1
|
Onorato F, Masoni V, Gagliardi L, Comba LC, Rivera F. What to Know about Antimicrobial Coatings in Arthroplasty: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:574. [PMID: 38674220 PMCID: PMC11052078 DOI: 10.3390/medicina60040574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Periprosthetic joint infections (PJIs) are one of the most worrying complications orthopedic surgeons could face; thus, methods to prevent them are evolving. Apart from systemic antibiotics, targeted strategies such as local antimicrobial coatings applied to prosthetics have been introduced. This narrative review aims to provide an overview of the main antimicrobial coatings available in arthroplasty orthopedic surgery practice. The search was performed on the PubMed, Web of Science, SCOPUS, and EMBASE databases, focusing on antimicrobial-coated devices used in clinical practice in the arthroplasty world. While silver technology has been widely adopted in the prosthetic oncological field with favorable outcomes, recently, silver associated with hydroxyapatite for cementless fixation, antibiotic-loaded hydrogel coatings, and iodine coatings have all been employed with promising protective results against PJIs. However, challenges persist, with each material having strengths and weaknesses under investigation. Therefore, this narrative review emphasizes that further clinical studies are needed to understand whether antimicrobial coatings can truly revolutionize the field of PJIs.
Collapse
Affiliation(s)
- Francesco Onorato
- Department of Orthopedics and Traumatology, University of Turin, Via Zuretti, 29, 10126 Turin, Italy; (F.O.); (V.M.); (L.G.)
| | - Virginia Masoni
- Department of Orthopedics and Traumatology, University of Turin, Via Zuretti, 29, 10126 Turin, Italy; (F.O.); (V.M.); (L.G.)
| | - Luca Gagliardi
- Department of Orthopedics and Traumatology, University of Turin, Via Zuretti, 29, 10126 Turin, Italy; (F.O.); (V.M.); (L.G.)
- Department of Orthopedics and Traumatology, Ospedale SS Annunziata, ASL CN1, Via Ospedali, 9, 12038 Savigliano, Italy;
| | - Luca Costanzo Comba
- Department of Orthopedics and Traumatology, Ospedale SS Annunziata, ASL CN1, Via Ospedali, 9, 12038 Savigliano, Italy;
| | - Fabrizio Rivera
- Department of Orthopedics and Traumatology, Ospedale SS Annunziata, ASL CN1, Via Ospedali, 9, 12038 Savigliano, Italy;
| |
Collapse
|
2
|
Drakou A, Sioutis S, Zafeiris I, Soucacos F, Karampikas V, Tsatsaragkou A, Mavrogenis AF, Koulalis D. Sucralfate Prevents Pin Site Infections of External Fixators in Open Tibia Fractures. J Long Term Eff Med Implants 2024; 34:1-7. [PMID: 37938199 DOI: 10.1615/jlongtermeffmedimplants.2023044966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pin site infections are the main complication of external fixators. The most common pathogens are Staphylococcus epidermidis and Staphylococcus aureus. The incidence of pin site infections ranges from 2% to 30%. Until now, no satisfactory prevention strategy exists. Therefore, we performed this study to assess the effect of a sucralfate gel 25% applied around the pins of external fixation systems in trauma patients with open tibia fractures. We prospectively studied two groups of patients with open tibia fractures treated with external fixators. In group A patients, pin site care was performed with the use of normal saline and plain dressings once a day. In group B patients, pin site care was performed with the use of sucralfate gel 25%. The incidence of pin site infections was 33.33% for patients of group A and 16.67% for patients of group B. Patients of group B showed significantly lower rate of pin site infections compared to patients of group A (p-value = 0.032). No patient experienced any complications related to the local application of the drug. Sucralfate significantly prevents pin site infections of external fixators in open tibia fractures. Therefore, it can be used as a preventive antimicrobial agent for pin site infections in patients with external fixators.
Collapse
Affiliation(s)
| | - Spyridon Sioutis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, University Medical School, Athens, Greece
| | - Ioannis Zafeiris
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Fotini Soucacos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasileios Karampikas
- First Department of Orthopedics, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece
| | | | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Dimitrios Koulalis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| |
Collapse
|
3
|
Osawa S, Oe K, Fukui T, Matsumoto T, Matsushita T, Kuroda R, Tsuchiya H, Niikura T. Infected Gustilo IIIB open knee joint fracture treated with an antimicrobial iodine-supported megaprosthesis: A case report. J Orthop Sci 2023; 28:495-498. [PMID: 32798111 DOI: 10.1016/j.jos.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Shin Osawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| |
Collapse
|
4
|
Hydroxyapatite-coated compared with stainless steel external fixation pins did not show impact in the rate of pin track infection: a multicenter prospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1163-1169. [PMID: 36773051 PMCID: PMC9918829 DOI: 10.1007/s00264-023-05717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/01/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Infection at the pin site remains the most common complication of external fixators (EFs). It is known that hydroxyapatite (HA)-coated pins increase bone adhesion and may lead to reduced rates of reported infections. The present study compares the rates of pin track infection associated with stainless steel and HA-coated pins. METHODS This is a prospective, multicenter, nonrandomized, comparative intervention study among patients undergoing surgical treatment with EFs of any type between April 2018 and October 2021. Patients were followed up until the removal of the EF, or the end of the study period (ranging from 1 to 27.6 months). The definition of pin track infection was based upon the Maz-Oxford-Nuffield (MON) pin infection grading system. RESULTS Overall, 132 patients undergoing external fixation surgery were included. Of these, 94 (71.2%) were male, with a mean age of 36.9 years (SD ± 18.9). Infection of any type (score > 1) was observed in 63 (47.7%) patients. Coated and uncoated-pin track-infection occurred in 45.7% and 48.5% of patients, respectively (P= 0.0887). The probability of developing infection (defined as a score ≥ 2) adjusted for comorbidities and follow-up time was not statistically higher among those who received uncoated pins compared to those who received pins coated with HA (odds ratio (OR) = 1.56, 95% confidence interval (95% CI): 0.67-3.67, p <0.05). CONCLUSION In the present study, the external fixator pin infection rates were similar when using HA coating and standard steel pins.
Collapse
|
5
|
Li H, Wang D, Zhang W, Xu G, Xu C, Liu W, Li J. Potential side effects of antibacterial coatings in orthopaedic implants: A systematic review of clinical studies. Front Bioeng Biotechnol 2023; 11:1111386. [PMID: 36845182 PMCID: PMC9947536 DOI: 10.3389/fbioe.2023.1111386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
Objective: The systematic review aimed to determine the potential side effects of antibacterial coatings in orthopaedic implants. Methods: Publications were searched in the databases of Embase, PubMed, Web of Science and Cochrane Library using predetermined keywords up to 31 October 2022. Clinical studies reporting side effects of the surface or coating materials were included. Results: A total of 23 studies (20 cohort studies and three case reports) reporting the concerns about the side effects of antibacterial coatings were identified. Three types of coating materials, silver, iodine and gentamicin were included. All of studies raised the concerns regarding safety of antibacterial coatings, and the occurrence of adverse events was observed in seven studies. The main side effect of silver coatings was the development of argyria. For iodine coatings, only one anaphylactic case was reported as an adverse event. No systemic or other general side effects were reported for gentamicin. Conclusion: Clinical studies on the side effects of antibacterial coatings were limited. Based on the available outcomes, the most reported side effects of antibacterial coatings in clinical use were argyria with silver coatings. However, researchers should always pay attention to the potential side effects of antibacterial materials, such as systematic or local toxicity and allergy.
Collapse
Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,School of Medicine, Nankai University, Tianjin, China
| | - Gaoxiang Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,*Correspondence: Cheng Xu, ; Wanheng Liu, ; Jiantao Li,
| | - Wanheng Liu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,*Correspondence: Cheng Xu, ; Wanheng Liu, ; Jiantao Li,
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,*Correspondence: Cheng Xu, ; Wanheng Liu, ; Jiantao Li,
| |
Collapse
|
6
|
Jacquart S, Girod-Fullana S, Brouillet F, Pigasse C, Siadous R, Fatnassi M, Grimoud J, Rey C, Roques C, Combes C. Injectable bone cement containing carboxymethyl cellulose microparticles as a silver delivery system able to reduce implant-associated infection risk. Acta Biomater 2022; 145:342-357. [PMID: 35429671 DOI: 10.1016/j.actbio.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
Abstract
In the challenging quest for a solution to reduce the risk of implant-associated infections in bone substitution surgery, the use of silver ions is promising regarding its broad spectrum on planktonic, sessile as well as multiresistant bacteria. In view of controlling its delivery in situ at the desired dose, we investigated its encapsulation in carboxymethyl cellulose (CMC) microparticles by spray-drying and included the latter in the formulation of a self-setting calcium phosphate bone cement. We implemented an original step-by-step methodology starting from the in vitro study of the antibacterial properties and cytotoxicity of two silver salts of different solubility in aqueous medium and then in the cement to determine the range of silver loading able to confer anti-biofilm and non-cytotoxic properties to the biomaterial. A dose-dependent efficiency of silver was demonstrated on the main species involved in bone-implant infection (S. aureus and S. epidermidis). Loading silver in microspheres instead of loading it directly inside the cement permitted to avoid undesired silver-cement interactions during setting and led to a faster release of silver, i.e. to a higher dose released within the first days combining anti-biofilm activity and preserved cytocompatibility. In addition, a combined interest of the introduction of about 10% (w/w) silver-loaded CMC microspheres in the cement formulation was demonstrated leading to a fully injectable and highly porous (77%) cement, showing a compressive strength analogous to cancellous bone. This injectable silver-loaded biomimetic composite cement formulation constitutes a versatile bone substitute material with tunable drug delivery properties, able to fight against bone implant associated infection. STATEMENT OF SIGNIFICANCE: This study is based on two innovative scientific aspects regarding the literature: i) Choice of silver ions as antibacterial agent combined with their way of incorporation: Carboxymethylcellulose has never been tested into bone cement to control its drug loading and release properties. ii) Methodology to formulate an antibacterial and injectable bone cement: original and multidisciplinary step-by-step methodology to first define, through (micro)biological tests on two silver salts with different solubilities, the targeted range of silver dose to include in carboxymethylcellulose microspheres and, then optimization of silver-loaded microparticles processing to fulfill requirements (encapsulation efficiency and size). The obtained fully injectable composite controls the early delivery of active dose of silver (from 3 h and over 2 weeks) able to fight against bone implant-associated infections.
