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Güzel Y, Golge UH, Goksel F, Vural A, Akcay M, Elmas S, Turkon H, Unver A. The Efficacy of Boric Acid Used to Treat Experimental Osteomyelitis Caused by Methicillin-Resistant Staphylococcus aureus: an In Vivo Study. Biol Trace Elem Res 2016; 173:384-9. [PMID: 26961291 DOI: 10.1007/s12011-016-0662-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
We explored the ability of local and systemic applications of boric acid (BA) to reduce the numbers of methicillin-resistant Staphylococcus aureus (MRSA) in a rat model of tibial osteomyelitis (OM), and compared boric acid with vancomycin (V). Implant-associated osteomyelitis was established in 35 rats. After 4 weeks, at which time OM was evident both radiologically and serologically in all animals, the rats were divided into five groups of equal number: group 1, control group (no local application of BA or other medication); group 2, V group; group 3, local BA + V group; group 4, local BA group; and group 5, local + systemic BA group. Serum total antioxidant status, and the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6, were measured. Pathological changes attributable to bone OM were evaluated using a grading system. Bacterial colony-forming units (CFUs) per gram of bone were counted. The lowest bacterial numbers were evident in group 3, and the bacterial numbers were significantly lower than that of the control group in all four test groups (p < 0.001). Group 3 also had the least severe bone infection (OM score 1.7 ± 1.1, p < 0.05). Upon histological and microbiological evaluation, no significant difference was evident between groups 2 and 3. Total antioxidant levels were significantly different in all treatment groups compared to the control group. Microbiological and histopathological evaluation showed that systemic or local application of BA was effective to treat OM, although supplementary V increased the effectiveness of BA.
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Moghaddam A, Graeser V, Westhauser F, Dapunt U, Kamradt T, Woerner SM, Schmidmaier G. Patients' safety: is there a systemic release of gentamicin by gentamicin-coated tibia nails in clinical use? Ther Clin Risk Manag 2016; 12:1387-93. [PMID: 27660456 PMCID: PMC5019425 DOI: 10.2147/tcrm.s107398] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Osteitis is one of the most serious complications in orthopedic surgery. Expert Tibia Nail (ETN) PROtect™ coated with a biodegradable layer of gentamicin-laden polymer was developed for prophylaxis of osteomyelitis. In systemic administration, gentamicin has only a small therapeutic index and serious side effects; it is potentially nephrotoxic as well as ototoxic. It is not yet known if relevant gentamicin concentrations are released into the systemic circulation after implantation of gentamicin-coated nails. In order to evaluate the patients' risks profiles and increase patient safety, we measured gentamicin levels in pre- and postoperative serum samples of patients undergoing implantation of ETN PROtect. METHODS Twenty-five patients who received ETN PROtect between March 2012 and August 2014 were included in this study. Collection of blood samples occurred before the operation, at weeks 1-4, 3 and 6 months, and up to 1 year after the implantation. Measurement of gentamicin levels in serum samples was performed at the central laboratory of Heidelberg University Hospital. Additionally, laboratory parameters, C-reactive protein, leukocyte number, urea and creatinine concentrations were analyzed in routine controls before and after operating and assessed for systemic side effects. RESULTS Over the course of this prospective observational study, we were able to determine that gentamicin-coated nails do not release gentamicin into the systemic circulation above the lowest detectable level of 0.2 mg/dL. There were slight increases in the mean inflammation and renal retention markers, but no gentamicin-associated side effects could be linked to implantation. Furthermore, no allergic reactions could be detected during our study. CONCLUSION Our findings suggest that there is no relevant release of gentamicin into the systemic circulation causing a systemic effect, and serious side effects due to gentamicin-coated tibia nails should not be feared. Postoperative monitoring of renal function does not seem necessary because of the implantation of ETN PROtect.
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Affiliation(s)
- Arash Moghaddam
- HTRG - Heidelberg Traume Research Group Center for Orthopedics, Trauma and Spinal Cord Injury, University Hospital Heidelberg, Heidelberg, Germany
| | - Viola Graeser
- HTRG - Heidelberg Traume Research Group Center for Orthopedics, Trauma and Spinal Cord Injury, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabian Westhauser
- HTRG - Heidelberg Traume Research Group Center for Orthopedics, Trauma and Spinal Cord Injury, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Dapunt
- HTRG - Heidelberg Traume Research Group Center for Orthopedics, Trauma and Spinal Cord Injury, University Hospital Heidelberg, Heidelberg, Germany
| | - Till Kamradt
- HTRG - Heidelberg Traume Research Group Center for Orthopedics, Trauma and Spinal Cord Injury, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan M Woerner
- Department of Internal Medicine and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Gerhard Schmidmaier
- HTRG - Heidelberg Traume Research Group Center for Orthopedics, Trauma and Spinal Cord Injury, University Hospital Heidelberg, Heidelberg, Germany
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Surdu-Bob CC, Coman C, Barbuceanu F, Turcu D, Bercaru N, Badulescu M. The influence of foreign body surface area on the outcome of chronic osteomyelitis. Med Eng Phys 2016; 38:870-6. [DOI: 10.1016/j.medengphy.2016.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/04/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
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Gentamicin coating of plasma chemical oxidized titanium alloy prevents implant-related osteomyelitis in rats. Biomaterials 2016; 101:156-64. [PMID: 27294535 DOI: 10.1016/j.biomaterials.2016.05.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/24/2016] [Indexed: 01/15/2023]
Abstract
Implant related infection is one of the most feared and devastating complication associated with the use of orthopaedic implant devices. Development of anti-infective surfaces is the main strategy to prevent implant contamination, biofilm formation and implant related osteomyelitis. A second concern in orthopaedics is insufficient osseointegration of uncemented implant devices. Recently, we reported on a macroporous titanium-oxide surface (bioactive TiOB) which increases osseointegration and implant fixation. To combine enhanced osseointegration and antibacterial function, the TiOB surfaces were, in addition, modified with a gentamicin coating. A rat osteomyelitis model with bilateral placement of titanium alloy implants was employed to analyse the prophylactic effect of gentamicin-sodiumdodecylsulfate (SDS) and gentamicin-tannic acid coatings in vivo. 20 rats were randomly assigned to four groups: (A) titanium alloy; PBS inoculum (negative control), (B) titanium alloy, Staphylococcus aureus inoculum (positive control), (C) bioactive TiOB with gentamicin-SDS and (D) bioactive TiOB plus gentamicin-tannic acid coating. Contamination of implants, bacterial load of bone powder and radiographic as well as histological signs of implant-related osteomyelitis were evaluated after four weeks. Gentamicin-SDS coating prevented implant contamination in 10 of 10 tibiae and gentamicin-tannic acid coating in 9 of 10 tibiae (infection prophylaxis rate 100% and 90% of cases, respectively). In Group (D) one implant showed colonisation of bacteria (swab of entry point and roll-out test positive for S. aureus). The interobserver reliability showed no difference in the histologic and radiographic osteomyelitis scores. In both gentamicin coated groups, a significant reduction of the histological osteomyelitis score (geometric mean values: C = 0.111 ± 0.023; D = 0.056 ± 0.006) compared to the positive control group (B: 0.244 ± 0.015; p < 0.05) was observed. The radiographic osteomyelitis scores confirmed these histological findings.
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55
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Constantino JA, Delgado-Rastrollo M, Pacha-Olivenza MA, González-Martín ML, Quiles M, Pérez-Giraldo C, Bruque JM, Gallardo-Moreno AM. In vivo bactericidal efficacy of the Ti6Al4V surface after ultraviolet C treatment. J Orthop Traumatol 2016; 18:59-67. [PMID: 27137674 PMCID: PMC5310995 DOI: 10.1007/s10195-016-0407-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 04/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background Biomaterial-associated infections are one of the most important complications in orthopedic surgery. The main goal of this study was to demonstrate the in vivo bactericidal effect of ultraviolet (UV) irradiation on Ti6Al4V surfaces. Materials and methods An experimental model of device-related infections was developed by direct inoculation of Staphylococcus aureus into the canal of both femurs of 34 rats. A UV-irradiated Ti6Al4V pin was press-fit into the canal by retrograde insertion in one femur and the control pin was inserted into the contralateral femur. To assess the efficacy of UV radiation, the mean colony counts after inoculation in the experimental subjects and the control group were compared at different times of sacrifice and at different inoculum doses. Results At 72 h, the mean colony counts after inoculation in experimental femurs were significantly lower than those of the control group, with a reduction percentage of 76 % (p = 0.041). A similar difference between control and experimental pins was observed at 24 h using an inoculum dose <104 colony-forming units (CFU), for which the reduction percentage was 70.48 % (p = 0.017). Conclusion The irradiated surface of Ti6Al4V is able to reduce early bacterial colonization of Ti6AlV pins located in the medullar channel and in the surrounding femur. The reductions depend on the initial inoculums used to cause infection in the animals and the greatest effects are detected for inoculums <104 CFU. Level of evidence Not applicable.
