Adjuvant antibiotic-loaded bone cement: Concerns with current use and research to make it work.
Biofilm Meeting
antibiotic-loaded bone cement (ALBC)
local antibiotics
musculoskeletal infection (MSKI)
Journal
Journal of orthopaedic research : official publication of the Orthopaedic Research Society
ISSN: 1554-527X
Titre abrégé: J Orthop Res
Pays: United States
ID NLM: 8404726
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
09
12
2019
revised:
07
01
2020
accepted:
13
01
2020
pubmed:
31
1
2020
medline:
1
5
2021
entrez:
31
1
2020
Statut:
ppublish
Résumé
Antibiotic-loaded bone cement (ALBC) is broadly used to treat orthopaedic infections based on the rationale that high-dose local delivery is essential to eradicate biofilm-associated bacteria. However, ALBC formulations are empirically based on drug susceptibility from routine laboratory testing, which is known to have limited clinical relevance for biofilms. There are also dosing concerns with nonstandardized, surgeon-directed, hand-mixed formulations, which have unknown release kinetics. On the basis of our knowledge of in vivo biofilms, pathogen virulence, safety issues with nonstandardized ALBC formulations, and questions about the cost-effectiveness of ALBC, there is a need to evaluate the evidence for this clinical practice. To this end, thought leaders in the field of musculoskeletal infection (MSKI) met on 1 August 2019 to review and debate published and anecdotal information, which highlighted four major concerns about current ALBC use: (a) substantial lack of level 1 evidence to demonstrate efficacy; (b) ALBC formulations become subtherapeutic following early release, which risks induction of antibiotic resistance, and exacerbated infection from microbial colonization of the carrier; (c) the absence of standardized formulation protocols, and Food and Drug Administration-approved high-dose ALBC products to use following resection in MSKI treatment; and (d) absence of a validated assay to determine the minimum biofilm eradication concentration to predict ALBC efficacy against patient specific micro-organisms. Here, we describe these concerns in detail, and propose areas in need of research.
Identifiants
pubmed: 31997412
doi: 10.1002/jor.24616
pmc: PMC7390691
mid: NIHMS1554063
doi:
Substances chimiques
Anti-Bacterial Agents
0
Bone Cements
0
Types de publication
Consensus Development Conference
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
227-239Subventions
Organisme : NIAMS NIH HHS
ID : P30 AR069655
Pays : United States
Organisme : NIAMS NIH HHS
ID : R21 AR073321
Pays : United States
Organisme : NIAMS NIH HHS
ID : R01 AR072513
Pays : United States
Organisme : NIAMS NIH HHS
ID : P50 AR072000
Pays : United States
Organisme : Stavros Niarchos Foundation
Organisme : NIGMS NIH HHS
ID : R01 GM124436
Pays : United States
Organisme : Hospital for Special Surgery
Organisme : NIAMS NIH HHS
ID : R01 AR069119
Pays : United States
Informations de copyright
© 2020 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
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