Collapse
Affiliation(s)
- Sylvaine Jacquart
- CIRIMAT, Université de Toulouse, CNRS, Toulouse INP - ENSIACET, Toulouse, France
| | - Sophie Girod-Fullana
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 - Paul Sabatier, Toulouse, France
| | - Fabien Brouillet
- CIRIMAT, Université de Toulouse, CNRS, Université Toulouse 3 - Paul Sabatier, Toulouse, France
| | - Christel Pigasse
- Laboratoire de Génie Chimique, Université de Toulouse, CNRS, INPT, Université Toulouse 3 - Paul Sabatier, Toulouse, France
| | - Robin Siadous
- Université de Bordeaux, Inserm U1026 Bioingénierie Tissulaire (BioTis), Bordeaux, France
| | - Mohamed Fatnassi
- CIRIMAT, Université de Toulouse, CNRS, Toulouse INP - ENSIACET, Toulouse, France
| | - Julien Grimoud
- Laboratoire de Génie Chimique, Université de Toulouse, CNRS, INPT, Université Toulouse 3 - Paul Sabatier, Toulouse, France
| | - Christian Rey
- CIRIMAT, Université de Toulouse, CNRS, Toulouse INP - ENSIACET, Toulouse, France
| | - Christine Roques
- Laboratoire de Génie Chimique, Université de Toulouse, CNRS, INPT, Université Toulouse 3 - Paul Sabatier, Toulouse, France; CHU Toulouse, Hôpital Purpan, Service de Bactériologie-Hygiène, Toulouse, France
| | - Christèle Combes
- CIRIMAT, Université de Toulouse, CNRS, Toulouse INP - ENSIACET, Toulouse, France.
| |
Collapse
|
7
|
Liang X, Zhang S, Gadd GM, McGrath J, Rooney DW, Zhao Q. Fungal-derived Selenium Nanoparticles and Their Potential Applications in Electroless Silver Coatings for Preventing Pin-tract Infections. Regen Biomater 2022; 9:rbac013. [PMID: 35449828 PMCID: PMC9017370 DOI: 10.1093/rb/rbac013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 11/15/2022] Open
Abstract
Pin-tract infections (PTIs) are a common complication of external fixation of fractures and current strategies for preventing PTIs have proven to be ineffective. Recent advances show that the use of anti-infection coatings with local antibacterial activity may solve this problem. Selenium has been considered as a promising anti-infection agent owing to its antibacterial and antibiofilm activities. In this study, selenium nanoparticles (SeNPs) were synthesized via a cost-effective fungi-mediated biorecovery approach and demonstrated excellent stability and homogeneity. To investigate their anti-infection potential, the SeNPs were doped in silver coatings through an electroless plating process and the silver–selenium (Ag–Se) coatings were tested for antibacterial and antibiofilm properties against Staphylococcus aureus F1557 and Escherichia coli WT F1693 as well as corrosion resistance in simulated body fluid. It was found that the Ag–Se coating significantly inhibited S.aureus growth and biofilm formation on the surface, reducing 81.2% and 59.7% of viable bacterial adhesion when compared with Ag and Ag–PTFE-coated surfaces after 3 days. The Ag–Se coating also exhibited improved corrosion resistance compared with the Ag coating, leading to a controlled release of Ag+, which in turn reduced the risk of cytotoxicity against hFOBs. These results suggest that the fungal-derived SeNPs may have potential in use as implant coatings to prevent PTIs. ![]()
Collapse
Affiliation(s)
- Xinjin Liang
- The Bryden Centre, School of Chemical and Chemistry Engineering, Queen’s University Belfast, Belfast, BT7 1NN, UK
- Geomicrobiology Group, School of Life Sciences, University of Dundee, Dundee, DD1 5EH, UK
| | - Shuai Zhang
- School of Pharmacy, Queen’s University Belfast, BT9 7BL, Belfast, UK
| | - Geoffrey Michael Gadd
- Geomicrobiology Group, School of Life Sciences, University of Dundee, Dundee, DD1 5EH, UK
- State Key Laboratory of Heavy Oil Processing, Beijing Key Laboratory of Oil and Gas Pollution Control, College of Chemical Engineering and Environment, China University of Petroleum, 18 Fuxue Road, Changping District, Beijing 102249, China
| | - John McGrath
- School of Biological Sciences, Queen's University Belfast, Belfast, BT9 5DL, United Kingdom
| | - David W Rooney
- School of Chemistry and Chemical Engineering, Queen’s University Belfast, Belfast, BT9 5AG, Northern Ireland, UK
| | - Qi Zhao
- School of Science and Engineering, University of Dundee, Dundee, DD1 4HN, UK
| |
Collapse
|
8
|
Ferreira A, Fernandes MM, Souza ALR, Correa MA, Lanceros-Mendez S, Vaz F. Flexible TiCu x Thin Films with Dual Antimicrobial and Piezoresistive Characteristics. ACS APPLIED BIO MATERIALS 2022; 5:1267-1272. [PMID: 35168328 DOI: 10.1021/acsabm.1c01273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The eradication of microorganisms from high traffic surfaces to prevent either viral or bacterial infections represents an urgent need, mainly in the scope of the present pandemic scenario. In this context, this work explores the dual functionality of titanium-copper thin films as pressure elements with antimicrobial properties, aiming for the implementation of touch and sensing capabilities in high traffic surfaces. Copper was employed as the antibacterial agent within a titanium matrix. The film's geometry and deposition parameters were varied in order to optimize antimicrobial and piezoresistive response. A considerable antimicrobial response has been obtained, increasing the copper amount (from 23 to 63 at. %) in the titanium matrix, leading to an outstanding 8 log10 CFU bacterial reduction in the case of Escherichia coli. Moreover, for the same amount of copper, the piezoresistive sensibility of the thin films increases up to a maximum gauge factor of 5.18 ± 0.09, which indicates an adequate electromechanical behavior for sensing applications. Our findings demonstrate the best combined antimicrobial and piezoresistive characteristics for the films with a Cu content of 63 at. %, indicating a potential use of these films for electromechanical sensor applications.
Collapse
Affiliation(s)
- Armando Ferreira
- Center of Physics, University of Minho, 4710-057 Braga, Portugal
| | - Margarida M Fernandes
- Center of Physics, University of Minho, 4710-057 Braga, Portugal.,Center of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal
| | - Arthur L R Souza
- Physics Department, Federal University of Rio Grande do Norte, 59078-900 Natal, RN, Brazil
| | - Marcio A Correa
- Center of Physics, University of Minho, 4710-057 Braga, Portugal.,Physics Department, Federal University of Rio Grande do Norte, 59078-900 Natal, RN, Brazil
| | - Senentxu Lanceros-Mendez
- BCMaterials, Basque Center for Materials, Applications and Nanostructures, UPV/EHU Science Park, 48940 Leioa, Spain.,Ikerbasque, Basque Foundation for Science, E-48009 Bilbao, Spain
| | - Filipe Vaz
- Center of Physics, University of Minho, 4710-057 Braga, Portugal
| |
Collapse
|
9
|
Jennison T, Arveladze S, Moriarty F. The influence of pin material and coatings on the incidence of pin site infection after external fixation. JOURNAL OF LIMB LENGTHENING & RECONSTRUCTION 2022. [DOI: 10.4103/jllr.jllr_35_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
10
|
Iobst C, Bafor A, Gehred A, Chimutengwende-Gordon M. Future directions in the prevention of pin-site infection: A scoping review. JOURNAL OF LIMB LENGTHENING & RECONSTRUCTION 2022. [DOI: 10.4103/jllr.jllr_2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
|
11
|
Shi Y, Zhu ML, Wu Q, Huang Y, Xu XL, Chen W. The Potential of Drug Delivery Nanosystems for Sepsis Treatment. J Inflamm Res 2021; 14:7065-7077. [PMID: 34984019 PMCID: PMC8702780 DOI: 10.2147/jir.s339113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/08/2021] [Indexed: 12/19/2022] Open
Abstract
Sepsis is a major immune response disorder caused by infection, with very high incidence and mortality rates. In the clinic, sepsis and its complications are mainly controlled and treated with antibiotics, anti-inflammatory, and antioxidant drugs. However, these treatments have some shortcomings, such as rapid metabolism and severe side effects. The emergence of drug delivery nanosystems can significantly improve tissue permeability, prolong drugs' circulation time, and reduce side effects. In this paper, we reviewed recent drug delivery nanosystems designed for sepsis treatment based on their mechanisms (anti-bacterial, anti-inflammatory, and antioxidant). Although great progress has been made recently, clinical practice transformation is still very difficult. Therefore, we also discussed key obstacles, including tissue distribution, overcoming bacterial resistance, and single treatment modes. Finally, a rigorous optimization of drug delivery nanosystems is expected to present great potential for sepsis therapy.
Collapse
Affiliation(s)
- Yi Shi
- ICU, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Meng-Lu Zhu
- Department of Pharmacy, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, 310006, People’s Republic of China
| | - Qian Wu
- ICU, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Yi Huang
- ICU, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Xiao-Ling Xu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, 310004, People’s Republic of China
| | - Wei Chen
- ICU, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| |
Collapse
|
12
|
Tran HA, Tran PA. In Situ Coatings of Silver Nanoparticles for Biofilm Treatment in Implant-Retention Surgeries: Antimicrobial Activities in Monoculture and Coculture. ACS APPLIED MATERIALS & INTERFACES 2021; 13:41435-41444. [PMID: 34448395 DOI: 10.1021/acsami.1c08239] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Bacterial biofilms are indicated in most medical device-associated infections. Treating these biofilms is challenging yet critically important for applications such as in device-retention surgeries, which can have reinfection rates of up to 80%. This in vitro study centered around our new method of treating biofilm and preventing reinfection. Ionic silver (Ag, in the form of silver nitrate) combined with dopamine and a biofilm-lysing enzyme (α-amylase) were applied to model 4-day-old Staphylococcus aureus biofilms on titanium substrates to degrade the extracellular matrix of the biofilm and kill the biofilm bacteria. In this process, the oxidative self-polymerization of dopamine converted Ag ions into Ag nanoparticles that, together with the resultant self-adhering polydopamine (PDA), formed coatings that strongly bound to the treated substrates. Surprisingly, although these Ag/PDA coatings significantly reduced S. aureus growth in standard bacterial monoculture, they showed much lower antimicrobial activity in coculture of the bacteria and osteoblastic MC3T3-E1 cells in which the bacteria were also found attached to the osteoblasts. This S. aureus- osteoblast interaction was also linked to bacterial survival against gentamicin treatment observed in coculture. Our study thus provided clear evidence suggesting that bacteria's interactions with tissue cells surrounding implants may significantly contribute to their resistance to antimicrobial treatment.