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Affiliation(s)
- Juan A Constantino
- Orthopaedic and Traumatic Service, Complejo Hospitalario Universitario de Badajoz, Avenida Tellez Lafuente s/n, 06010, Badajoz, Spain.
| | - María Delgado-Rastrollo
- Department of Biomedical Sciences, Microbiology Area, Faculty of Medicine, University of Extremadura, Avda de Elvas s/n, 06006, Badajoz, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain
| | - Miguel A Pacha-Olivenza
- Department of Applied Physics, Faculty of Science, University of Extremadura, Avda de Elvas s/n, 06006, Badajoz, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain
| | - M Luisa González-Martín
- Department of Applied Physics, Faculty of Science, University of Extremadura, Avda de Elvas s/n, 06006, Badajoz, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain
| | - Manuel Quiles
- Orthopaedic and Traumatic Service, Complejo Hospitalario Universitario de Badajoz, Avenida Tellez Lafuente s/n, 06010, Badajoz, Spain
| | - C Pérez-Giraldo
- Department of Biomedical Sciences, Microbiology Area, Faculty of Medicine, University of Extremadura, Avda de Elvas s/n, 06006, Badajoz, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain
| | - José M Bruque
- Department of Applied Physics, Faculty of Science, University of Extremadura, Avda de Elvas s/n, 06006, Badajoz, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain
| | - Amparo M Gallardo-Moreno
- Department of Applied Physics, Faculty of Science, University of Extremadura, Avda de Elvas s/n, 06006, Badajoz, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Badajoz, Spain
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Harrasser N, Gorkotte J, Obermeier A, Feihl S, Straub M, Slotta-Huspenina J, von Eisenhart-Rothe R, Moser W, Gruner P, de Wild M, Gollwitzer H, Burgkart R. A new model of implant-related osteomyelitis in the metaphysis of rat tibiae. BMC Musculoskelet Disord 2016; 17:152. [PMID: 27060078 PMCID: PMC4826501 DOI: 10.1186/s12891-016-1005-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
Background Animal models serve as an important tool to understand peri-implant infection. Most of the models use high bacterial loads (>104 colony forming units, CFU) to provide high infection rates. Therefore these animals evolve rather similarly, making comparison between groups and statistical analysis possible. On the other hand, to mimic clinical constellation of surgery-related infections the use of low amounts of bacteria would be more advantageous. Methods We developed a metaphyseal rat model of peri-implant bone infection with low amount of bacterial loads (102 and 103 CFU of Staphylococcus aureus) and investigated osseointegration of the implants coated with hydroxyapatite (HA) and low-dosed HA-silver (HA-Ag). Non-infected implants served as controls. After 6 weeks rats were sacrificed and implants evaluated for osseointegration and infection. Results Infection of implanted devices was reliably induced, independently whether 102 or 103 CFU of S. aureus were inoculated and HA or HA-Ag coated implants were used. No systemic infection was present in any of the animals at the time of sacrifice, and no animal developed acute infection requiring premature sacrifice. All CFU counts of the implant and the bone at sacrifice were significantly higher than the inoculated load (p < .05). All sterilely inserted implants showed excellent osseointegration and no infection. Conclusions Our present study of a rat tibia model reliably induced osteomyelitis in the metaphysis with low-doses of bacteria. The addition of low-dosed Ag to the implant coating was not able to reduce the infection rates. The results demonstrate that it is possible to develop a model of implant-related osteomyelitis in rats with low amounts of bacteria to better mimic clinical constellations. No other promoters of infection besides insertion of the screw implant were used in this model.
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Affiliation(s)
- Norbert Harrasser
- Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Johannes Gorkotte
- Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Obermeier
- Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Susanne Feihl
- Institute for Medical Microbiology and Immunology, Technical University of Munich, Trogerstr. 30, 81675, Munich, Germany
| | - Melanie Straub
- Institute of Pathology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Julia Slotta-Huspenina
- Institute of Pathology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ruediger von Eisenhart-Rothe
- Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Walter Moser
- Atesos medical AG, Schachenallee 29, CH-5000, Aarau, Switzerland
| | - Philipp Gruner
- Medicoat AG, Almuesenacherstrasse 2a, CH-5506, Maegenwil, Switzerland
| | - Michael de Wild
- University of Applied Sciences and Arts Northwestern Switzerland (FHNW), School of Life Sciences, CH-4132, Muttenz, Switzerland
| | - Hans Gollwitzer
- Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,ATOS Clinic, Effnerstr.38, 81925, Munich, Germany
| | - Rainer Burgkart
- Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Fölsch C, Federmann M, Lakemeier S, Kuehn KD, Kittinger C, Kerwat M, Fuchs-Winkelmann S, Paletta JRJ, Roessler PP. Systemic antibiotic therapy does not significantly improve outcome in a rat model of implant-associated osteomyelitis induced by Methicillin susceptible Staphylococcus aureus. Arch Orthop Trauma Surg 2016; 136:585-92. [PMID: 26873243 DOI: 10.1007/s00402-016-2419-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Treatment of implant-associated osteomyelitis regularly involves the use of systemic antibiotics in addition to surgical intervention. However, it remains unclear if perioperative systemic application of bactericide substances can improve overall outcome in models of severe intramedullary infection. The present study investigated the use of systemic gentamicin in addition to a controlled local release from a highly lipophilic gentamicinpalmitate compound while the previous study showed efficacy of sole antibiotic implant-coating. METHODS Forty male Sprague-Dawley rats were divided into two groups receiving an intramedullary femoral injection of 10(2) CFU of a common methicillin susceptible Staphylococcus aureus strain (MSSA Rosenbach). Group I received an uncoated implant whereas group II received a coated implant. All animals received a single shot intraperitoneal application of gentamicinsulfate directly after wound closure while the historical control group III (n = 20) had no antibiotic treatment at all. Animals were observed for 28 and 42 days. Serum haptoglobin and relative weight gain were assessed as well as roll over cultures of explanted femur nails and histological scores of periprosthetic infection in dissected femora. RESULTS Systemic application of gentamicin combined with antibiotic-coated implant did not further reduce bacterial growth significantly compared with systemic or local antibiotic application alone. Combined local and systemic therapy reduced serum haptoglobin significantly after day 7, 28 and 42 whereas systemic application alone did not compare to controls. CONCLUSIONS Systemic perioperative and implant-associated application of antibiotics were both comparably effective to treat implant-associated infections whereas the combined antibiotic therapy further reduced systemic signs of infection time dependent.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopaedic Surgery, University Hospital Gießen, Marburg, Germany.,Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - Maike Federmann
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - Stefan Lakemeier
- Department of Orthopaedics, University Hospital Goettingen, Göttingen, Germany
| | - Klaus D Kuehn
- Department of Orthopaedics and Orthopaedic Surgery, Medical University of Graz, Graz, Austria
| | - Clemens Kittinger
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Martina Kerwat
- Institute of Medical Microbiology and Hygiene, Philipps-University Marburg, Marburg, Germany
| | | | - Jürgen R J Paletta
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - Philip P Roessler
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany. .,Department of Orthopaedics and Traumatology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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Wagner JM, Zöllner H, Wallner C, Ismer B, Schira J, Abraham S, Harati K, Lehnhardt M, Behr B. Surgical Debridement Is Superior to Sole Antibiotic Therapy in a Novel Murine Posttraumatic Osteomyelitis Model. PLoS One 2016; 11:e0149389. [PMID: 26872128 PMCID: PMC4752466 DOI: 10.1371/journal.pone.0149389] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Bone infections after trauma, i.e. posttraumatic osteomyelitis, pose one of the biggest problems of orthopedic surgery. Even after sufficient clinical therapy including vast debridement of infected bone and antibiotic treatment, regeneration of postinfectious bone seems to be restricted. One explanation includes the large sized defects resulting from sufficient debridement. Furthermore, it remains unclear if inflammatory processes after bone infection do affect bone regeneration. For continuing studies in this field, an animal model is needed where bone regeneration after sufficient treatment can be studied in detail. Methods For this purpose we created a stable infection in murine tibiae by Staphylococcus aureus inoculation. Thereafter, osteomyelitic bones were debrided thoroughly and animals were subsequently treated with antibiotics. Controls included debrided, non-infected, as well as infected animals exclusively treated with antibiotics. To verify sufficient treatment of infected bone, different assessments detecting S. aureus were utilized: agar plates, histology and RT-qPCR. Results All three detection methods revealed massive reduction or eradication of S. aureus within debrided bones 1 and 2 weeks postoperatively, whereas sole antibiotic therapy could not provide sufficient treatment of osteomyelitic bones. Debrided, previously infected bones showed significantly decreased bone formation, compared to debrided, non-infected controls. Discussion Thus, the animal model presented herein provides a reliable and fascinating tool to study posttraumatic osteomyelitis for clinical therapies.
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Affiliation(s)
| | - Hannah Zöllner
- Department of Plastic Surgery, BG Bergmannsheil Bochum, Ruhr-University of Bochum, Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, BG Bergmannsheil Bochum, Ruhr-University of Bochum, Bochum, Germany
| | - Britta Ismer
- Department of Plastic Surgery, BG Bergmannsheil Bochum, Ruhr-University of Bochum, Bochum, Germany
| | - Jessica Schira
- Department of Plastic Surgery, BG Bergmannsheil Bochum, Ruhr-University of Bochum, Bochum, Germany
| | - Stephanie Abraham
- Department of Plastic Surgery, BG Bergmannsheil Bochum, Ruhr-University of Bochum, Bochum, Germany
| | - Kamran Harati
- Department of Plastic Surgery, BG Bergmannsheil Bochum, Ruhr-University of Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG Bergmannsheil Bochum, Ruhr-University of Bochum, Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG Bergmannsheil Bochum, Ruhr-University of Bochum, Bochum, Germany
- * E-mail:
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59
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Oh EJ, Oh SH, Lee IS, Kwon OS, Lee JH. Antibiotic-eluting hydrophilized PMMA bone cement with prolonged bactericidal effect for the treatment of osteomyelitis. J Biomater Appl 2016; 30:1534-44. [DOI: 10.1177/0885328216629823] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteomyelitis is still considered to be one of the major challenges for orthopedic surgeons despite advanced antiseptic surgical procedures and pharmaceutical therapeutics. In this study, hydrophilized poly(methyl methacrylate) (PMMA) bone cements containing Pluronic F68 (EG79PG28EG79) as a hydrophilic additive and vancomycin ( F68-VA cements) were prepared to allow the sustained release of the antibiotic for adequate periods of time without any significant loss of mechanical properties. The compressive strengths of the bone cements with Pluronic F68 compositions less than 7 wt% were not significantly different compared with the control vancomycin-loaded bone cement ( VA cement). The F68 (7 wt%)-VA cement showed sustained release of the antibiotic for up to 11 weeks and almost 100% release from the bone cement. It also prohibited the growth of S. aureus (zone of inhibition) over six weeks (the required period to treat osteomyelitis), and it did not show any notable cytotoxicity. From an animal study using a femoral osteomyelitis rat model, it was observed that the F68 (7 wt%)-VA cement was effective for the treatment of osteomyelitis, probably as a result of the prolonged release of antibiotic from the PMMA bone cement. On the basis of these findings, it can be suggested that the use of Pluronic F68 as a hydrophilic additive for antibiotic-eluting PMMA bone cement can be a promising strategy for the treatment of osteomyelitis.
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Affiliation(s)
- Eun Jo Oh
- Department of Advanced Materials, Hannam University, Daejeon, Republic of Korea
| | - Se Heang Oh
- Department of Nanobiomedical Science, Dankook University, Cheonan, Republic of Korea
| | - In Soo Lee
- Department of Biotechnology, Hannam University, Daejeon, Republic of Korea
| | - Oh Soo Kwon
- Department of Orthopedics, Catholic University Hospital, Daejeon, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials, Hannam University, Daejeon, Republic of Korea
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60
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Zhao Y, Cao H, Wang J, Qin H, Li B, Wang D, Meng F, Zhang X, Liu X. Restoring the osteogenic activity of bacterial debris contaminated titanium by doping with magnesium. RSC Adv 2016. [DOI: 10.1039/c6ra11854b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bacterial debris can impair the osseointegration of implants and co-doping with magnesium and silver is a promising method to solve this issue.
