[Bone cement as a local antibiotic carrier].
Knochenzement als lokaler Antibiotikaträger.
Antibiotic prophylaxis
Drug release
Drug synergism
PMMA
Prosthesis related infection
Journal
Orthopadie (Heidelberg, Germany)
ISSN: 2731-7153
Titre abrégé: Orthopadie (Heidelb)
Pays: Germany
ID NLM: 9918384887206676
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
accepted:
01
09
2023
medline:
4
12
2023
pubmed:
13
10
2023
entrez:
13
10
2023
Statut:
ppublish
Résumé
There is widespread consensus that adjuvant local use of antimicrobial agents in combination with their systemic administration can better prevent and treat implant-associated musculoskeletal infections. The advantage of local antibiotics lies in their particular pharmacokinetics with initially high antibiotic concentrations at the implant site with only low systemic uptake. The aim of local application is to protect the foreign bodies directly at the implantation site from bacterial colonization and biofilm formation (prophylaxis) and to support the eradication of an already established infection after surgical debridement (treatment). Since the observations of Prof. Buchholz, bone cement has been the most frequently used local carrier system. In cases of infection, surgeons should ideally work together with microbiologists, infectiologists or clinical pharmacists to determine which anti-infective agents are indicated systemically for the patient and which ones are indicated locally with PMMA cement, based on the pathogen(s) and antibiograms. However, for the anti-infective agents administered with bone cement, there is still uncertainty about which agents can be added to this carrier material and at what concentrations. Accordingly, the authors of this review article not only summarize the rationale and evidence for local antibiotic use but also elaborate on the points that must be considered for admixing these agents to the cement. HINTERGRUND: Es besteht weitgehend Konsens darüber, dass der adjuvante lokale Einsatz von antimikrobiellen Wirkstoffen in Kombination mit ihrer systemischen Verabreichung implantatassoziierte muskuloskelettale Infektionen besser bekämpfen kann. Der Vorteil der lokalen Antibiotika liegt in ihrer besonderen Pharmakokinetik mit initial hohen Antibiotikakonzentrationen am Implantationsort bei nur geringer systemischer Aufnahme. Ziel der lokalen Anwendung ist der Schutz des körperfremden Materials direkt am Implantationsort vor Keimbesiedelung und Biofilmbildung (Prophylaxe) sowie die Unterstützung der Sanierung einer Infektion nach chirurgischem Debridement (Behandlung). Knochenzement ist dabei seit den Beobachtungen von Prof. Buchholz der am häufigsten verwendete lokale Wirkstoffträger. In Infektfällen bestimmen dabei im Idealfall Chirurgen gemeinsam mit Mikrobiologen, Infektiologen oder klinischen Pharmazeuten auf der Basis des Keimnachweises und Antibiogramms, welche antiinfektiven Wirkstoffe systemisch und welche mit PMMA-Zement lokal für den Patienten indiziert sind. Allerdings besteht für die mit dem Knochenzement verabreichten Antiinfektiva nach wie vor Unsicherheit darüber, welche Wirkstoffe in welchen Konzentrationen diesem Trägermaterial zugemischt werden können. Entsprechend fassen die Autoren dieses Übersichtsartikels nicht nur die Rationale und die Evidenz des lokalen Antibiotikaeinsatzes zusammen, sondern führen auch aus, welche Punkte für die Zumischung dieser Wirkstoffe zum Zement beachtet werden müssen.
Sections du résumé
BACKGROUND
BACKGROUND
There is widespread consensus that adjuvant local use of antimicrobial agents in combination with their systemic administration can better prevent and treat implant-associated musculoskeletal infections. The advantage of local antibiotics lies in their particular pharmacokinetics with initially high antibiotic concentrations at the implant site with only low systemic uptake.
AIM OF TREATMENT
UNASSIGNED
The aim of local application is to protect the foreign bodies directly at the implantation site from bacterial colonization and biofilm formation (prophylaxis) and to support the eradication of an already established infection after surgical debridement (treatment). Since the observations of Prof. Buchholz, bone cement has been the most frequently used local carrier system.
APPLICATION
CONCLUSIONS
In cases of infection, surgeons should ideally work together with microbiologists, infectiologists or clinical pharmacists to determine which anti-infective agents are indicated systemically for the patient and which ones are indicated locally with PMMA cement, based on the pathogen(s) and antibiograms. However, for the anti-infective agents administered with bone cement, there is still uncertainty about which agents can be added to this carrier material and at what concentrations. Accordingly, the authors of this review article not only summarize the rationale and evidence for local antibiotic use but also elaborate on the points that must be considered for admixing these agents to the cement.
ZUSAMMENFASSUNG
UNASSIGNED
HINTERGRUND: Es besteht weitgehend Konsens darüber, dass der adjuvante lokale Einsatz von antimikrobiellen Wirkstoffen in Kombination mit ihrer systemischen Verabreichung implantatassoziierte muskuloskelettale Infektionen besser bekämpfen kann. Der Vorteil der lokalen Antibiotika liegt in ihrer besonderen Pharmakokinetik mit initial hohen Antibiotikakonzentrationen am Implantationsort bei nur geringer systemischer Aufnahme.
BEHANDLUNGSZIEL
UNASSIGNED
Ziel der lokalen Anwendung ist der Schutz des körperfremden Materials direkt am Implantationsort vor Keimbesiedelung und Biofilmbildung (Prophylaxe) sowie die Unterstützung der Sanierung einer Infektion nach chirurgischem Debridement (Behandlung). Knochenzement ist dabei seit den Beobachtungen von Prof. Buchholz der am häufigsten verwendete lokale Wirkstoffträger.
ANWENDUNG
UNASSIGNED
In Infektfällen bestimmen dabei im Idealfall Chirurgen gemeinsam mit Mikrobiologen, Infektiologen oder klinischen Pharmazeuten auf der Basis des Keimnachweises und Antibiogramms, welche antiinfektiven Wirkstoffe systemisch und welche mit PMMA-Zement lokal für den Patienten indiziert sind. Allerdings besteht für die mit dem Knochenzement verabreichten Antiinfektiva nach wie vor Unsicherheit darüber, welche Wirkstoffe in welchen Konzentrationen diesem Trägermaterial zugemischt werden können. Entsprechend fassen die Autoren dieses Übersichtsartikels nicht nur die Rationale und die Evidenz des lokalen Antibiotikaeinsatzes zusammen, sondern führen auch aus, welche Punkte für die Zumischung dieser Wirkstoffe zum Zement beachtet werden müssen.
Autres résumés
Type: Publisher
(ger)
HINTERGRUND: Es besteht weitgehend Konsens darüber, dass der adjuvante lokale Einsatz von antimikrobiellen Wirkstoffen in Kombination mit ihrer systemischen Verabreichung implantatassoziierte muskuloskelettale Infektionen besser bekämpfen kann. Der Vorteil der lokalen Antibiotika liegt in ihrer besonderen Pharmakokinetik mit initial hohen Antibiotikakonzentrationen am Implantationsort bei nur geringer systemischer Aufnahme.
Identifiants
pubmed: 37831092
doi: 10.1007/s00132-023-04447-6
pii: 10.1007/s00132-023-04447-6
doi:
Substances chimiques
Anti-Bacterial Agents
0
Bone Cements
0
Anti-Infective Agents
0
Types de publication
English Abstract
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Pagination
981-991Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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