Collapse
Affiliation(s)
- Hien A Tran
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), 2 George Street, Brisbane, Queensland 4000, Australia
- Interface Science and Materials Engineering Group, School of Mechanical, Medical and Process Engineering, QUT, 2 George Street, Brisbane, Queensland 4000, Australia
| | - Phong A Tran
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), 2 George Street, Brisbane, Queensland 4000, Australia
- Interface Science and Materials Engineering Group, School of Mechanical, Medical and Process Engineering, QUT, 2 George Street, Brisbane, Queensland 4000, Australia
| |
Collapse
|
13
|
Investigation of the Long-Term Antibacterial Properties of Titanium by Two-Step Micro-Arc Oxidation Treatment. COATINGS 2021. [DOI: 10.3390/coatings11070798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recently, biofilm formation caused by bacterial adhesion and colonization has been recognized as the major cause of failure in orthopedic and dental implant surgeries. In this study, a customized micro-arc oxidation (MAO) treatment technique was developed to obtain desirable antibacterial properties on Ti surfaces. The two-step MAO treatment was applied in the fabrication of specimens with Ag and with/without Zn in their surface oxide layer. In order to simulate practical usage, surface analyses and immersion tests were performed to evaluate the incorporation of Ag and Zn into the resulting oxide layer and ion release behavior, respectively. Additionally, the antibacterial properties of the specimens after long-term immersion in physiological saline were evaluated using Gram-negative facultative anaerobic bacteria. The MAO-treated specimens containing Ag and Zn exhibited excellent antibacterial properties against Escherichia coli, which were sustained even after 6 months of immersion in physiological saline to simulate practical usage. Moreover, the Ag ions released from the surface oxide indicate the antibacterial properties of the specimen in the early stage, while the release of the corrosion products of Zn demonstrates its antibacterial properties in the later stage.
Collapse
|
14
|
Ferguson D, Harwood P, Allgar V, Roy A, Foster P, Taylor M, Moulder E, Sharma H. The PINS Trial: a prospective randomized clinical trial comparing a traditional versus an emollient skincare regimen for the care of pin-sites in patients with circular frames. Bone Joint J 2021; 103-B:279-285. [PMID: 33517738 DOI: 10.1302/0301-620x.103b2.bjj-2020-0680.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Pin-site infection remains a significant problem for patients treated by external fixation. A randomized trial was undertaken to compare the weekly use of alcoholic chlorhexidine (CHX) for pin-site care with an emollient skin preparation in patients with a tibial fracture treated with a circular frame. METHODS Patients were randomized to use either 0.5% CHX or Dermol (DML) 500 emollient pin-site care. A skin biopsy was taken from the tibia during surgery to measure the dermal and epidermal thickness and capillary, macrophage, and T-cell counts per high-powered field. The pH and hydration of the skin were measured preoperatively, at follow-up, and if pin-site infection occurred. Pin-site infection was defined using a validated clinical system. RESULTS Out of 116 patients who were enrolled in the study, 23 patients (40%) in the CHX group and 26 (44%) in the DML group had at least one bad or ugly pin-site infection. This difference was not statistically significant (p = 0.71). There was no significant relationship between pH or hydration of the skin and pin-site infection. The epidermal thickness was found to be significantly greater in patients who had a pin-site infection compared with those who did not (p = 0.01). Skin irritation requiring a change of treatment occurred in four patients (7%) using CHX, and none using DML. CONCLUSION We found no significant difference in the incidence of pin-site infection between the CHX and DML treatment groups. Dermol appeared to offer a small but significant advantage in terms of tolerability. We did not find a significant association between patient or treatment related factors and pin-site infection. It is therefore difficult to make specific recommendations based upon these results. The use of either cleaning agent appears to be appropriate. Cite this article: Bone Joint J 2021;103-B(2):279-285.
Collapse
Affiliation(s)
- David Ferguson
- Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, UK
| | - Paul Harwood
- Limb Reconstruction Unit, Leeds General Infirmary, Leeds, UK
| | - Victoria Allgar
- Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Anu Roy
- United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Patrick Foster
- Limb Reconstruction Unit, Leeds General Infirmary, Leeds, UK
| | - Martin Taylor
- Limb Reconstruction Unit, Leeds General Infirmary, Leeds, UK
| | | | - Hemant Sharma
- Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| |
Collapse
|
15
|
Papafilippou L, Claxton A, Dark P, Kostarelos K, Hadjidemetriou M. Nanotools for Sepsis Diagnosis and Treatment. Adv Healthc Mater 2021; 10:e2001378. [PMID: 33236524 DOI: 10.1002/adhm.202001378] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/07/2020] [Indexed: 12/12/2022]
Abstract
Sepsis is one of the leading causes of death worldwide with high mortality rates and a pathological complexity hindering early and accurate diagnosis. Today, laboratory culture tests are the epitome of pathogen recognition in sepsis. However, their consistency remains an issue of controversy with false negative results often observed. Clinically used blood markers, C reactive protein (CRP) and procalcitonin (PCT) are indicators of an acute-phase response and thus lack specificity, offering limited diagnostic efficacy. In addition to poor diagnosis, inefficient drug delivery and the increasing prevalence of antibiotic-resistant microorganisms constitute significant barriers in antibiotic stewardship and impede effective therapy. These challenges have prompted the exploration for alternative strategies that pursue accurate diagnosis and effective treatment. Nanomaterials are examined for both diagnostic and therapeutic purposes in sepsis. The nanoparticle (NP)-enabled capture of sepsis causative agents and/or sepsis biomarkers in biofluids can revolutionize sepsis diagnosis. From the therapeutic point of view, currently existing nanoscale drug delivery systems have proven to be excellent allies in targeted therapy, while many other nanotherapeutic applications are envisioned. Herein, the most relevant applications of nanomedicine for the diagnosis, prognosis, and treatment of sepsis is reviewed, providing a critical assessment of their potentiality for clinical translation.
Collapse
Affiliation(s)
- Lana Papafilippou
- Nanomedicine Lab Faculty of Biology Medicine and Health AV Hill Building The University of Manchester Manchester M13 9PT UK
| | - Andrew Claxton
- Department of Critical Care Salford Royal Foundation Trust Stott Lane Salford M6 8HD UK
| | - Paul Dark
- Manchester NIHR Biomedical Research Centre Division of Infection Immunity and Respiratory Medicine University of Manchester Manchester M13 9PT UK
| | - Kostas Kostarelos
- Nanomedicine Lab Faculty of Biology Medicine and Health AV Hill Building The University of Manchester Manchester M13 9PT UK
- Catalan Institute of Nanoscience and Nanotechnology (ICN2) Campus UAB Bellaterra Barcelona 08193 Spain
| | - Marilena Hadjidemetriou
- Nanomedicine Lab Faculty of Biology Medicine and Health AV Hill Building The University of Manchester Manchester M13 9PT UK
| |
Collapse
|
16
|
Shimabukuro M, Tsutsumi H, Tsutsumi Y, Manaka T, Chen P, Ashida M, Ishikawa K, Katayama H, Hanawa T. Enhancement of antibacterial property of titanium by two-step micro arc oxidation treatment. Dent Mater J 2020; 40:592-598. [PMID: 33361664 DOI: 10.4012/dmj.2020-188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A customized micro arc oxidation (MAO) treatment technique was developed to obtain desirable antibacterial properties on titanium surfaces. The two-step MAO treatment was applied to fabricate a specimen containing both Ag and Zn in its surface oxide layer. Surface analyses and metal-ion release tests were performed to evaluate the presence of Ag and Zn and the ion release behavior for simulating practical usage, respectively. Additionally, the antibacterial properties of the specimens were also evaluated using gram-negative facultative anaerobic bacteria. The MAO-treated specimens containing both Ag and Zn showed excellent antibacterial properties against Escherichia coli, and the properties were sustained even after 28 days of immersion in physiological saline to simulate the living environment.
Collapse
Affiliation(s)
- Masaya Shimabukuro
- Department of Biomaterials, Faculty of Dental Science, Kyushu University.,Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Harumi Tsutsumi
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU)
| | - Yusuke Tsutsumi
- Research Center for Structural Materials, National Institute for Materials Science (NIMS)
| | - Tomoyo Manaka
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Peng Chen
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU)
| | - Maki Ashida
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU)
| | - Kunio Ishikawa
- Department of Biomaterials, Faculty of Dental Science, Kyushu University
| | - Hideki Katayama
- Research Center for Structural Materials, National Institute for Materials Science (NIMS)
| | - Takao Hanawa
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU)
| |
Collapse
|
17
|
Betts HD, Whitehead C, Harris HH. Silver in biology and medicine: opportunities for metallomics researchers. Metallomics 2020; 13:6029133. [PMID: 33570135 DOI: 10.1093/mtomcs/mfaa001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 12/06/2020] [Indexed: 12/13/2022]
Abstract
The antibacterial properties of silver have been known for centuries and the threat of antibiotic-resistant bacteria has led to renewed focus on the noble metal. Silver is now commonly included in a range of household and medical items to imbue them with bactericidal properties. Despite this, the chemical fate of the metal in biological systems is poorly understood. Silver(I) is a soft metal with high affinity for soft donor atoms and displays much similarity to the chemistry of Cu(I). In bacteria, interaction of silver with the cell wall/membrane, DNA, and proteins and enzymes can lead to cell death. Additionally, the intracellular generation of reactive oxygen species by silver is posited to be a significant antimicrobial action. While the antibacterial action of silver is well known, bacteria found in silver mines display resistance against it through use of a protein ensemble thought to have been specifically developed for the metal, highlighting the need for judicious use. In mammals, ∼10-20% of ingested silver is retained by the body and thought to predominantly localize in the liver or kidneys. Chronic exposure can result in argyria, a condition characterized by blue staining of the skin, resulting from subdermal deposition of silver [as Ag(0)/sulfides], but more insidious side effects, such as inclusions in the brain, seizures, liver/kidney damage, and immunosuppression, have also been reported. Here, we hope to highlight the current understanding of the biological chemistry of silver and the necessity for continued study of these systems to fill existing gaps in knowledge.