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Affiliation(s)
- Yaochao Zhao
- Department of Orthopedics
- Shanghai Sixth People's Hospital
- Shanghai Jiao Tong University
- Shanghai 200233
- China
| | - Huiliang Cao
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
| | - Jiaxing Wang
- Department of Orthopedics
- Shanghai Sixth People's Hospital
- Shanghai Jiao Tong University
- Shanghai 200233
- China
| | - Hui Qin
- Department of Orthopedics
- Shanghai Sixth People's Hospital
- Shanghai Jiao Tong University
- Shanghai 200233
- China
| | - Bin Li
- Department of Orthopedics
- Shanghai Sixth People's Hospital
- Shanghai Jiao Tong University
- Shanghai 200233
- China
| | - Donghui Wang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
| | - Fanhao Meng
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
| | - Xianlong Zhang
- Department of Orthopedics
- Shanghai Sixth People's Hospital
- Shanghai Jiao Tong University
- Shanghai 200233
- China
| | - Xuanyong Liu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai 200050
- China
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61
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Lovati AB, Bottagisio M, de Vecchi E, Gallazzi E, Drago L. Animal Models of Implant-Related Low-Grade Infections. A Twenty-Year Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 971:29-50. [PMID: 27718217 DOI: 10.1007/5584_2016_157] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The demand for joint replacement and surgical treatment is continuously increasing, thus representing a clinical burden and a cost for the healthcare system. Among several pathogens involved in implant-related infections, staphylococci account for the two-thirds of clinically isolated bacteria. Despite most of them are highly virulent microorganisms (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa), low virulent bacteria (Staphylococcus epidermidis, Propionibacterium acnes) are responsible for delayed, low-grade infections without specific clinical signs and hardly distinguishable from aseptic prosthetic failure. Therefore, there is a real need to study the pathogenesis of orthopedic infections through in vivo animal models. The present review of the literature provides a 20-year overview of animal models of acute, subclinical or chronic orthopedic infections according to the pathogen virulence and inocula. Through this analysis, a great variety of conditions in terms of bacterial strains and inocula emerged, thus encouraging the development of more reproducible in vivo studies to provide relevant information for a translational approach to humans.
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Affiliation(s)
- Arianna Barbara Lovati
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.
| | - Marta Bottagisio
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.,Department of Veterinary Medicine, University of Milan, via Celoria 10, 20133, Milan, Italy
| | - Elena de Vecchi
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy
| | - Enrico Gallazzi
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy
| | - Lorenzo Drago
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Science for Health, University of Milan, via L. Mangiagalli 31, 20133, Milan, Italy
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Helbig L, Guehring T, Rosenberger S, Ivanova A, Kaeppler K, Fischer CA, Moghaddam A, Schmidmaier G. A new animal model for delayed osseous union secondary to osteitis. BMC Musculoskelet Disord 2015; 16:362. [PMID: 26585516 PMCID: PMC4653915 DOI: 10.1186/s12891-015-0816-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/12/2015] [Indexed: 12/03/2022] Open
Abstract
Background The treatment of infection-related delayed bone unions is still very challenging for the orthopedic surgeon. The prevalence of such infection-related types of osteitis is high in complex fractures, particularly in open fractures with extensive soft-tissue damage. The aim of this study was to develop a new animal model for delayed union due to osteitis. Methods After randomization to infected or non-infected groups 20 Sprague–Dawley rats underwent a transverse fracture of the midshaft tibia. After intramedullary inoculation with staphylococcus aureus (103 CFU) fracture stabilization was done by intramedullary titanium K-wires. After 5 weeks all rats were euthanized and underwent biomechanical testing to evaluate bone consolidation or delayed union, respectively. Micro-CT scans were additionally used to quantitatively evaluate the callus formation by the score of Lane and Sandhu. Blood samples were taken to analyze infectious disease markers (day 1, 14 and 35). Results Biomechanical testing showed a significant higher maximum torque in the non-infected group 5 weeks postoperatively compared with the infected group (p < 0.001). According to the Lane and Sandhu score a significantly higher callus formation was found in the non-infected group (p < 0.001). Similarly, the leucocyte count in the infected group was significantly higher than in the non-infected group (p < 0.05). Conclusions Here we have established a new animal model for delayed osseous union secondary to osteitis. The animal model appears to be appropriate for future experimental studies to test new therapeutic strategies in these difficult to treat bone healing complications.
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Affiliation(s)
- Lars Helbig
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Thorsten Guehring
- Klinik für Unfallchirurgie und Orthopädie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
| | - Svenja Rosenberger
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Adriana Ivanova
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Kathrin Kaeppler
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Christian Alexander Fischer
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Arash Moghaddam
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Gerhard Schmidmaier
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Bilgili F, Balci HI, Karaytug K, Sariyilmaz K, Atalar AC, Bozdag E, Tuna M, Bilgic B, Gurler N. Can Normal Fracture Healing Be Achieved When the Implant Is Retained on the Basis of Infection? An Experimental Animal Model. Clin Orthop Relat Res 2015; 473:3190-6. [PMID: 25981711 PMCID: PMC4562922 DOI: 10.1007/s11999-015-4331-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Infection after open fractures is a common complication. Treatment options for infections developed after intramedullary nailing surgery remain a topic of controversy. We therefore used a rat fracture model to evaluate the effects of infection on osseous union when the implant was maintained. QUESTIONS/PURPOSES In a rat model, (1) does infection alter callus strength; (2) does infection alter the radiographic appearance of callus; and (3) does infection alter the histological properties of callus? METHODS An open femoral fracture was created and fixed with an intramedullary Kirschner wire in 72 adult male Sprague-Dawley rats, which were divided into two study groups. In the infection group, the fracture site was contaminated with Staphylococcus aureus (36 animals), whereas in the control group, there was no bacterial contamination (36 animals). No antibiotics were used either for prophylaxis or for treatment. We performed biomechanical (maximum torque causing failure and stiffness), radiographic (Lane and Sandhu scoring for callus formation), and histologic (scoring for callus maturity) assessments at 3 and 6 weeks. The number of bacteria colonies on the femur, wire, and soft tissue inside knee were compared to validate that we successfully created an infection model. The number of bacteria colonies in the soft tissue inside the knee was higher in the infection group after 6 weeks than after the third week, demonstrating the presence of locally aggressive infection. RESULTS Infection decreased callus strength at 6 weeks. Torque to failure (299.07 ± 65.53 Nmm versus 107.20 ± 88.81, mean difference with 95% confidence interval, 192 [43-340]; p = 0.007) and stiffness at 6 weeks (11.28 ± 2.67 Nmm versus 2.03 ± 1.68, mean difference with 95% confidence interval, 9 [3-16]; p = 0.004) both were greater in the control group than in the group with infection. Radiographic analysis at 6 weeks demonstrated the fracture line was less distinct (Lane and Sandhu score of 2-3) in the infection group and complete union was observed (Lane and Sandhu score of 3-4) in the control group (p = 0.001). Semiquantitative histology scores were not different between the noninfected controls and the rats with infection (score 10 versus 9). CONCLUSIONS Retaining an implant in the presence of an underlying infection without antibiotic treatment leads to weaker callus and impedes callus maturation compared with noninfected controls in a rat model. Future studies might evaluate whether antibiotic treatment would modify this result. CLINICAL RELEVANCE This model sets the stage for further investigations that might study the influence of different interventions on fracture healing in implant-associated osteomyelitis. Future observational studies might also evaluate the histological properties of callus in patients with osteomyelitis.
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Affiliation(s)
- Fuat Bilgili
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Fatih/Capa, Istanbul, 34093, Turkey,
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Mesenchymal stromal cell implantation for stimulation of long bone healing aggravates Staphylococcus aureus induced osteomyelitis. Acta Biomater 2015; 21:165-77. [PMID: 25805108 DOI: 10.1016/j.actbio.2015.03.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/05/2015] [Accepted: 03/17/2015] [Indexed: 01/08/2023]
Abstract
Large bone defects requiring long-term osteosynthetic stabilization or repeated surgeries show a considerable rate of infection. Mesenchymal stromal cells (MSCs) have been successfully used to enhance bone regeneration, but their powerful immunomodulatory effects may impose an enhanced risk for osteomyelitis development. In order to unravel whether implantation of MSCs aggravates a simultaneous bone infection, a hydrogel-supported osteomyelitis ostectomy model was developed in which rats received a femoral bone defect with rigid plate-fixation. After fibrin-assisted transfer of Staphylococcus aureus (SA), effects of MSC implantation on osteomyelitis development were quantified over 3-4 weeks. All SA-infected animals developed an acute local osteomyelitis with significantly increased blood neutrophil count, abscess formation and bone destruction. MSC-treatment of infected defects aggravated osteomyelitis according to a significantly elevated osteomyelitis score and enhanced distal bone loss with spongy alteration of cortical bone architecture. Increased attraction of macrophages, osteoclasts and regulation of pro- and anti-inflammatory mediators were potential MSC actions. Overall trophic actions of MSCs implanted into non-sterile bone defects may enhance an infection and/or exacerbate osteomyelitis. Studies on antibiotic carrier augmentation or antibiotic treatment are warranted to decide whether MSC implantation is a safe and promising therapy for orthopedic implant-stabilized bone defects at high risk for development of infection.
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Zn/Ag micro-galvanic couples formed on titanium and osseointegration effects in the presence of S. aureus. Biomaterials 2015; 65:22-31. [PMID: 26141835 DOI: 10.1016/j.biomaterials.2015.06.040] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/18/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022]
Abstract
Titanium implants possessing simultaneous osseointegration and antibacterial ability are desirable. In this work, three types of Zn/Ag micro-galvanic couples are fabricated on titanium by plasma immersion ion implantation to investigate the osseointegration and antibacterial effects as well as the involved mechanisms. The in vitro findings disclose enhanced proliferation, osteogenic differentiation, and gene expressions of the rat bone mesenchymal stem cells (rBMSCs), as well as good antibacterial ability on all three micro-galvanic couples. Excellent antimicrobial ability is also observed in vivo and the micro-CT and histological results reveal notable osseointegration in vivo despite the presence of bacteria. The Zn/Ag micro-galvanic couple formed on Zn/Ag dual-ion co-implanted titanium shows the best osseointegration as well as good antibacterial properties in vivo obtained from a rabbit tibia model. The difference among the three Zn/Ag micro-galvanic couples can be ascribed to the contact between the Ag NPs and Zn film, which affects the corrosion process. Our results indicate that the biological behavior can be controlled by the corrosion process of the Zn/Ag micro-galvanic couples.
