinetics were also elucidated.
This compilation describes thirty-two antibiotics and three antifungals that have successfully managed orthopedic surgery-related infections, including infections with numerous recalcitrant and multidrug-resistant species. Optimized ratios of carrier to antimicrobial are provided for each delivery method. The elution and efficacy profiles of the various antibiotics are described when available.
DISCUSSION/CONCLUSION: These recommendations offer the most up-to-date and comprehensive practice guidelines for using antimicrobials in cements and beads for treating orthopedic hardware-related infections. With the ever-evolving propensity of bacteria to develop antibiotic resistance, these recommendations are dynamic. Collaboration with medicine, infectious disease, and/or pharmacology teams is recommended to create institutional protocols for antibiotic-eluting implants and close comanagement to ensure efficacy and patient safety.
骨科创伤和关节置换手术中的植入物为生物膜形成创造了有利环境。载抗菌剂的水泥（ABC）和珠粒已成为治疗急性和慢性骨科手术相关感染的热门方法。抗菌药物耐药性的不断增加，使得人们需要探索替代抗生素药物。本综述旨在为骨科医生在处理这些复杂感染时提供有意义的临床决策指导。
本研究方案遵循 PRISMA 清单和 Cochrane 系统评价干预手册的指南。使用适用的搜索词在 PubMed、Ovid MEDLINE、Web of Science 和其他数据库中进行查询。从 1976 年至 2019 年发表的 74 篇文章中，回顾并编译了相关的剂量、疗效和洗脱曲线。针对罕见和耐药细菌，确定了一线和靶向治疗方法。还阐明了由于细胞毒性过大或输送动力学不佳而不推荐使用的药物疗法。
本汇编描述了 32 种抗生素和 3 种抗真菌药物，这些抗生素和抗真菌药物成功地治疗了骨科手术相关感染，包括对多种顽固性和多药耐药物种的感染。为每种给药方法提供了载药与抗菌剂的最佳比例。在有可用数据时，描述了各种抗生素的洗脱和疗效曲线。
讨论/结论：这些建议为使用水泥和珠粒中的抗生素治疗骨科硬件相关感染提供了最新和最全面的实践指南。随着细菌产生抗生素耐药性的倾向不断发展，这些建议也在不断变化。建议与内科、传染病和/或药理学团队合作，制定抗生素洗脱植入物的机构方案，并进行密切的共同管理，以确保疗效和患者安全。
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