Collapse
Affiliation(s)
- Harley D Betts
- Department of Chemistry, The University of Adelaide, North Terrace, SA 5005, Australia
| | - Carole Whitehead
- Department of Chemistry, The University of Adelaide, North Terrace, SA 5005, Australia
| | - Hugh H Harris
- Department of Chemistry, The University of Adelaide, North Terrace, SA 5005, Australia
| |
Collapse
|
18
|
Kriechbaumer LK, Happak W, Distelmaier K, Thalhammer G, Kaiser G, Kugler S, Tan Y, Leonhard M, Zatorska B, Presterl E, Nürnberger S. Disinfection of contaminated metal implants with an Er:YAG laser. J Orthop Res 2020; 38:2464-2473. [PMID: 32167192 PMCID: PMC7687249 DOI: 10.1002/jor.24662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Infections related to orthopedic procedures are considered particularly severe when implantation materials are used, because effective treatments for biofilm removal are lacking. In this study, the relatively new approach for infection control by using an erbium:yttrium-aluminum-garnet (Er:YAG) laser was tested. This laser vaporizes all water containing cells in a very effective, precise, and predictable manner and results in only minimal thermal damage. For preliminary testing, 42 steel plates and 42 pins were seeded with mixed cultures. First, the minimally necessary laser energy for biofilm removal was determined. Subsequently, the effectiveness of biofilm removal with the Er:YAG laser and the cleansing of the metal implants with octenidine-soaked gauze was compared. Then, we compared the effectiveness of biofilm removal on 207 steel pins from 41 patients directly after explantation. Sonication and scanning electron microscopy were used for analysis. Laser fluences exceeding 2.8 J/cm2 caused a complete extinction of all living cells by a single-laser impulse. Cleansing with octenidine-soaked gauze and irradiation with the Er:YAG laser are both thoroughly effective when applied to seeded pins. In contrast, when explanted pins with fully developed biofilms were analyzed, we found a significant advantage of the laser procedure. The Er:YAG laser offers a secure, complete, and nontoxic eradication of all kinds of pathogens from metal implants without damaging the implant and without the possible development of resistance. The precise noncontact removal of adjacent tissue is a decisive advantage over conventional disinfectants. Therefore, laser irradiation could become a valuable method in every debridement, antibiotics, and implant retention procedure.
Collapse
Affiliation(s)
- Lukas K. Kriechbaumer
- University Clinic of Orthopaedics and TraumatologyParacelsus Medical UniversitySalzburgAustria,Division of Trauma‐Surgery, Department of Orthopedics and Trauma‐SurgeryMedical University of ViennaViennaAustria
| | - Wolfgang Happak
- Division of Plastic and Reconstructive Surgery, Department of SurgeryMedical University of ViennaViennaAustria
| | - Klaus Distelmaier
- Division of Cardiology, Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Gerhild Thalhammer
- Division of Trauma‐Surgery, Department of Orthopedics and Trauma‐SurgeryMedical University of ViennaViennaAustria
| | - Georg Kaiser
- Division of Trauma‐Surgery, Department of Orthopedics and Trauma‐SurgeryMedical University of ViennaViennaAustria
| | - Sylvia Kugler
- Department of Dermatology, Division of Immunology Allergy and Infectious DiseasesMedical University of ViennaViennaAustria
| | - Yulong Tan
- Department of Otorhinolaryngology and Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Matthias Leonhard
- Department of Otorhinolaryngology and Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Beata Zatorska
- Department of Infection Control and Hospital EpidemiologyMedical University of ViennaViennaAustria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital EpidemiologyMedical University of ViennaViennaAustria
| | - Sylvia Nürnberger
- Division of Trauma‐Surgery, Department of Orthopedics and Trauma‐SurgeryMedical University of ViennaViennaAustria
| |
Collapse
|
19
|
Zhang B, Li J, He L, Huang H, Weng J. Bio-surface coated titanium scaffolds with cancellous bone-like biomimetic structure for enhanced bone tissue regeneration. Acta Biomater 2020; 114:431-448. [PMID: 32682055 DOI: 10.1016/j.actbio.2020.07.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
In view of the fact that titanium (Ti)-based implants still face the problem of loosening and failure of the implants caused by the slow biological response, the low osseointegration rate and the implant bacterial infection in clinical application, we designed a cancellous bone-like biomimetic Ti scaffold using the template accumulated by sugar spheres as a pore-forming agent. And based on a modified surface mineralization process and mussel-like adhesion mechanism, a silicon-doped calcium phosphate composite coating (Van-pBNPs/pep@pSiCaP) with Vancomycin (Van)-loaded polydopamine (pDA)-modified albumin nanoparticles (Van-pBNPs) and cell adhesion peptides (GFOGER) was constructed on the surface of Ti scaffold for mimicking the extracellular matrix (ECM) microenvironment of natural bone matrix to induce greater tissue regeneration. The in vitro study demonstrated that this porous Ti scaffold with functional bio-surface could distinctly facilitate cell early adhesion and spreading, and activate the expression of α2β1 integrin receptor on the cell membrane through promoting the formation of focal adhesions (FAs) in bone marrow stromal cells (BMSCs), thus mediating greater osteogenic cell differentiation. And it could also effectively inhibit the adhesion and growth of Staphylococcus epidermidis, exhibiting good antibacterial properties. Moreover, the Van-pBNPs/pep@pSiCaP-Ti scaffolds showed enhanced in vivo bone-forming ability due to the contributions of bioactive chemical components and the natural cancellous bone-like macrostructure. This work offers a promising structural and functional bio-inspired strategy for designing metal implants with desirable ability of osteoinduction synergistically with antibacterial efficacy for promoting bone regeneration and infection prevention simultaneously. STATEMENT OF SIGNIFICANCE: This manuscript describes a new method for making porous Ti scaffolds with a natural cancellous bone-like structure. Besides, a functional bio-surface was constructed on the bionic structure, mimicking some of the functions of the collagen-rich organic matrix and inorganic CaP nanocrystallites of native ECM of bone in chemical components and biological activities. This interconnected inter-pore opening structure encouraged the migration of cells among open macro-pores within the scaffold. In addition, the functionalized surface not only improved early cell adhesion, spreading, stimulated greater osteogenic differentiation of bone-forming cells, but also endowed the scaffold with excellent antibacterial effect. The biomimetic metal implant with multiple biomedical functions designed in this study has a great clinical application potential. This study represents a feasible method for the preparation of biomimetic structure of metal implants and the improvement of their surface biological activity.
Collapse
Affiliation(s)
- Bingjun Zhang
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, 610031, P. R. China; State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
| | - Jia Li
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, 610031, P. R. China
| | - Lei He
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, 610031, P. R. China
| | - Hao Huang
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, 610031, P. R. China
| | - Jie Weng
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, 610031, P. R. China.
| |
Collapse
|
20
|
Toxic Effect of Vancomycin on Viability and Functionality of Different Cells Involved in Tissue Regeneration. Antibiotics (Basel) 2020; 9:antibiotics9050238. [PMID: 32397094 PMCID: PMC7277215 DOI: 10.3390/antibiotics9050238] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 01/10/2023] Open
Abstract
To prevent infections local delivery of antibiotics is a useful tool. Especially in bone fractures, vancomycin impregnated bone cements are often used allowing high concentrations of antibiotics at the infection side without high serum concentrations. However, besides potential pathogens, cells involved in tissue regeneration may also be affected by the drug. We investigated the effect of vancomycin on the viability and functionality on osteoblasts, endothelial cells, fibroblasts and skeletal muscle cells. Our results show that the viability of all cells analyzed was reduced by vancomycin and that the observed effects were time and concentration dependent. The most pronounced toxic effect was detected on day three when even the lowest concentration of 0.01 mg/ml led to a significant decrease in proliferation compared to control. Functionality assays of osteoblasts and skeletal muscle cells revealed a sensitive reaction of the cells to the drug, indicating that vancomycin is toxic to these cells during the process of differentiation. These data suggest that the vancomycin administration is critical for cell survival and function. Therefore, the concentration of administered antibiotics needs to be carefully evaluated to find a balance between defense against pathogens and functionality of host cells and tissues.
Collapse
|
21
|
Foster AL, Moriarty TF, Trampuz A, Jaiprakash A, Burch MA, Crawford R, Paterson DL, Metsemakers WJ, Schuetz M, Richards RG. Fracture-related infection: current methods for prevention and treatment. Expert Rev Anti Infect Ther 2020; 18:307-321. [DOI: 10.1080/14787210.2020.1729740] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew L Foster
- AO Research Institute Davos, Davos, Switzerland
- Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, Australia
- Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | | | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Septic Unit Charité-Universitätsmedizin, Berlin, Germany
| | - Anjali Jaiprakash
- Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, Australia
| | | | - Ross Crawford
- Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, Australia
| | - David L Paterson
- University of Queensland Centre of Clinical Research (UQCCR), Brisbane, Australia
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Belgium
| | - Michael Schuetz
- Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, Australia
- Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | | |
Collapse
|
22
|
Abstract
Fracture-related infection (FRI) remains a challenging complication that imposes a heavy burden on orthopaedic trauma patients. The surgical management eradicates the local infectious focus and if necessary facilitates bone healing. Treatment success is associated with debridement of all dead and poorly vascularized tissue. However, debridement is often associated with the formation of a dead space, which provides an ideal environment for bacteria and is a potential site for recurrent infection. Dead space management is therefore of critical importance. For this reason, the use of locally delivered antimicrobials has gained attention not only for local antimicrobial activity but also for dead space management. Local antimicrobial therapy has been widely studied in periprosthetic joint infection, without addressing the specific problems of FRI. Furthermore, the literature presents a wide array of methods and guidelines with respect to the use of local antimicrobials. The present review describes the scientific evidence related to dead space management with a focus on the currently available local antimicrobial strategies in the management of FRI. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
23
|
Shimabukuro M, Tsutsumi Y, Yamada R, Ashida M, Chen P, Doi H, Nozaki K, Nagai A, Hanawa T. Investigation of Realizing Both Antibacterial Property and Osteogenic Cell Compatibility on Titanium Surface by Simple Electrochemical Treatment. ACS Biomater Sci Eng 2019; 5:5623-5630. [PMID: 33405692 DOI: 10.1021/acsbiomaterials.8b01058] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recently, the problem of infection on implanted devices caused by the formation of biofilms has been recognized. Surface treatment to prevent the initial stages of bacterial adhesion and subsequent bacterial growth is the only possible solution against such infection. In this study, simple electrochemical treatment was used for introducing silver, an antibiotic agent, on the titanium surface. A porous oxide layer containing small amounts of silver was formed on the metal of the substrate. This was done by microarc oxidation using the electrolyte with silver nitrate. The porous oxide layer was almost amorphous with a small fraction of anatase phase. The samples prepared using the electrolyte containing 0.04 mM or a higher concentration of silver nitrate showed an excellent antibacterial effect against both E. coli and S. aureus. However, the proliferation of osteoblast-like cells in the samples was not affected when a concentration of 0.5 mM or lower was used. Moreover, samples containing silver showed no harmful effects on the process of bone differentiation. Furthermore, the calcification process of the cells on the samples treated with and without silver were more promoted than that on untreated Ti. Thus, we found that it is possible to use this optimum concentration of silver to realize the conflicting biofunctions: its antibacterial property and osteogenic cell compatibility.