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Teixeira LEM, Soares GG, Teixeira HC, Takenaka IKTM, Diniz SOF, de Andrade MAP, Cardoso VN, de Araújo ID. Efficacy of (99m)Tc-Labeled Ceftizoxime in the Diagnosis of Subclinical Infections Associated with Titanium Implants in Rats. Surg Infect (Larchmt) 2015; 16:352-7. [PMID: 26046250 DOI: 10.1089/sur.2014.186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Metal implants are used frequently in orthopedic procedures and the occurrence of subclinical low-virulence infection is difficult to diagnose. The objective of this study was to examine the hypothesis that peri-prosthetic subclinical infections may be diagnosed effectively in a murine model system using scintigraphic imaging with (99m)Tc-labeled ceftizoxime. METHODS A sample population of 3-mo old Wistar rats (mean weight 327 g) was divided randomly into a control group (n=6), which received sterile implants, and an experimental group (n=6), which received implants contaminated with Staphylococcus aureus strain ATCC6538-P. Animals were anesthetized and femoral titanium implants were fixed beneath muscle tissue in left hind limbs. Three weeks after surgery, animals were injected with (99m)Tc-ceftizoxime solution (62.9 MBq) and scintigraphic images were obtained at 3.5 and 6.5 h after tracer injection. RESULTS According to the scintigraphic images, the radiopharmaceutical showed affinity for the operated thigh areas of experimental animals but not for those of the control group. There was no difference between the control and experimental groups regarding the amount of radioactivity in the regions of interest measured at 3.5 h after injection of radiolabeled antibiotic, but the between-group difference determined at 6.5 h after treatment was statistically significant (p=0.026). Moreover, the level of radioactivity recorded in resected thigh tissues derived from experimental animals was greater than that of the control group (p=0.035). CONCLUSION (99m)Tc-ceftizoxime scintigraphy can localize preferentially periprosthetic-infected areas adjacent to metal implants in a murine model. Furthermore, the radiolabeled antibiotic appears to be capable of detecting alterations in the micro-environment close to the implant and of reaching the bacteria attached to the implant surface.
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Affiliation(s)
- Luiz Eduardo Moreira Teixeira
- 1Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Guilherme Gontijo Soares
- 2Serviço de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Henrique Cembranelli Teixeira
- 2Serviço de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Valbert Nascimento Cardoso
- 3Departamento de Radioisótopos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ivana Duval de Araújo
- 4Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Fölsch C, Federmann M, Kuehn KD, Kittinger C, Kogler S, Zarfel G, Kerwat M, Braun S, Fuchs-Winkelmann S, Paletta JRJ, Roessler PP. Coating with a novel gentamicinpalmitate formulation prevents implant-associated osteomyelitis induced by methicillin-susceptible Staphylococcus aureus in a rat model. INTERNATIONAL ORTHOPAEDICS 2014; 39:981-8. [PMID: 25380688 DOI: 10.1007/s00264-014-2582-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/22/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Implant-associated osteomyelitis still represents a demanding challenge due to unfavourable biological conditions, bacterial properties and incremental resistance to antibiotic treatment. Therefore different bactericide or bacteriostatic implant coatings have been developed recently to control local intramedullary infections. Controlled local release of gentamicin base from a highly lipophilic gentamicin palmitate compound achieves extended intramedullary retention times and thus may improve its bactericide effect. METHODS Forty male Sprague-Dawley rats were divided into two groups receiving an intramedullary femoral injection of 10(2) colony-forming units (CFU) of a common methicillin susceptible Staphylococcus aureus strain (MSSA Rosenbach) and either an uncoated femur nail (Group I) or a nail coated with gentamicin palmitate (Group II). Animals were observed for 28 and 42 days. Serum haptoglobin and relative weight gain were assessed as well as rollover cultures of explanted femur nails and histological scores of periprosthetic infection in dissected femurs. RESULTS Implants coated with gentamicin palmitate significantly reduced periprosthetic bacterial growth as well as signs of systemic inflammation compared with uncoated implants. CONCLUSIONS Gentamicin palmitate appears to be a viable coating for the prevention of implant-associated infections. These findings will have to be confirmed in larger animal models as well as in clinical trials.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
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Qin H, Cao H, Zhao Y, Zhu C, Cheng T, Wang Q, Peng X, Cheng M, Wang J, Jin G, Jiang Y, Zhang X, Liu X, Chu PK. In vitro and in vivo anti-biofilm effects of silver nanoparticles immobilized on titanium. Biomaterials 2014; 35:9114-25. [PMID: 25112937 DOI: 10.1016/j.biomaterials.2014.07.040] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/23/2014] [Indexed: 01/09/2023]
Abstract
Prevention of periprosthetic infection (PPI) by inhibiting biofilm formation on prostheses is crucial to orthopedic surgery. In this work, silver nanoparticles (Ag NPs) are fabricated in situ and immobilized on titanium by silver plasma immersion ion implantation (PIII). The anti-biofilm activity rendered by the immobilized Ag NPs is assessed using Staphylococcus epidermidis, a biofilm producing strain, in vitro and in vivo. The immobilized Ag NPs show no apparent cytotoxicity but reduce biofilm formation in vitro by inhibiting bacteria adhesion and icaAD transcription. The immobilized Ag NPs offer a good defense against multiple cycles of bacteria attack in vitro, and the mechanism is independent of silver release. Radiographic assessment, microbiological cultures, and histopathological results demonstrate the ability of the functionalized surface against bacterial infection to reduce the risk of implant-associated PPI.
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Affiliation(s)
- Hui Qin
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Huiliang Cao
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Yaochao Zhao
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Cheng Zhu
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Tao Cheng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Qiaojie Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Xiaochun Peng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Mengqi Cheng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Jiaxin Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Guodong Jin
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Yao Jiang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Xianlong Zhang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Xuanyong Liu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China.
| | - Paul K Chu
- Department of Physics & Materials Science, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
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In vivo effect of quaternized chitosan-loaded polymethylmethacrylate bone cement on methicillin-resistant Staphylococcus epidermidis infection of the tibial metaphysis in a rabbit model. Antimicrob Agents Chemother 2014; 58:6016-23. [PMID: 25070107 DOI: 10.1128/aac.03489-14] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Infection of open tibial fractures with contamination remains a challenge for orthopedic surgeons. Local use of antibiotic-impregnated polymethylmethacrylate (PMMA) beads and blocks is a widely used procedure to reduce the risk of infection. However, the development of antibiotic-resistant organisms make the management of infection more difficult. Our in vitro study demonstrated that quaternized chitosan (hydroxypropyltrimethyl ammonium chloride chitosan [HACC])-loaded PMMA bone cement exhibits strong antibacterial activity toward antibiotic-resistant bacteria. Therefore, the present study aimed to investigate the in vivo antibacterial activity of quaternized chitosan-loaded PMMA. Twenty-four adult female New Zealand White rabbits were used in this study. The right proximal tibial metaphyseal cavity was prepared, 10(7) CFU of methicillin-resistant Staphylococcus epidermidis was inoculated, and PMMA-only, gentamicin-loaded PMMA (PMMA-G), chitosan-loaded PMMA (PMMA-C), or HACC-loaded PMMA (PMMA-H) bone cement cylinders were inserted. During the follow-up period, the infections were evaluated using X rays on days 21 and 42 and histopathological and microbiological analyses on day 42 after surgery. Radiographic indications of bone infections, including bone lysis, periosteal reactions, cyst formation, and sequestral bone formation, were evident in the PMMA, PMMA-G, and PMMA-C groups but not in the PMMA-H group. The radiographic scores and gross bone pathological and histopathological scores were significantly lower in the PMMA-H group than in the PMMA, PMMA-G, and PMMA-C groups (P < 0.05). Explant cultures also indicated significantly less bacterial growth in the PMMA-H group than in the PMMA, PMMA-G, and PMMA-C groups (P < 0.01). We concluded that PMMA-H bone cement can inhibit the development of bone infections in this animal model inoculated with antibiotic-resistant bacteria, thereby demonstrating its potential application for treatment of local infections in open fractures.
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Synergistic effects of dual Zn/Ag ion implantation in osteogenic activity and antibacterial ability of titanium. Biomaterials 2014; 35:7699-713. [PMID: 24947228 DOI: 10.1016/j.biomaterials.2014.05.074] [Citation(s) in RCA: 230] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/25/2014] [Indexed: 01/01/2023]
Abstract
Zinc (Zn) and silver (Ag) are co-implanted into titanium by plasma immersion ion implantation. A Zn containing film with Ag nanoparticles (Ag NPs) possessing a wide size distribution is formed on the surface and the corrosion resistance is improved due to the micro-galvanic couples formed by the implanted Zn and Ag. Not only are the initial adhesion, spreading, proliferation and osteogenic differentiation of rBMSCs observed from the Zn/Ag implanted Ti in vitro, but also bacteria killing is achieved both in vitro and in vivo. Electrochemical polarization and ion release measurements suggest that the excellent osteogenic activity and antibacterial ability of the Zn/Ag co-implanted titanium are related to the synergistic effect resulting from the long-range interactions of the released Zn ions and short-range interactions of the embedded Ag NPs. The Zn/Ag co-implanted titanium offers both excellent osteogenic activity and antibacterial ability and has large potential in orthopedic and dental implants.
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Reizner W, Hunter J, O’Malley N, Southgate R, Schwarz E, Kates S. A systematic review of animal models for Staphylococcus aureus osteomyelitis. Eur Cell Mater 2014; 27:196-212. [PMID: 24668594 PMCID: PMC4322679 DOI: 10.22203/ecm.v027a15] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Staphylococcus aureus (S. aureus) osteomyelitis is a significant complication for orthopaedic patients undergoing surgery, particularly with fracture fixation and arthroplasty. Given the difficulty in studying S. aureus infections in human subjects, animal models serve an integral role in exploring the pathogenesis of osteomyelitis, and aid in determining the efficacy of prophylactic and therapeutic treatments. Animal models should mimic the clinical scenarios seen in patients as closely as possible to permit the experimental results to be translated to the corresponding clinical care. To help understand existing animal models of S. aureus, we conducted a systematic search of PubMed and Ovid MEDLINE to identify in vivo animal experiments that have investigated the management of S. aureus osteomyelitis in the context of fractures and metallic implants. In this review, experimental studies are categorised by animal species and are further classified by the setting of the infection. Study methods are summarised and the relevant advantages and disadvantages of each species and model are discussed. While no ideal animal model exists, the understanding of a model's strengths and limitations should assist clinicians and researchers to appropriately select an animal model to translate the conclusions to the clinical setting.