Collapse
Affiliation(s)
- Masaya Shimabukuro
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Yusuke Tsutsumi
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Chiyoda, Tokyo, Japan.,Graduate School of Engineering, The University of Tokyo, Bunyko, Tokyo, Japan
| | - Risa Yamada
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Maki Ashida
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Chiyoda, Tokyo, Japan
| | - Peng Chen
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Chiyoda, Tokyo, Japan
| | - Hisashi Doi
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Chiyoda, Tokyo, Japan
| | - Kosuke Nozaki
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Chiyoda, Tokyo, Japan
| | - Akiko Nagai
- Department of Anatomy, School of Dentistry, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Takao Hanawa
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Chiyoda, Tokyo, Japan
| |
Collapse
|
24
|
Surface Characterization and Copper Release of a-C:H:Cu Coatings for Medical Applications. COATINGS 2019. [DOI: 10.3390/coatings9020119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper focuses on the surface properties of a-C:H:Cu composite coatings for medical devices and how the release of Cu2+ ions from such coatings can be controlled. The released Cu ions have the potential to act as a bactericidal agent and inhibit bacterial colonization. A PVD–PECVD hybrid process was used to deposit a-C:H:Cu composite coatings onto Ti6Al4V substrates. We examine the layer surface properties using atomic force microscopy and static contact angle measurements. An increasing surface roughness and increasing contact angle of Ringer’s solution was measured with increasing copper mole fraction (XCu) in the coatings. The contact angle decreased when a supplementary bias voltage of −50 V was used during the a-C:H:Cu deposition. These findings are in line with earlier published results regarding these types of coatings. The release of Cu2+ ions from a-C:H:Cu coatings in Ringer’s solution was measured by anodic stripping voltammetry. Different layer structures were examined to control the time-resolved Cu release. It was found that the Cu release depends on the overall XCu in the a-C:H:Cu coatings and that an additional a-C:H barrier layer on top of the a-C:H:Cu layer effectively delays the release of Cu ions.
Collapse
|
25
|
Shao J, Wang B, Bartels CJM, Bronkhorst EM, Jansen JA, Walboomers XF, Yang F. Chitosan-based sleeves loaded with silver and chlorhexidine in a percutaneous rabbit tibia model with a repeated bacterial challenge. Acta Biomater 2018; 82:102-110. [PMID: 30342284 DOI: 10.1016/j.actbio.2018.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 11/27/2022]
Abstract
Various strategies have been explored to prevent pin tract infections (PTI), including the use of antibacterial sleeves. However, an ideal animal model to evaluate the efficacy of antibacterial strategies is still lacking. This study aimed to construct an animal model with a consistent induction of infection after bacterial challenge. Further, the efficacy of silver and chlorhexidine loaded chitosan sleeves was evaluated to prevent PTI around a percutaneous implant. Titanium pins wrapped with sleeves were implanted in anterior lateral rabbit tibia. After 2 weeks, Staphylococcus aureus suspensions (1 × 106 CFU) were injected weekly to the exit site, and the clinical infection status was recorded. After 6 weeks, all rabbits were euthanized to evaluate the bacterial colonization microbiologically and histomorphometrically. Results showed that the implant screw bilaterally penetrated the tibia and kept the implant stable. A rod length of twice the thickness of the soft-tissue layer was necessary to maintain the percutaneous penetration of the implants. A 100% infection rate was obtained by the bacterial inoculation. Silver loaded sleeves reduced significantly the bacterial density and reduced the inflammatory symptoms of the percutaneous pin tract. However, the addition of chlorhexidine to the sleeves had no added value in terms of further reduction of bacteria and inflammation. In conclusion, a consistent animal model was designed to evaluate strategies to prevent PTI. In addition, the use of silver loaded chitosan sleeves can be pursued for further (pre-)clinical exploration for the prevention of PTI. STATEMENT OF SIGNIFICANCE: This study constructed a bacterial challenged percutaneous rabbit tibia model to evaluate the potential of antibacterial strategies for the prevention of pin tract infections. The model was applied to evaluate a silver and chlorhexidine loaded membranes as an antibacterial sleeve. Our results demonstrate that the rabbit tibia model is suitable to evaluate antibacterial strategies for the prevention of pin tract infection as evidenced by the stable, bone fixed percutaneous implant and a 100% infection rate of the percutaneous pin tract. Silver loaded sleeves can lower the bacterial density of the percutaneous pin tract, but the addition of chlorhexidine to the silver-loaded sleeves does not contribute to an enhanced antibacterial effect. Such experiments are of considerable interest to those in the research community, industry, and clinicians involved the occurrence of infection of skin penetrating medical devices.
Collapse
Affiliation(s)
- Jinlong Shao
- Department of Biomaterials, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Bing Wang
- Department of Biomaterials, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Carla J M Bartels
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Ewald M Bronkhorst
- Department of Biomaterials, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - John A Jansen
- Department of Biomaterials, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - X Frank Walboomers
- Department of Biomaterials, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Fang Yang
- Department of Biomaterials, Radboud University Medical Centre, Nijmegen, The Netherlands.
| |
Collapse
|
26
|
Wan Y, Wang G, Ren B, Liu Z, Ge P. Construction of Antibacterial and Bioactive Surface for Titanium Implant. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s41871-018-0028-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
27
|
Total Knee Arthroplasty after Correction of Tibial Diaphyseal Nonunion with Clamshell Osteotomy. Case Rep Orthop 2018; 2018:2632963. [PMID: 30356357 PMCID: PMC6176307 DOI: 10.1155/2018/2632963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/30/2018] [Accepted: 08/16/2018] [Indexed: 11/18/2022] Open
Abstract
Total knee arthroplasty is mostly done to relieve pain and disability from a severe and degenerated knee. Deformities in the coronal and sagittal plane could be corrected with the help of cuts made in tibia and femur during total knee replacement as well as with ligament release. However, large deformities in the lower extremity particularly in the diaphysis region need correction prior to the total knee replacement. It helps to limit the amount of bone that will be cut and helps the ligament release. Several extra articular and intra-articular methods for the correction of diaphyseal deformity have been described. We present the case of clamshell osteotomy for the correction of diaphyseal deformity in the tibia and a total knee replacement after the osteotomy site healed.
Collapse
|
28
|
Tiziani S, Dienstknecht T, Osterhoff G, Hand TL, Teuben M, Werner CML, Pape HC. Standards for external fixation application: national survey under the auspices of the German Trauma Society. INTERNATIONAL ORTHOPAEDICS 2018; 43:1779-1785. [PMID: 30191276 DOI: 10.1007/s00264-018-4127-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/21/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION External fixation is widely accepted as a provisional or sometimes definitive treatment for long-bone fractures. Indications include but are not limited to damage control surgery in poly-traumatized patients as well as provisional bridging to definite treatment with soft tissue at risk. As little is known about surgeon's habits in applying this treatment strategy, we performed a national survey. METHODS We utilized the member database of the German Trauma Society (DGU). The questionnaire encompassed 15 questions that addresses topics including participants' position, experience, workplace, and questions regarding specifics of external fixation application in different anatomical regions. Furthermore, we compared differences between trauma centre levels and surgeon-related factors. RESULTS The participants predominantly worked in level 1 trauma centres (42.7%) and were employed as attendings (54.7%). There was widespread consensus for planning and intra-operative radiographical control of external fixation. Surgeons appointed at a level I trauma centre preferred significantly more often supra-acetabular pin placement in external fixation of the pelvis rather than the utilization of iliac pins (75.8%, p = 0.0001). Moreover, they were more likely to favor a mini-open approach to insert humeral pins (42.4%, p = 0.003). Overall, blunt dissection and mini-open approaches seemed equally popular (38.2 and 34.1%). Department chairmen indicated more often than their colleagues to follow written pin-care protocols for minimization of infection (16.7%, p = 0.003). CONCLUSION Despite the fact that external fixation usage is widespread and well established among trauma surgeons in Germany, there are substantial differences in the method of application.
Collapse
Affiliation(s)
- Simon Tiziani
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Thomas Dienstknecht
- Department of Orthopaedic Surgery, St. Augustinus Hospital Lendersdorf, Renkerstreet 45, 52355, Dueren, Germany
| | - Georg Osterhoff
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas L Hand
- Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
| | - Michel Teuben
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Clément M L Werner
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
29
|
Slate AJ, Wickens DJ, El Mohtadi M, Dempsey-Hibbert N, West G, Banks CE, Whitehead KA. Antimicrobial activity of Ti-ZrN/Ag coatings for use in biomaterial applications. Sci Rep 2018; 8:1497. [PMID: 29367635 PMCID: PMC5784091 DOI: 10.1038/s41598-018-20013-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/12/2018] [Indexed: 12/31/2022] Open
Abstract
Severely broken bones often require external bone fixation pins to provide support but they can become infected. In order to reduce such infections, novel solutions are required. Titanium zirconium nitride (Ti-ZrN) and Ti-ZrN silver (Ti-ZrN/Ag) coatings were deposited onto stainless steel. Surface microtopography demonstrated that on the silver containing surfaces, Sa and Sv values demonstrated similar trends whilst the Ra, average height and RMS value and Sp values increased with increasing silver concentration. On the Ti-ZrN/Ag coatings, surface hydrophobicity followed the same trend as the Sa and Sv values. An increase in dead Staphylococcus aureus and Staphylococcus epidermidis cells was observed on the coatings with a higher silver concentration. Using CTC staining, a significant increase in S. aureus respiration on the silver containing surfaces was observed in comparison to the stainless steel control whilst against S. epidermidis, no significant difference in viable cells was observed across the surfaces. Cytotoxicity testing revealed that the TiZrN coatings, both with and without varying silver concentrations, did not possess a detrimental effect to a human monocyte cell line U937. This work demonstrated that such coatings have the potential to reduce the viability of bacteria that result in pin tract infections.
Collapse
Affiliation(s)
- Anthony J Slate
- Microbiology at Interfaces Group, School of Healthcare Sciences, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.,School of Science and the Environment, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | | | - Mohamed El Mohtadi
- Microbiology at Interfaces Group, School of Healthcare Sciences, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Nina Dempsey-Hibbert
- Microbiology at Interfaces Group, School of Healthcare Sciences, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Glen West
- Surface Engineering Group, School of Engineering, Manchester Metropolitan University, Manchester, M1 5GD, UK
| | - Craig E Banks
- School of Science and the Environment, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Kathryn A Whitehead
- Microbiology at Interfaces Group, School of Healthcare Sciences, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.
| |
Collapse
|
30
|
Darouiche RO. Antimicrobial Coating of Devices for Prevention of Infection: Principles and Protection. Int J Artif Organs 2018; 30:820-7. [DOI: 10.1177/039139880703000912] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Device-associated infections are responsible for about half of nosocomial infections and can cause major medical and economical sequelae. Despite adherence to basic infection control measures, which constitute the mainstay for preventing infection, infections associated with certain devices continue to exist at unacceptably high rates. Potentially-preventive, antimicrobial-utilizing strategies include systemic antibiotic prophylaxis and local administration of antimicrobial agents (antibiotics or antiseptics), which includes antimicrobial irrigation of the surgical field, placement of antimicrobial carriers, antiseptic cleansing of the skin, dipping of surgical implants in antimicrobial solutions, and inserting antimicrobial-coated implants. Since bacterial colonization of the indwelling device is a prelude to infection, prevention of device colonization may lead to a lower rate of clinical infection. Different approaches for antimicrobial coating of devices have been variably successful in preventing device-associated infections. Optimal characteristics of antimicrobial coating can help predict the likelihood and degree of clinical protection against infection. This review addresses the impact of device-related infection, antimicrobial-utilizing approaches for preventing infection, clinical protection afforded by different types of antimicrobial coating, characteristics that predict the ability of antimicrobial coating of devices to prevent clinical infection, and future directions of antimicrobial coating.
Collapse
Affiliation(s)
- R. O. Darouiche
- Center for Prostheses Infection and Infectious Disease Section, Michael E. Debakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas - USA
| |
Collapse
|
31
|
A review of local antibiotic implants and applications to veterinary orthopaedic surgery. Vet Comp Orthop Traumatol 2017; 26:251-9. [DOI: 10.3415/vcot-12-05-0065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 01/27/2013] [Indexed: 11/17/2022]
Abstract
SummaryIn the face of increasing incidence of multidrug resistant implant infections, local antibiotic modalities are receiving increased attention for both infection prophylaxis and treatment. Local antibiotic therapy that achieves very high antibiotic drug concentrations at the site of the implant may represent an avenue for treatment of biofilmforming bacterial pathogens. Randomized controlled trials in human patients have demonstrated an infection risk reduction when antibiotic-impregnated cement is used for infection prophylaxis in implanted joint prostheses, and when a gentamicin-impregnated collagen sponge is used for infection prophylaxis in midline sternotomy. The other modalities discussed have for the most part yet to be evaluated in randomized controlled trials in veterinary or human patients. In general, the in vivo pharmacokinetics and appropriate dosing profiles for local antibiotic modalities have yet to be elucidated. Toxicity is possible, and attention to the dose applied is warranted.
Collapse
|
32
|
Shao J, Kolwijck E, Jansen JA, Yang F, Walboomers XF. Animal models for percutaneous-device-related infections: a review. Int J Antimicrob Agents 2017; 49:659-667. [DOI: 10.1016/j.ijantimicag.2017.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 01/05/2023]
|
33
|
Kalaiselvam S, Sandhya J, Krishnan KVH, Kedharnath A, Arulkumar G, Roseline AA. Investigation of Structural, Compositional and Anti-Microbial Properties of Copper Thin Film Using Direct Current Magnetron Sputtering for Surgical Instruments. INTERNATIONAL JOURNAL OF NANOSCIENCE 2017. [DOI: 10.1142/s0219581x16500253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surgical instruments and other bioimplant devices, owing to their importance in the biomedical industry require high biocompatibility to be used in the human body. Nevertheless, issues of compatibility, bacterial infections are quite common in such devices. Hence development of surface coatings on various substrates for implant applications is a promising technique to combat the issues arising in these implant materials. The present investigation aims at coating copper on stainless steel substrate using DC Magnetron sputtering which is used to achieve film of required thickness (0.5–8[Formula: see text][Formula: see text]m). The deposition pressure, substrate temperature, power supply, distance between the specimen and target are optimized and maintained constant, while the sputtering time (30–110[Formula: see text]min) is varied. The sputtered copper thin film’s morphology, composition are characterized by SEM and EDAX. X-ray diffraction analysis shows copper oriented on (111) and (002) and copper oxide on (111) planes. The contact angle of copper thin film is 92[Formula: see text] while AISI 316L shows 73[Formula: see text]. The antimicrobial studies carried in Staphylococcus aureus, Escherichia Coli, Klebsiella pneumonia and Candida albicans show that the maximum reduction was seen upto 35, 26, 54, 39[Formula: see text]CFU/mL, respectively after 24[Formula: see text]h. The cell viability is studied by MTT assay test on Vero cell line for 24[Formula: see text]h, 48[Formula: see text]h and 72[Formula: see text]h and average cell viability is 43.85%. The copper release from the thin film to the culture medium is 6691[Formula: see text][Formula: see text]g/L (maximum) is estimated from AAS studies. The copper coated substrate does not show much reaction with living Vero cells whereas the bacteria and fungi are found to be destroyed.
Collapse
Affiliation(s)
- S. Kalaiselvam
- Department of Mechanical Engineering, Anna University, Chennai – 600 025, India
- Department of Applied Science and Technology, Anna University, Chennai – 600 025, India
| | - J. Sandhya
- Department of Applied Science and Technology, Anna University, Chennai – 600 025, India
- Centre for Nanoscience and Technology, Anna University, Chennai – 600 025, India
| | - K. V. Hari Krishnan
- Department of Mechanical Engineering, Anna University, Chennai – 600 025, India
| | - A. Kedharnath
- Department of Mechanical Engineering, Anna University, Chennai – 600 025, India
| | - G. Arulkumar
- Department of Mechanical Engineering, Anna University, Chennai – 600 025, India
| | - A. Ameelia Roseline
- Department of Electronics and Communication, Panimalar Engineering College, Chennai – 600 123, India
| |
Collapse
|
34
|
Dong H, Mukinay T, Li M, Hood R, Soo SL, Cockshott S, Sammons R, Li X. Improving tribological and anti-bacterial properties of titanium external fixation pins through surface ceramic conversion. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:5. [PMID: 27885572 PMCID: PMC5122620 DOI: 10.1007/s10856-016-5816-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
In this study, an advanced ceramic conversion surface engineering technology has been applied for the first time to self-drilling Ti6Al4V external fixation pins to improve their performance in terms of biomechanical, bio-tribological and antibacterial properties. Systematic characterisation of the ceramic conversion treated Ti pins was carried out using Scanning electron microscope, X-ray diffraction, Glow-discharge optical emission spectroscopy, nano- and micro-indentation and scratching; the biomechanical and bio-tribological properties of the surface engineered Ti pins were evaluated by insertion into high density bone simulation material; and the antibacterial behaviour was assessed with Staphylococcus aureus NCTC 6571. The experimental results have demonstrated that the surfaces of Ti6Al4V external fixation pins were successfully converted into a TiO2 rutile layer (~2 μm in thickness) supported by an oxygen hardened case (~15 μm in thickness) with very good bonding due to the in-situ conversion nature. The maximum insertion force and temperature were reduced from 192N and 31.2 °C when using the untreated pins to 182N and 26.1 °C when the ceramic conversion treated pins were tested. This is mainly due to the significantly increased hardness (more than three times) and the effectively enhanced wear resistance of the cutting edge of the self-drilling Ti pins following the ceramic conversion treatment. The antibacterial tests also revealed that there was a significantly reduced number of bacteria isolated from the ceramic conversion treated pins compared to the untreated pins of around 50 % after 20 h incubation, P < 0.01 (0.0024). The results reported are encouraging and could pave the way towards high-performance anti-bacterial titanium external fixation pins with reduced pin-track infection and pin loosing.