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Affiliation(s)
| | | | | | | | | | - S.L. Kates
- Address for correspondence: Stephen L. Kates, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA,
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Bastari K, Arshath M, Ng ZHM, Chia JH, Yow ZXD, Sana B, Tan MFC, Lim S, Loo SCJ. A controlled release of antibiotics from calcium phosphate-coated poly(lactic-co-glycolic acid) particles and their in vitro efficacy against Staphylococcus aureus biofilm. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:747-57. [PMID: 24370968 DOI: 10.1007/s10856-013-5125-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 12/13/2013] [Indexed: 05/28/2023]
Abstract
Ceramic-polymer hybrid particles, intended for osteomyelitis treatment, were fabricated by preparing poly(lactic-co-glycolic acid) particles through an emulsion solvent evaporation technique, followed by calcium phosphate (CaP) coating via a surface adsorption-nucleation method. The presence of CaP coating on the surface of the particles was confirmed by scanning electron microscopy, energy-dispersive X-ray spectroscopy, and X-ray photoelectron spectroscopy. Subsequently, two antibiotics for treating bone infection, nafcillin (hydrophilic) and levofloxacin (amphiphilic), were loaded into these hybrid particles and their in vitro drug release studies were investigated. The CaP coating was shown to reduce burst release, while providing sustained release of the antibiotics for up to 4 weeks. In vitro bacterial study against Staphylococcus aureus demonstrated the capability of these antibiotic-loaded hybrid particles to inhibit biofilm formation as well as deteriorate established biofilm, making this hybrid system a potential candidate for further investigation for osteomyelitis treatment.
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Affiliation(s)
- Kelsen Bastari
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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Haenle M, Zietz C, Lindner T, Arndt K, Vetter A, Mittelmeier W, Podbielski A, Bader R. A model of implant-associated infection in the tibial metaphysis of rats. ScientificWorldJournal 2013; 2013:481975. [PMID: 24381519 PMCID: PMC3871506 DOI: 10.1155/2013/481975] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/18/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Implant-associated infections remain serious complications in orthopaedic and trauma surgery. A main scientific focus has thus been drawn to the development of anti-infective implant coatings. Animal models of implant-associated infections are considered helpful in the in vivo testing of new anti-infective implant coatings. The aim of the present study was to evaluate a novel animal model for generation of implant-associated infections in the tibial metaphysis of rats. MATERIALS AND METHODS A custom-made conical implant made of Ti6Al4V was inserted bilaterally at the medial proximal tibia of 26 female Sprague-Dawley rats. Staphylococcus aureus in amounts spanning four orders of magnitude and each suspended in 15 μ l phosphate buffered saline (PBS) was inoculated into the inner cavity of the implant after the implantation into the defined position. Controls were treated accordingly with PBS alone. Animals were then followed for six weeks until sacrifice. Implant-associated infection was evaluated by microbiological investigation using swabs and determination of viable bacteria in the bone around the implant and the biofilm on the implants after sonification. RESULTS Irrespective of the initial inoculum, all animals in the various groups harbored viable bacteria in the intraoperative swabs as well as the sonication fluid of the implant and the bone samples. No correlation could be established between initially inoculated CFU and population sizes on implant surfaces at sacrifice. However, a significantly higher viable count was observed from peri-implant bone samples for animals inoculated with 10(6) CFU. Macroscopic signs of animal infection (pus and abscess formation) were only observed for implants inoculated with at least 10(5) CFU S. aureus. DISCUSSION/CONCLUSION The results demonstrate the feasibility of this novel animal model to induce an implant-associated infection in the metaphysis of rats, even with comparatively low bacterial inocula. The specific design of the implant allows an application of bacteria in reproducible numbers at well-defined contact sites to the animal bone.
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Affiliation(s)
- Maximilian Haenle
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Carmen Zietz
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Tobias Lindner
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Kathleen Arndt
- Institute of Medical Microbiology, Virology and Hygiene, University Rostock, Schillingallee 70, 18057 Rostock, Germany
| | - Anika Vetter
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Andreas Podbielski
- Institute of Medical Microbiology, Virology and Hygiene, University Rostock, Schillingallee 70, 18057 Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
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Helbig L, Simank HG, Lorenz H, Putz C, Wölfl C, Suda AJ, Moghaddam A, Schmidmaier G, Guehring T. Establishment of a new methicillin resistant Staphylococcus aureus animal model of osteomyelitis. INTERNATIONAL ORTHOPAEDICS 2013; 38:891-7. [PMID: 24170130 DOI: 10.1007/s00264-013-2149-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/02/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The increase in methicillin-resistant Staphylococcus aureus (MRSA) infections is currently a major health care problem. Vancomycin is still often the first-line anti-microbiological agent for treating such infections; however, a recent decline in efficacy of vancomycin in MRSA infections has raised concerns and accelerated the search for new antibiotics. The aim of this study was to establish a MRSA peri-implant osteomyelitis animal model for future testing of new anti-microbiological agents under typical MRSA infection conditions. METHODS Eighteen randomised NZW-rabbits underwent a standardised surgical procedure with the insertion of a femoral bone implant. Animals were then divided into group 1 (MRSA inoculation, no antibiotics; M/N), group 2 (MRSA inoculation, Vancomyin; M/V), and group 3 (no MRSA inoculation, no antibiotics; N/N). The primary study outcome parameters were animal leucocyte count, animal weight, and animal body temperature at one, seven, and 42 days after surgery. Additionally, a histo-morphometrical score was established and adjusted to a modified histological Smeltzer score. RESULTS Macroscopic and histo-morphometrical findings showed a peri-implant osteomyelitis in group 1 with both increased acute and chronic infection parameters in M/N, as compared to M/V and N/N, indicating that vancomycin treatment prevented typical morphological changes of MRSA peri-implant osteomyelitis. Similarly, there was a reduction in animal weight and increase in leucocyte count and body temperature in group 1 (each p < 0.005). Vancomycin treatment again resulted in significantly reduced leucocyte count and body temperature, and increased animal body weight. CONCLUSIONS Here we have established a peri-implant MRSA osteomyelitis model that successfully combined clinical and laboratory outcome parameters of infection with histo-morphometrical results; this model appears to be valuable for future experimental use and therapeutic monitoring of new anti-microbiological MRSA drugs.
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Affiliation(s)
- Lars Helbig
- Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Heidelberg, Germany
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75
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Eardley WGP, Watts SA, Clasper JC. Modelling for conflict: the legacy of ballistic research and current extremity in vivo modelling. J ROY ARMY MED CORPS 2013; 159:73-83. [PMID: 23720587 DOI: 10.1136/jramc-2013-000074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Extremity ballistic injury is unique and the literature intended to guide its management is commonly misinterpreted. In order to care for those injured in conflict and conduct appropriate research, clinicians must be able to identify key in vivo studies, understand their weaknesses and desist the propagation of miscited and misunderstood ballistic dogma. This review provides the only inclusive critical overview of key studies of relevance to military extremity injury. In addition, the non-ballistic studies of limb injury, stabilisation and contamination that will form the basis from which future small animal extremity studies are constructed are presented. With an awareness of the legacy of military wound models and an insight into available generic models of extremity injury and contamination, research teams are well placed to optimise future military extremity injury management.
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Affiliation(s)
- William G P Eardley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Institute of Research and Development, Birmingham, UK.
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76
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Akiyama T, Miyamoto H, Yonekura Y, Tsukamoto M, Ando Y, Noda I, Sonohata M, Mawatari M. Silver oxide-containing hydroxyapatite coating has in vivo antibacterial activity in the rat tibia. J Orthop Res 2013; 31:1195-200. [PMID: 23589130 DOI: 10.1002/jor.22357] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 03/07/2013] [Indexed: 02/04/2023]
Abstract
Bacterial infection is a serious postoperative complication of joint replacement. To prevent infections related to implantation, we have developed a novel antibacterial coating with Ag-containing hydroxyapatite (Ag-HA). In the present study, we examined the antibacterial activity of Ag-HA implant coatings in the medullary cavity of rat tibiae. Forty 10-week-old rats received implantation of Ag-HA- or HA-coated titanium rods, then were inoculated with ∼1.0 × 10(2) colony-forming units of methicillin-resistant Staphylococcus aureus. Bacterial counts were calculated for rats euthanized at 24, 48, and 72 h postoperatively. Serum levels of Ag (in the Ag-HA group only) were calculated for rats euthanized at 24, 48, 72 h and 4 weeks. Radiographic evaluations of bone infection were also performed at 4 weeks. Tibiae from both groups showing infection were evaluated histologically. Significant differences in bacterial counts were seen at 24, 48, and 72 h. Mean concentrations of Ag in serum peaked about 48 h after implantation, then gradually decreased. Mean radiographic scores for infection were significantly lower with Ag-HA implants than with HA implants. Histological examination showed better results for abscesses, bone resorption, and destruction of cortical bone around Ag-HA-coated implants. These results indicate that Ag-HA coatings may help prevent surgical-site infections associated with joint replacement.
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Affiliation(s)
- Takayuki Akiyama
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan.
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Søe NH, Jensen NV, Nürnberg BM, Jensen AL, Koch J, Poulsen SS, Pier G, Johansen HK. A novel knee prosthesis model of implant-related osteomyelitis in rats. Acta Orthop 2013; 84:92-7. [PMID: 23409845 PMCID: PMC3584611 DOI: 10.3109/17453674.2013.773121] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE There have been numerous reports of animal models of osteomyelitis. Very few of these have been prosthesis models that imitate human conditions. We have developed a new rat model of implant-related osteomyelitis that mimics human osteomyelitis, to investigate the pathology of infection after orthopedic implant surgery. METHODS 2 wild-type strains of Staphylococcus aureus, MN8 and UAMS-1, and their corresponding mutants that are unable to produce poly-N-acetyl glucosamine (PNAG) (ica::tet) were injected into the medullary canals of the femur and tibia at 3 different doses: 10(2), 10(3), and > 10(4) CFU/rat. We measured clinical signs, inflammatory markers, radiographic signs, histopathology, and bacteriology in the infected animals. RESULTS An inoculum of at least 10(4) cfu of either wild-type bacterial strain resulted in histological, bacteriological, and radiographic signs of osteomyelitis with loosening of the prosthesis. An inoculum of 10(3) CFU gave signs of osteomyelitis but the prosthesis remained in situ. Bacterial inocula of 10(2) cfu gave no signs of osteolysis. INTERPRETATION We have established a new knee prosthesis model that is suitable for reliable induction of experimental implant-associated osteomyelitis with the prosthesis in situ, using a small inoculum of S. aureus. At a dose of 10(3) CFU/rat, bacteria unable to produce PNAG (ica::tet) had only minor defects in their virulence.
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Affiliation(s)
- Niels H Søe
- Hand Section, Department of Planned Surgery Z, Gentofte University Hospital
| | - Nina Vendel Jensen
- Department of Anaesthesiology, Intensive Care and Operations, Gentofte University Hospital
| | | | | | - Janne Koch
- Faculty of Health and Medical Science, University of Copenhagen
| | | | - Gerald Pier
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Helle Krogh Johansen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University, Denmark.
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78
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Cashman JD, Jackson JK, Mugabe C, Gilchrist S, Ball K, Tredwell S, Burt HM. The use of tissue sealants to deliver antibiotics to an orthopaedic surgical site with a titanium implant. J Orthop Sci 2013; 18:165-74. [PMID: 23096950 DOI: 10.1007/s00776-012-0325-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Orthopaedic surgery is associated with unacceptable infection rates that respond poorly to systemic antibiotics. The objective of this study was to use an animal model for orthopaedic implant infection to examine the ability of a new-generation fibrin tissue sealant to effectively deliver antibiotics to the surgical site. METHODS The antibiotics cefazolin, fusidic acid or 5-fluorouracil were blended into Vitagel tissue sealant. The release rate of the drugs was measured using HPLC methods and bioactivity was measured by the zone of inhibition method with pathogenic Staphylococcus aureus. The antibiotic activity of the drug-loaded sealant was then tested in rats using infected orthopaedic surgical sites (titanium clip on spine). Efficacy was evaluated by residual bacterial counts on clips, clinical observations of infection, and histological findings. RESULTS The drugs were released in a controlled manner over 2-4 days. All three antibiotics demonstrated strong antibacterial activity when released from the sealants. None of the treated animals demonstrated systemic illness. Post mortem dissection revealed a well-encapsulated abscess surrounding the titanium clip with erosion of the bony process. Using an inoculum of 1-5 × 10(3) CFU, treatment with antibiotic-loaded fibrin sealant demonstrated reduced infective swelling and reduced bacterial counts on surgical clip swabs compared to control rats or rats treated with antibiotic only. This model allowed for almost 100 % infectivity with a 0 % mortality rate due to infection, mimicking the clinical features of human implant infection. CONCLUSION The results support the use of antibiotic-loaded commercially available fibrin sealants to prevent infection after implant surgery.
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Affiliation(s)
- Johanne D Cashman
- Angiotech Pharmaceuticals, 1618 Station Street, Vancouver, BC V6A 1B6, Canada
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79
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Differentiation of septic and aseptic loosening by PET with both 11C-PK11195 and 18F-FDG in rat models. Nucl Med Commun 2012; 33:747-56. [PMID: 22513886 DOI: 10.1097/mnm.0b013e328353bbd3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aims to determine the value of PET with C-isoquinoline carboxamide (C-PK11195) and F-fluorodeoxyglucose (F-FDG) in assisting the differentiation of aseptic loosening (AL) from septic loosening (SL) in rat models. PROCEDURES Initially, the histological profiles of SL and AL (cellular infiltration and the number of CD68 macrophage and PBR cells) were compared. Subsequently, we investigated whether C-PK11195 alone and also in combination with F-FDG increases the sensitivity and specificity of PET imaging for distinguishing SL from AL. RESULTS There were distinguishable features between the histological profiles of the SL and AL rat groups. The number of CD68/PBR cells in AL rats was significantly higher than that seen in SL rats (P<0.05). The uptake of C-PK1195 was higher in AL and lower in SL rats. The uptake of F-FDG was higher in SL and lower in AL rats. CONCLUSION PET with a C-PK11195 and F-FDG imaging protocol is helpful in the clinical differential diagnosis of AL from SL.
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Preliminary study of anti-infective function of a copper-bearing stainless steel. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2012. [DOI: 10.1016/j.msec.2012.03.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Yang CJ, Li Q, Wu GC, Wang YQ, Mao-Ying QL. A practical model of osteomyelitis-induced bone pain by intra-tibial injection of Staphylococcus aureus in rats. Neurosci Lett 2012; 513:198-203. [DOI: 10.1016/j.neulet.2012.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/10/2012] [Accepted: 02/12/2012] [Indexed: 11/26/2022]
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Fuchs T, Stange R, Schmidmaier G, Raschke MJ. The use of gentamicin-coated nails in the tibia: preliminary results of a prospective study. Arch Orthop Trauma Surg 2011; 131:1419-25. [PMID: 21617934 PMCID: PMC3175046 DOI: 10.1007/s00402-011-1321-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND The use of antibiotic-coated implants may reduce the rate of infection and facilitate fracture healing after surgical treatment of tibial shaft fractures. A new biodegradable gentamicin-loaded coating of an implant (UTN PROtect) was CE-certified in August 2005. In this prospective, non-randomized case series, we investigated the clinical, laboratory and radiological outcomes of 21 patients who underwent surgical treatment in closed or open tibial fractures, as well as revisions with the UTN PROtect gentamicin-coated intramedullary nail. METHODS Of 21 patients (13 men, 8 women), 19 completed the 6-month follow-up. The study population included patients with complex tibial fractures and late revision cases. Clinical outcomes comprised adverse events, including infections and the SF-36 physical score. Laboratory outcomes, including C-reactive protein and leukocyte count as inflammatory markers, haemoglobin and serum gentamicin, were measured at baseline and up to 6 months post operatively. Radiographic assessments of fracture healing and weight-bearing capacity were determined at 5 weeks, 3 and 6 months after surgery. RESULTS No implant-related infections occurred; one patient had superficial wound healing problems. Mean C-reactive protein levels remained below 5 mg/L throughout the study, with a peak at 4-7 days after surgery (4.4 mg/L; range 0.5-16.1 mg/L). Leukocyte counts and haemoglobin levels did not vary over time during the study. The mean SF-36 physical score at 6 months was 42.6 (range 19.4-56.7). Radiographic union defined as three or four bridged cortices was achieved in 11 patients (58%) after 6 months. The remaining eight patients showed partial fracture healing with one or two bridged cortices. Additionally, 13 patients (68%) demonstrated full weight-bearing capacity after 6 months. CONCLUSIONS The use of the UTN PROtect intramedullary nail was associated with good clinical, laboratory and radiological outcomes after 6 months. These preliminary results support the use of gentamicin-coated implants as a new potential treatment option for the prevention of infection in trauma patients and in revision cases. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Thomas Fuchs
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Münster, Germany.
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83
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Patel M, Rojavin Y, Jamali AA, Wasielewski SJ, Salgado CJ. Animal models for the study of osteomyelitis. Semin Plast Surg 2011; 23:148-54. [PMID: 20567737 DOI: 10.1055/s-0029-1214167] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteomyelitis is an acute or chronic inflammatory process of the bone and its related structures secondary to an infection with pyogenic organisms. Because of the variety in disease presentations and pathophysiology of osteomyelitis, it is very difficult to evaluate in clinical studies. Therefore, animal models have been created for in vivo experimentation. A PubMed and OVID search was performed on March 31, 2008, using keywords osteomyelitis, animal model (rabbit, rat, mouse, avian, dog, sheep, and goat), and experimental osteomyelitis. The objective of this review was to provide a literature review of the animal models created to study osteomyelitis. The models were chosen based on historical relevance and clinical applicability. Numerous animal models exist to study both acute and chronic osteomyelitis. Many models have been created that allow investigators to study various aspects in the treatment and diagnosis of osteomyelitis. Based on the needs of investigators, an animal model must be carefully selected for ideal research, as no single model encompasses all aspects of osteomyelitis.
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Affiliation(s)
- Mitul Patel
- Department of Surgery, Cooper University Hospital, Robert Wood Johnson Medical School, Camden, New Jersey
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84
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Alt V, Lips KS, Henkenbehrens C, Muhrer D, Oliveira Cavalcanti MC, Sommer U, Thormann U, Szalay G, Heiss C, Pavlidis T, Domann E, Schnettler R. A new animal model for implant-related infected non-unions after intramedullary fixation of the tibia in rats with fluorescent in situ hybridization of bacteria in bone infection. Bone 2011; 48:1146-53. [PMID: 21281750 DOI: 10.1016/j.bone.2011.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/28/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
There is no adequate animal model to mimic the difficult clinical situation of infected non-union of the tibia after intramedullary stabilization. The purpose was to establish an animal model of implant-related infected non-unions of the tibia in rats. Furthermore, it was evaluated if detection of bacteria by fluorescent in situ hybridisation (FISH) technique is possible in bone infection. 17 rats were used in which osteotomy of the midshaft tibia was performed and stabilized with an intramedullary device. Two groups were tested: group 1: contamination of the osteotomy site with 10(4) colony forming units (CFUs) of Staphylococcus aureus (11 animals), group 2: no bacterial contamination (6 animals). The animals were sacrificed after 42 days and bone healing and infection were assessed clinically, by X-ray, micro-CT, and microbiological methods including FISH technique using EUB and STAPHY probes. Histology and scanning electron microscopy (SEM) for biofilm formation were performed. All animals of the control group showed uneventful bone healing after 6 weeks without any signs of local infections. 10 of 11 (90.9%) animals of group 1 with bacterial contamination exhibited infected non-union formation with positive clinical, radiological and microbiological infection signs of the tibia but without any systemic infection signs. FISH technique was able to identify bacteria in the infected bone. All intramedullary implants from the infected animals showed positive biofilm formation in SEM. This work presents the first animal model for the induction of intramedullary device-related infected non-union in the tibia and detection of bacteria by FISH technique in infected bone.