Collapse
Affiliation(s)
- Huan Dong
- Royal Derby Hospital, Derby, DE22 3NE, UK.
| | - Tatiana Mukinay
- School of Metallurgy and Materials, University of Birmingham, Birmingham, B15 2TT, UK
| | - Maojun Li
- School of Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | - Richard Hood
- School of Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sein Leung Soo
- School of Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | | | - Rachel Sammons
- School of Dentistry, University of Birmingham, Birmingham, B4 6NN, UK
| | - Xiaoying Li
- School of Metallurgy and Materials, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
35
|
Gerits E, Kucharíková S, Van Dijck P, Erdtmann M, Krona A, Lövenklev M, Fröhlich M, Dovgan B, Impellizzeri F, Braem A, Vleugels J, Robijns SCA, Steenackers HP, Vanderleyden J, De Brucker K, Thevissen K, Cammue BPA, Fauvart M, Verstraeten N, Michiels J. Antibacterial activity of a new broad-spectrum antibiotic covalently bound to titanium surfaces. J Orthop Res 2016; 34:2191-2198. [PMID: 27003909 DOI: 10.1002/jor.23238] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/17/2016] [Indexed: 02/04/2023]
Abstract
Biofilm-associated infections, particularly those caused by Staphylococcus aureus, are a major cause of implant failure. Covalent coupling of broad-spectrum antimicrobials to implants is a promising approach to reduce the risk of infections. In this study, we developed titanium substrates on which the recently discovered antibacterial agent SPI031, a N-alkylated 3, 6-dihalogenocarbazol 1-(sec-butylamino)-3-(3,6-dichloro-9H-carbazol-9-yl)propan-2-ol, was covalently linked (SPI031-Ti). We found that SPI031-Ti substrates prevent biofilm formation of S. aureus and Pseudomonas aeruginosa in vitro, as quantified by plate counting and fluorescence microscopy. To test the effectiveness of SPI031-Ti substrates in vivo, we used an adapted in vivo biomaterial-associated infection model in mice in which SPI031-Ti substrates were implanted subcutaneously and subsequently inoculated with S. aureus. Using this model, we found a significant reduction in biofilm formation (up to 98%) on SPI031-Ti substrates compared to control substrates. Finally, we demonstrated that the functionalization of the titanium surfaces with SPI031 did not influence the adhesion and proliferation of human cells important for osseointegration and bone repair. In conclusion, these data demonstrate the clinical potential of SPI031 to be used as an antibacterial coating for implants, thereby reducing the incidence of implant-associated infections. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2191-2198, 2016.
Collapse
Affiliation(s)
- Evelien Gerits
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium
| | - Soňa Kucharíková
- Department of Molecular Microbiology, VIB, KU Leuven, Kasteelpark Arenberg 31 box 2438, 3001 Leuven, Belgium.,Laboratory of Molecular Cell Biology, KU Leuven, Kasteelpark Arenberg 31 box 2438, 3001 Leuven, Belgium
| | - Patrick Van Dijck
- Department of Molecular Microbiology, VIB, KU Leuven, Kasteelpark Arenberg 31 box 2438, 3001 Leuven, Belgium.,Laboratory of Molecular Cell Biology, KU Leuven, Kasteelpark Arenberg 31 box 2438, 3001 Leuven, Belgium
| | | | - Annika Krona
- Department of Structure and Material Design, SP Food and Bioscience, Box 5401, 402 29 Gothenburg, Sweden
| | - Maria Lövenklev
- Department of Structure and Material Design, SP Food and Bioscience, Box 5401, 402 29 Gothenburg, Sweden
| | - Mirjam Fröhlich
- Educell Ltd, Prevale 9, 1236 Trzin, Slovenia.,Faculty of Medicine, Institute of Cell Biology, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | | | | | - Annabel Braem
- Department of Materials Engineering (MTM), KU Leuven, Kasteelpark Arenberg 44 box 2450, 3001 Leuven, Belgium
| | - Jef Vleugels
- Department of Materials Engineering (MTM), KU Leuven, Kasteelpark Arenberg 44 box 2450, 3001 Leuven, Belgium
| | - Stijn C A Robijns
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium
| | - Hans P Steenackers
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium
| | - Jozef Vanderleyden
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium
| | - Katrijn De Brucker
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium
| | - Karin Thevissen
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium
| | - Bruno P A Cammue
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium.,Department of Plant Systems Biology, VIB, Technologiepark 927, 9052 Ghent, Belgium
| | - Maarten Fauvart
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium.,Department of Life Science Technologies, imec, Smart Systems and Emerging Technologies Unit, Kapeldreef 75, 3001 Leuven, Belgium
| | - Natalie Verstraeten
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium
| | - Jan Michiels
- Centre of Microbial and Plant Genetics, KU Leuven, Kasteelpark Arenberg 20 box 2460, 3001 Leuven, Belgium
| |
Collapse
|
36
|
From prevention of pin-tract infection to treatment of osteomyelitis during paediatric external fixation. J Child Orthop 2016; 10:605-612. [PMID: 27848193 PMCID: PMC5145837 DOI: 10.1007/s11832-016-0787-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023] Open
Abstract
Pin-tract infection (PTI) is the most commonly expected problem, or even an almost inevitable complication, when using external fixation. Left unteated, PTI will progress unavoidably, lead to mechanical pin loosening, and ultimately cause instability of the external fixator pin-bone construct. Thus, PTI remains a clinical challenge, specifically in cases of limb lengthening or deformity correction. Standardised pin site protocols which encompass an understanding of external fixator biomechanics and meticulous surgical technique during pin and wire insertion, postoperative pin site care and pin removal could limit the incidence of major infections and treatment failures. Here we discuss concepts regarding the epidemiology, physiopathology and microbiology of PTI in paediatric populations, as well as the clinical presentations, diagnosis, classification and treatment of these infections.
Collapse
|
37
|
Formation of bioactive N-doped TiO2 on Ti with visible light-induced antibacterial activity using NaOH, hot water, and subsequent ammonia atmospheric heat treatment. Colloids Surf B Biointerfaces 2016; 145:285-290. [DOI: 10.1016/j.colsurfb.2016.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/22/2016] [Accepted: 05/05/2016] [Indexed: 11/24/2022]
|
38
|
Effects of Electrically Activated Silver–Titanium Implant System Design Parameters on Time-Kill Curves Against Staphylococcus aureus. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0136-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
39
|
Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Strategies Trauma Limb Reconstr 2016; 11:75-85. [PMID: 27174086 PMCID: PMC4960058 DOI: 10.1007/s11751-016-0256-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/03/2016] [Indexed: 12/21/2022] Open
Abstract
Pin site infections are a common complication of external fixation that places a significant burden on the patient and healthcare system. Such infections increase the number of clinic visits required during a patient’s course of treatment, can result in the need for additional treatment including antibiotics and surgery, and most importantly can compromise patient outcomes should osteomyelitis or instability result from pin loosening or need for pin or complete construct removal. Factors that may influence the development of pin site infections include patient-specific risk factors, surgical technique, pin design characteristics, use of prophylactic antibiotics, and the post-operative pin care protocol including cleansing, dressing changes, and showering. Despite numerous studies that work to derive evidence-based recommendations for prevention of pin site infections, substantial controversy exists in regard to the optimal protocol. This review comprehensively evaluates the current literature to provide an overview of factors that may influence the incidence of pin site infections in patients undergoing treatment with external fixators, and concludes with a description of the preferred surgical and post-operative pin site protocols employed by the senior authors (ATF and SRR).
Collapse
Affiliation(s)
- Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA, 19104, USA.
| | - Austin T Fragomen
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
| |
Collapse
|
40
|
Kuehl R, Brunetto PS, Woischnig AK, Varisco M, Rajacic Z, Vosbeck J, Terracciano L, Fromm KM, Khanna N. Preventing Implant-Associated Infections by Silver Coating. Antimicrob Agents Chemother 2016; 60:2467-75. [PMID: 26883700 PMCID: PMC4808148 DOI: 10.1128/aac.02934-15] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/04/2016] [Indexed: 01/22/2023] Open
Abstract
Implant-associated infections (IAIs) are a dreaded complication mainly caused by biofilm-forming staphylococci. Implant surfaces preventing microbial colonization would be desirable. We examined the preventive effect of a silver-coated titanium-aluminum-niobium (TiAlNb) alloy. The surface elicited a strong, inoculum-dependent activity againstStaphylococcus epidermidisandStaphylococcus aureusin an agar inhibition assay. Gamma sterilization and alcohol disinfection did not alter the effect. In a tissue cage mouse model, silver coating of TiAlNb cages prevented perioperative infections in an inoculum-dependent manner and led to a 100% prevention rate after challenge with 2 × 10(6)CFU ofS. epidermidisper cage. InS. aureusinfections, silver coating had only limited effect. Similarly, daptomycin or vancomycin prophylaxis alone did not preventS. aureusinfections. However, silver coating combined with daptomycin or vancomycin prophylaxis thwarted methicillin-resistantS. aureusinfections at a prevention rate of 100% or 33%, respectively. Moreover, silver release from the surface was independent of infection and occurred rapidly after implantation. On day 2, a peak of 82 μg Ag/ml was reached in the cage fluid, corresponding to almost 6× the MIC of the staphylococci. Cytotoxicity toward leukocytes in the cage was low and temporary. Surrounding tissue did not reveal histological signs of silver toxicity.In vitro, no emergence of silver resistance was observed in several clinical strains of staphylococci upon serial subinhibitory silver exposures. In conclusion, our data demonstrate that silver-coated TiAlNb is potent for prevention of IAIs and thus can be considered for clinical application.
Collapse
Affiliation(s)
- Richard Kuehl
- Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | | | - Anne-Kathrin Woischnig
- Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland
| | - Massimo Varisco
- Department of Chemistry, University of Fribourg, Fribourg, Switzerland
| | - Zarko Rajacic
- Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland
| | - Juerg Vosbeck
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Luigi Terracciano
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Katharina M Fromm
- Department of Chemistry, University of Fribourg, Fribourg, Switzerland
| | - Nina Khanna
- Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| |
Collapse
|
41
|
Moriarty TF, Kuehl R, Coenye T, Metsemakers WJ, Morgenstern M, Schwarz EM, Riool M, Zaat SA, Khana N, Kates SL, Richards RG. Orthopaedic device-related infection: current and future interventions for improved prevention and treatment. EFORT Open Rev 2016; 1:89-99. [PMID: 28461934 PMCID: PMC5367564 DOI: 10.1302/2058-5241.1.000037] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Orthopaedic and trauma device-related infection (ODRI) remains one of the major complications in modern trauma and orthopaedic surgery.Despite best practice in medical and surgical management, neither prophylaxis nor treatment of ODRI is effective in all cases, leading to infections that negatively impact clinical outcome and significantly increase healthcare expenditure.The following review summarises the microbiological profile of modern ODRI, the impact antibiotic resistance has on treatment outcomes, and some of the principles and weaknesses of the current systemic and local antibiotic delivery strategies.The emerging novel strategies aimed at preventing or treating ODRI will be reviewed. Particular attention will be paid to the potential for clinical impact in the coming decades, when such interventions are likely to be critically important.The review focuses on this problem from an interdisciplinary perspective, including basic science innovations and best practice in infectious disease. Cite this article: Moriarty TF, Kuehl R, Coenye T, et al. Orthopaedic device related infection: current and future interventions for improved prevention and treatment. EFORT Open Rev 2016;1:89-99. DOI: 10.1302/2058-5241.1.000037.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Nina Khana
- University Hospital of Basel, Switzerland
| | | | | |
Collapse
|
42
|
Electrochemical Surface Treatment of a β-titanium Alloy to Realize an Antibacterial Property and Bioactivity. METALS 2016. [DOI: 10.3390/met6040076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
43
|
Getzlaf MA, Lewallen EA, Kremers HM, Jones DL, Bonin CA, Dudakovic A, Thaler R, Cohen RC, Lewallen DG, van Wijnen AJ. Multi-disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee. J Orthop Res 2016; 34:177-86. [PMID: 26449208 PMCID: PMC4824296 DOI: 10.1002/jor.23068] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/06/2015] [Indexed: 02/04/2023]
Abstract
Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria.