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MESH Headings
- Animals
- Biofilms
- Bone Diseases, Infectious/complications
- Bone Diseases, Infectious/diagnostic imaging
- Bone Diseases, Infectious/microbiology
- Bone Diseases, Infectious/pathology
- Disease Models, Animal
- Fracture Fixation, Intramedullary/adverse effects
- Fractures, Ununited/complications
- Fractures, Ununited/diagnostic imaging
- Fractures, Ununited/microbiology
- Fractures, Ununited/pathology
- In Situ Hybridization, Fluorescence
- Prosthesis-Related Infections/complications
- Prosthesis-Related Infections/diagnostic imaging
- Prosthesis-Related Infections/microbiology
- Prosthesis-Related Infections/pathology
- Rats
- Rats, Sprague-Dawley
- Staphylococcus aureus/cytology
- Staphylococcus aureus/physiology
- Staphylococcus aureus/ultrastructure
- Tibial Fractures/complications
- Tibial Fractures/diagnostic imaging
- Tibial Fractures/microbiology
- Tibial Fractures/pathology
- X-Ray Microtomography
- X-Rays
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Affiliation(s)
- Volker Alt
- Department of Trauma Surgery Giessen, University Hospital of Giessen-Marburg, Giessen, Germany.
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85
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Rabinovich M, Somayaji SN, Raghavan Pillai R, Hudson MC, Ellington JK, Bosse M, Horton J, Gonsalves KE. Active Polymer Nanoparticles: Delivery of Antibiotics. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-1019-ff05-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractAntibiotic-encapsulated PLA and PLGA nanoparticles were prepared by the single emulsion-solvent evaporation technique. Different PLA and PLGA systems were prepared, varying the copolymer composition and the amount of the surfactant polyvinyl alcohol. Characterization and drug loading studies were performed by UV-Visible spectrophotometry, dynamic light scattering, and scanning electron microscopy (SEM).Simultaneously, in order to model the diffusion of the nanoparticles within the osteoblast, QDs such as functionalized InGaP/ZnS and polymer encapsulated InGaP/ZnS nanoparticles were added to confluent cultures of primary mouse osteoblasts. Following PreFer fixation, cultures were examined via confocal microscopy. QDs were clearly visible within osteoblasts.
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86
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Robinson DA, Bechtold JE, Carlson CS, Evans RB, Conzemius MG. Development of a fracture osteomyelitis model in the rat femur. J Orthop Res 2011; 29:131-7. [PMID: 20602463 DOI: 10.1002/jor.21188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Osteomyelitis contributes significantly to fracture morbidity. Our objective was to develop a model of induced implant-associated osteomyelitis following fracture repair by modifying an existing rat femur fracture model. Thirty male Sprague-Dawley rats were divided into three groups (Control, Staphylococcus aureus, S. aureus + ceftriaxone). The closed femur fracture model (right femur), stabilized with an intramedullary pin, was combined with inoculation of 10(4) colony-forming units (CFU) of S. aureus. Radiographs were obtained immediately after surgery and at weeks 1, 2, and 3 and were evaluated by individuals blinded to treatment group. At necropsy the CFU of S. aureus per femur and pin were determined and synovial tissue and blood were cultured. The fractured femur from two rats in each group was evaluated histologically. A statistically significant difference in the CFU/femur and CFU/pin was found across treatment groups, with the highest CFU in the S. aureus group and the lowest in the Control group. Cultures of synovial tissue were positive in 11/19 of inoculated limbs. Osteomyelitis was present both radiographically and histopathologically in both S. aureus groups but not in the controls. No rats were systemically ill or had positive blood cultures at the study endpoint. This model will be useful for the evaluation of treatments or prophylactics designed for use in implant-associated osteomyelitis.
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Affiliation(s)
- Duane A Robinson
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, 1352 Boyd Avenue, St Paul, Minnesota 55108, USA
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87
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Vester H, Wildemann B, Schmidmaier G, Stöckle U, Lucke M. Gentamycin delivered from a PDLLA coating of metallic implants: In vivo and in vitro characterisation for local prophylaxis of implant-related osteomyelitis. Injury 2010; 41:1053-9. [PMID: 20541756 DOI: 10.1016/j.injury.2010.05.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 04/30/2010] [Accepted: 05/06/2010] [Indexed: 02/02/2023]
Abstract
Locally applied antibiotics support prophylaxis of highly feared implant associated infections. Implant coatings with poly(D,L-lactide) (PDLLA)/gentamicin seem to be a promising approach. Aims of this study were to analyse the release kinetics of gentamicin in vivo, in vitro, to analyse the antibacterial efficacy,the resistance development and its impact on osteoblasts. For the in vitro release experiments titanium implants were coated with PDLLA/gentamicin and the antibiotic release in aqueous solution was analysed at 20 time points (from 10 s to 110 days). For the in vivo experiments PDLLA/gentamicin-coated kirschner wires were implanted in the tibiae of 18 rats. Gentamicin concentration in the bone was analysed at several time points (n = 3 each, 1 h to 7 days). Bactericidal efficacy, bacterial adhesion on the implants and resistance development were tested. AP activity, cell count and CICP expression of osteoblasts were analysed. Gentamicin was released rapidly with an initial burst in aqueous solution and followed by a slow release. Similarly, in vivo gentamicin concentration reached a high peak initially followed by a decrease to a low level. No development of resistance was observed in the investigated setting, the antibacterial efficacy was not affected by the coating process and significantly fewer bacteria were attached to the implant. Osteoblasts were not negatively affected by the gentamicin released from the coating. PDLLA/gentamicin coating resulted in a desired antibiotic peak concentration within the bone. Bacterial adhesion was successfully prevented. No bacterial resistances were developed. This coating seems to be a suitable supplement for prophylaxis of implant-associated infections.
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Affiliation(s)
- Helen Vester
- Department of Traumatology, MRI, Klinikum rechts der lsar, Technische Universität München, Ismaningerstrasse 22, 81675 München, Germany.
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The use of a biodegradable, load-bearing scaffold as a carrier for antibiotics in an infected open fracture model. J Orthop Trauma 2010; 24:587-91. [PMID: 20736800 DOI: 10.1097/bot.0b013e3181ed1349] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Open fractures with bone loss are common, disabling injuries. Biodegradable, load-bearing scaffolds able to carry high concentrations of local antibiotics are an emerging technology to address these injuries. This study investigates the use of such scaffolds with gentamicin (along with bone morphogenetic protein) in an infected rat open fracture model to decrease osteomyelitis and promote fracture healing. METHODS A contaminated open fracture was created in 32 Brown Norway rats. A comminuted femoral fracture was created, followed by crushing, and the 5-mm bone defect was inoculated with Staphylococcus aureus (10 colony-forming units/mL) and Escherichia coli (10 colony-forming units/mL). The scaffold was stabilized in the defect with an intramedullary Kirschner wire. Gentamicin was loaded onto the scaffolds at two doses, either 10 mg (n = 12) or 20 mg (n = 10). Controls (n = 10) received no antibiotics. All three groups had 10 microg bone morphogenetic protein loaded on the scaffold. Serial radiographs were obtained. Microbiologic analysis, microcomputed tomography, and histology were performed. RESULTS There was a statistically significant difference in the radiographic evidence of osteomyelitis (P = 0.004) and callus formation (P = 0.021) between the treated and control groups. Bone culture analysis results were not significant for S. aureus (P = 0.29) or E. coli (P = 0.25). There was no difference in the mean scaffold volume or density of the three treatment groups. CONCLUSIONS Our results suggest that gentamicin applied to a biodegradable scaffold is effective at decreasing radiographically defined osteomyelitis in an infected open fracture.
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89
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Lindsey BA, Clovis NB, Smith ES, Salihu S, Hubbard DF. An animal model for open femur fracture and osteomyelitis: Part I. J Orthop Res 2010; 28:38-42. [PMID: 19637274 DOI: 10.1002/jor.20960] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Infection is an everyday problem in orthopaedics and is quite common in open fracture management. To study this process and provide a basis to prevent infection, we developed a model that includes trauma (blunt fracture in the fashion of Bonnarens and Einhorn), surgical stabilization (standardized intramedullary K-wire fixation), and infection (Staphylococcus aureus inoculum). In this two-part study, we found that 10(2) colony-forming units of inoculum produced an optimal infection rate of 90-100%, which substantially challenged the immune system without overwhelming sepsis. We hypothesized that, in traumatic fractures, there is a specific immunological response that may lead to an increased rate of infection. In Part 2, we demonstrated immunosuppression (decreased Interleukin-12 levels) at days 6, 10, and 12 after fracture fixation versus nonfractured control groups (p < 0.05). This study describes a rat model of femur factures with osteomyelitis that allows investigation of posttraumatic immunosuppression.
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Affiliation(s)
- Brock A Lindsey
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Health Sciences Center, Morgantown, West Virginia 26506-9196, USA.
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90
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Lindsey BA, Clovis NB, Smith ES, Salihu S, Hubbard DF. An animal model for open femur fracture and osteomyelitis--Part II: Immunomodulation with systemic IL-12. J Orthop Res 2010; 28:43-7. [PMID: 19623664 DOI: 10.1002/jor.20959] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Infection resulting from open fracture is a common problem in orthopedics. The purpose of this project was to study the effect of Interleukin-12 (IL-12) systemic therapy on a previously established open fracture model. One hundred seven male Sprague-Dawley rats were assigned to five groups: (1) normal (baseline), (2) control (controlled for anesthesia), (3) fracture, (4) staph, and (5) staph and IL-12 (SIL). Each group was divided into four time periods: 6, 10, 14, and 21 days after injury and fixation. The operative groups had a standardized femur fracture and fixation using a Kirschner wire as an intramedullary device. The two infection groups (staph and SIL) were inoculated with Staphylococcus aureus following fracture and fixed with an identical technique. The SIL group was treated with systemic IL-12 for a total of 10 doses over 10 days. Significantly decreased serum IL-12 levels were noted at day 10 in the operative groups compared to the normal and control groups. The SIL group showed significantly higher macrophage activation levels and total platelet counts at day 21 compared to all the other groups. The overall infection rate was not changed by IL-12 supplementation; however, bacterial qualitative growth scores were significantly lower in the SIL group at day 10, which corresponded to the lowest level of systemic IL-12 in the fracture group.
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Affiliation(s)
- Brock A Lindsey
- Department of Orthopaedics, West Virginia University, P.O. Box 9196 Health Sciences Center, Morgantown, West Virginia 26506-9196, USA.