Collapse
Affiliation(s)
- Matthew A. Getzlaf
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Eric A. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Hilal M. Kremers
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Dakota L. Jones
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905,Department of Biomedical Engineering and Physiology, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Carolina A. Bonin
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Roman Thaler
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Robert C. Cohen
- Reconstructive Research and Development, Stryker Orthopedics, 325 Corporate Drive, Mahwah, New Jersey 07430
| | - David G. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| |
Collapse
|
44
|
Kadar A, Eisenberg G, Yahav E, Drexler M, Salai M, Steinberg E. Surgical site infection in elderly patients with hip fractures, silver-coated versus regular dressings: a randomised prospective trial. J Wound Care 2015; 24:441-2, 444-5. [DOI: 10.12968/jowc.2015.24.10.441] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A. Kadar
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - G. Eisenberg
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - E. Yahav
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - M. Drexler
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - M. Salai
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - E.L. Steinberg
- All at the Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| |
Collapse
|
45
|
Percutaneous external fixator pins with bactericidal micron-thin sol–gel films for the prevention of pin tract infection. Biomaterials 2015; 62:95-105. [DOI: 10.1016/j.biomaterials.2015.05.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/19/2015] [Accepted: 05/24/2015] [Indexed: 11/20/2022]
|
46
|
Ogbemudia AO, Bafor A, Ogbemudia EJ, Edomwonyi E. Efficacy of 1 % silver sulphadiazine dressings in preventing infection of external fixation pin-tracks: a randomized study. Strategies Trauma Limb Reconstr 2015; 10:95-9. [PMID: 26276386 PMCID: PMC4570890 DOI: 10.1007/s11751-015-0226-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/13/2015] [Indexed: 11/18/2022] Open
Abstract
Pin-track infection (PTI) is a common complication of external fixation. Antimicrobial dressings of the pin-site interface should reduce the severity and incidence of PTI. This study is aimed at determining the efficacy of 1 % silver sulphadiazine dressings in preventing PTI in external fixation. We compared the incidence of PTI between group A (dry sterile gauze dressing) and group B (1 % silver sulphadiazine impregnated gauze dressing). PTI was diagnosed when there was: (1) redness around any pin-site, (2) tenderness near a pin-site and (3) serous or purulent discharge from the pin-skin interface. With infection, swab was obtained for microscopy, culture and sensitivity. Pin-track infections were diagnosed in 22.5 and 4.1 % of patients in groups A and B, respectively. This difference was statistically significant. The commonest organism isolated from swabs was Staphyloccus aureus. In patients with external fixation, 1 % silver sulphadiazine lowered PTI. This further underlines the need for antimicrobial dressings of pin-sites. We recommend the use of 1 % silver sulphadiazine impregnated ribbon gauze for pin-site dressings. Level of evidence II.
Collapse
Affiliation(s)
- Alfred O Ogbemudia
- Department of Orthopaedics and Trauma, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria.
| | - Anirejuoritse Bafor
- Department of Orthopaedics and Trauma, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria
| | | | - Edwin Edomwonyi
- Department of Orthopaedics and Trauma, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| |
Collapse
|
47
|
Brennan SA, Ní Fhoghlú C, Devitt BM, O'Mahony FJ, Brabazon D, Walsh A. Silver nanoparticles and their orthopaedic applications. Bone Joint J 2015; 97-B:582-9. [PMID: 25922449 DOI: 10.1302/0301-620x.97b5.33336] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/13/2015] [Indexed: 01/31/2023]
Abstract
Implant-associated infection is a major source of morbidity in orthopaedic surgery. There has been extensive research into the development of materials that prevent biofilm formation, and hence, reduce the risk of infection. Silver nanoparticle technology is receiving much interest in the field of orthopaedics for its antimicrobial properties, and the results of studies to date are encouraging. Antimicrobial effects have been seen when silver nanoparticles are used in trauma implants, tumour prostheses, bone cement, and also when combined with hydroxyapatite coatings. Although there are promising results with in vitro and in vivo studies, the number of clinical studies remains small. Future studies will be required to explore further the possible side effects associated with silver nanoparticles, to ensure their use in an effective and biocompatible manner. Here we present a review of the current literature relating to the production of nanosilver for medical use, and its orthopaedic applications.
Collapse
Affiliation(s)
- S A Brennan
- Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - C Ní Fhoghlú
- Our Lady of Lourdes Hospital Drogheda, 45 Balkill Park, Howth, Dublin, Ireland
| | - B M Devitt
- Royal College of Surgeons, Dublin, Ireland
| | | | | | - A Walsh
- Our Lady of Lourdes Hospital Drogheda, 45 Balkill Park, Howth, Dublin, Ireland
| |
Collapse
|
48
|
Berean KJ, Adetutu EM, Zhen Ou J, Nour M, Nguyen EP, Paull D, Mcleod J, Ramanathan R, Bansal V, Latham K, Bishop-Hurley GJ, McSweeney C, Ball AS, Kalantar-Zadeh K. A unique in vivo approach for investigating antimicrobial materials utilizing fistulated animals. Sci Rep 2015; 5:11515. [PMID: 26098413 PMCID: PMC4476420 DOI: 10.1038/srep11515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 05/28/2015] [Indexed: 12/28/2022] Open
Abstract
Unique in vivo tests were conducted through the use of a fistulated ruminant, providing an ideal environment with a diverse and vibrant microbial community. Utilizing such a procedure can be especially invaluable for investigating the performance of antimicrobial materials related to human and animal related infections. In this pilot study, it is shown that the rumen of a fistulated animal provides an excellent live laboratory for assessing the properties of antimicrobial materials. We investigate microbial colonization onto model nanocomposites based on silver (Ag) nanoparticles at different concentrations into polydimethylsiloxane (PDMS). With implantable devices posing a major risk for hospital-acquired infections, the present study provides a viable solution to understand microbial colonization with the potential to reduce the incidence of infection through the introduction of Ag nanoparticles at the optimum concentrations. In vitro measurements were also conducted to show the validity of the approach. An optimal loading of 0.25 wt% Ag is found to show the greatest antimicrobial activity and observed through the in vivo tests to reduce the microbial diversity colonizing the surface.
Collapse
Affiliation(s)
- Kyle J Berean
- School of Electrical and Computer Engineering, RMIT University, Melbourne, Australia, 3000
| | - Eric M Adetutu
- School of Applied Science, RMIT University, Bundoora, Australia, 3083
| | - Jian Zhen Ou
- School of Electrical and Computer Engineering, RMIT University, Melbourne, Australia, 3000
| | - Majid Nour
- School of Electrical &Computer Engineering, King Abdulaziz University, Jeddah, Saudi Arabia, 22254
| | - Emily P Nguyen
- School of Electrical and Computer Engineering, RMIT University, Melbourne, Australia, 3000
| | - David Paull
- CSIRO Agriculture, Armidale, Australia, 2350
| | - Jess Mcleod
- CSIRO Agriculture, Armidale, Australia, 2350
| | - Rajesh Ramanathan
- School of Applied Science, RMIT University, Melbourne, Australia, 3000
| | - Vipul Bansal
- School of Applied Science, RMIT University, Melbourne, Australia, 3000
| | - Kay Latham
- School of Applied Science, RMIT University, Melbourne, Australia, 3000
| | | | | | - Andrew S Ball
- School of Applied Science, RMIT University, Bundoora, Australia, 3083
| | - Kourosh Kalantar-Zadeh
- School of Electrical and Computer Engineering, RMIT University, Melbourne, Australia, 3000
| |
Collapse
|
49
|
Seasonal Temperature and Pin Site Care Regimen Affect the Incidence of Pin Site Infection in Pediatric Supracondylar Humeral Fractures. BIOMED RESEARCH INTERNATIONAL 2015; 2015:838913. [PMID: 26064957 PMCID: PMC4429189 DOI: 10.1155/2015/838913] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/30/2014] [Indexed: 12/16/2022]
Abstract
Pin site infection is a common complication after fracture fixation and bone lengthening, and daily pin site care is recommended. Weather is a strong environmental factor of infection, but few articles studied the issue of weather and pin site infection. We performed a prospective comparative study of 61 children with supracondylar humeral fractures treated by closed reduction and percutaneous pinning. The patients were divided into high-temperature season or low-temperature season by the months they received surgery. The patients within each season were further allocated to 2 groups by the different postoperative pin site care methods of daily care or noncare. The infection rate per patient was significantly higher in the high-temperature season compared to low-temperature season (45% versus 19%, P = 0.045). In the high-temperature season, the infection rate per patient was significantly higher in the daily care group versus the noncare group (70% versus 20%, P = 0.001). In the low-temperature season, the infection rate per patient was not significantly different in the daily care group versus the noncare group (10% versus 27.3%, P = 0.33). We recommend that careful monitoring of infection signs, rather than pin site cleaning, would be appropriate in the treatment of pediatric supracondylar humeral fractures, especially during the summer months.
Collapse
|
50
|
Mitchell PM, Corrigan CM, Patel NA, Silverberg AJ, Greenberg SE, Thakore RV, Obremskey WT, Ehrenfeld JM, Evans JM, Sethi MK. 13-Year experience in external fixation of the pelvis: complications, reduction and removal. Eur J Trauma Emerg Surg 2015; 42:91-6. [DOI: 10.1007/s00068-015-0499-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
|