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91
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Wysk RA, Sebastianelli WJ, Shirwaiker RA, Bailey GM, Charumani C, Kennett M, Kaucher A, Abrahams R, Fuller TA, Royer P, Voigt RC, Cohen PH. Prophylactic Bactericidal Orthopedic Implants – Animal Testing Study. ACTA ACUST UNITED AC 2010. [DOI: 10.4236/jbise.2010.39122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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92
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Gollwitzer H, Roessner M, Langer R, Gloeck T, Diehl P, Horn C, Stemberger A, von Eiff C, Gerdesmeyer L. Safety and effectiveness of extracorporeal shockwave therapy: results of a rabbit model of chronic osteomyelitis. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:595-602. [PMID: 19110371 DOI: 10.1016/j.ultrasmedbio.2008.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2007] [Revised: 07/29/2008] [Accepted: 10/03/2008] [Indexed: 05/27/2023]
Abstract
Extracorporeal shockwave therapy (ESWT) is applied successfully in various orthopedic disorders. Since shockwaves have demonstrated significant bactericidal effectiveness in vitro, safety and effectiveness of ESWT in vivo were evaluated in a rabbit model of osteomyelitis. Chronic osteomyelitis was induced by injecting sodium morrhuate and Staphylococcus aureus into the proximal tibia of 12 New Zealand white rabbits. Four and five wk after the initial operation, soft focused ESWT was applied twice to the infected limbs. Clinical parameters and laboratory values were followed and blood samples were taken for culture before and 30 min after ESWT. Following sacrifice after 8 wk, lungs, spleen and kidneys were studied histologically for signs of sepsis and secondary infection. Tibial osteomyelitis was assessed clinically, and by radiologic, microbiologic and histologic procedures. Signs of bacterial spreading were not detectable after ESWT, neither in blood cultures nor in histologic analyses of representative organs. Temperature, body weight, C-reactive protein and white blood cell levels also remained unchanged after ESWT. Of particular interest, histologic scores of osteomyelitis were significantly decreased in the ESWT-group compared to the untreated control (p = 0.019). However, S. aureus was still detectable in tissue samples of all animals. This is the first study investigating the effects of ESWT applied to infected target areas. ESWT of infected bone did neither induce bacterial spreading nor worsening of infection, and the results suggest the reported treatment protocol of ESWT to be beneficial in the treatment of chronic bone infections.
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Affiliation(s)
- Hans Gollwitzer
- Klinik für Orthopädie und Unfallchirurgie, Technische Universität München, Ismaninger Strasse 22, Munich, Germany.
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93
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Pillai RR, Somayaji SN, Rabinovich M, Hudson MC, Gonsalves KE. Nafcillin-loaded PLGA nanoparticles for treatment of osteomyelitis. Biomed Mater 2008; 3:034114. [DOI: 10.1088/1748-6041/3/3/034114] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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94
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Alvarez H, Castro C, Moujir L, Perera A, Delgado A, Soriano I, Evora C, Sánchez E. Efficacy of ciprofloxacin implants in treating experimental osteomyelitis. J Biomed Mater Res B Appl Biomater 2008; 85:93-104. [PMID: 17696153 DOI: 10.1002/jbm.b.30921] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ciprofloxacin (CFX) implants containing poly(D,L-lactide) and calcium phosphates (tricalcium phosphate and hydroxyapatite) was evaluated in 50 rabbits in an experimental osteomyelitis model. Their femoral cavity was inoculated with Staphylococcus aureus. After 2 weeks, the infected focus was cleaned out and the delivery system implanted. The infection and subsequent response to treatment were evaluated by microbiological analysis, biochemical and hematological markers, body weight, temperature, clinical signs, X-rays, and histology. Infected bone cultures, treated with CFX implants, showed reduced bacterial growth against controls. All CFX was released within 6 weeks. All animals recovered within 4 weeks. Even 12 weeks after implantation, no recurrence of infection was observed. Serum C-reactive protein, platelet, and leukocyte levels increased in all animals before treatment, and 4 weeks after it were maintained or rose in control animals, while decreased to normal levels in treated ones. Body weight was characterized by pretreatment losses, then gains during recuperation, or further loss in untreated animals; with no significant intraindividual differences in body temperature. Body weight, leucocytes, platelets, and C-reactive protein turned out to be highly useful markers for monitoring this kind of infection and its treatment. CFX implants demonstrated to be an effective therapy for S. aureus bone infection. Their efficacy was also reflected in decreasing severity of clinical signs, nonprogress of radiological signs indicative of infection, and good integration into bone structure. Histological examination revealed repair, with new bone formation extending into implants.
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Affiliation(s)
- H Alvarez
- Traumatology Service, Hospitén Rambla, Tenerife, Spain
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95
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Li D, Gromov K, Søballe K, Puzas JE, O’Keefe RJ, Awad H, Drissi H, Schwarz EM. Quantitative mouse model of implant-associated osteomyelitis and the kinetics of microbial growth, osteolysis, and humoral immunity. J Orthop Res 2008; 26:96-105. [PMID: 17676625 PMCID: PMC2701346 DOI: 10.1002/jor.20452] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although osteomyelitis (OM) remains a serious problem in orthopedics, progress has been limited by the absence of an in vivo model that can quantify the bacterial load, metabolic activity of the bacteria over time, immunity, and osteolysis. To overcome these obstacles, we developed a murine model of implant-associated OM in which a stainless steel pin is coated with Staphylococcus aureus and implanted transcortically through the tibial metaphysis. X-ray and micro-CT demonstrated concomitant osteolysis and reactive bone formation, which was evident by day 7. Histology confirmed all the hallmarks of implant-associated OM, namely: osteolysis, sequestrum formation, and involucrum of Gram-positive bacteria inside a biofilm within necrotic bone. Serology revealed that mice mount a protective humoral response that commences with an IgM response after 1 week, and converts to a specific IgG2b response against specific S. aureus proteins by day 11 postinfection. Real-time quantitative PCR (RTQ-PCR) for the S. aureus specific nuc gene determined that the peak bacterial load occurs 11 days postinfection. This coincidence of decreasing bacterial load with the generation of specific antibodies is suggestive of protective humoral immunity. Longitudinal in vivo bioluminescent imaging (BLI) of luxA-E transformed S. aureus (Xen29) combined with nuc RTQ-PCR demonstrated the exponential growth phase of the bacteria immediately following infection that peaks on day 4, and is followed by the biofilm growth phase at a significantly lower metabolic rate (p < 0.05). Collectively, these studies demonstrate the first quantitative model of implant-associated OM that defines the kinetics of microbial growth, osteolysis, and humoral immunity following infection.
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Affiliation(s)
- Dan Li
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Kirill Gromov
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
- The Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Søballe
- The Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - J. Edward Puzas
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Regis J. O’Keefe
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Hani Awad
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Hicham Drissi
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Edward M. Schwarz
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
- To whom correspondence should be addressed: Dr. Edward M. Schwarz, The Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, Phone 585-275-3063, FAX 585-756-4727, E-mail:
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96
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Aktekin CN, Ozturk AM, Tabak AY, Altay M, Korkusuz F. A different perspective for radiological evaluation of experimental osteomyelitis. Skeletal Radiol 2007; 36:945-50. [PMID: 17624529 DOI: 10.1007/s00256-007-0342-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2007] [Revised: 05/02/2007] [Accepted: 05/12/2007] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Radiological scoring systems used in experimental osteomyelitis combine several factors into a single score. Because response of bone tissue to infection is a dynamic process, such systems have limited ability to differentiate between treatment groups. The analyzing of radiological criteria separately at different stages of the disease may be superior to a general score. METHODS AND METHODS Osteomyelitis was induced with Staphylococcus aureus in the left tibiae of 72 adult Wistar albino rats. The rats were assigned to one of six different treatment groups. Their radiographs were graded (1) by the use of previously published general scoring systems and (2) by the evaluation of periosteal reaction, bone deformation, diaphyseal widening, osteolysis, soft tissue swelling, bone mineral content (BMC) and bone mineral density (BMD), separately. The assessments were performed 3 weeks after induction as well as 3 weeks and 6 weeks after treatment. RESULTS Periosteal reaction and diaphyseal widening demonstrated significant differences within 3 weeks of treatment, contrary to the general scores. After 6 weeks of treatment, individual criteria, including diaphyseal widening, osteolysis and BMC but only one of the general grading scores, were able to differentiate between treatment groups. CONCLUSIONS For differentiation of treatments in experimental osteomyelitis individual assessment of radiological criteria is superior to previously published general scoring systems.
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Affiliation(s)
- Cem Nuri Aktekin
- Ankara Numune Research and Training Hospital, 5th Orthopaedics and Traumatology Clinic, Ankara, Turkey
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Zelken J, Wanich T, Gardner M, Griffith M, Bostrom M. PMMA is superior to hydroxyapatite for colony reduction in induced osteomyelitis. Clin Orthop Relat Res 2007; 462:190-4. [PMID: 17514008 DOI: 10.1097/blo.0b013e3180ca9521] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Staphylococcus aureus infection is a serious complication in patients receiving orthopaedic implants. Treatment with antibiotic-loaded cements can deliver high local concentrations and reduce toxic side effects associated with systemic antibiotic administration, but polymethylmethacrylate cement is nondegradable and may necessitate additional surgery for removal. Previous studies provide support for hydroxyapatite as a biodegradable carrier, but consensus has not been achieved. We hypothesized vancomycin-loaded hydroxyapatite was superior to vancomycin-loaded polymethylmethacrylate in reducing the number of bacterial colony-forming units in the setting of osteomyelitis. Osteomyelitis was induced in rats using an established model. Animals then were randomly assigned to a control group (no antibiotics), a group treated with vancomycin-loaded polymethylmethacry-late, and two groups treated with hydroxyapatite loaded with either low-dose or high-dose vancomycin. After 6 weeks we compared the number of colony-forming units per gram of harvested bone between groups. Vancomycin-loaded hydroxyapatite was inferior to vancomycin-loaded polymethylmethacrylate in reducing the number of bacterial colony-forming units and vancomycin-loaded polymethylmethacry-late was superior to the control group. We observed no difference between low- and high-dose vancomycin-loaded hydroxyapatite groups. The poor handling properties of hydroxyapatite paste may explain these findings. Based on these results, a hydroxyapatite carrier cannot be recommended for the treatment of osteomyelitis.
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98
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Antoci V, Adams CS, Hickok NJ, Shapiro IM, Parvizi J. Vancomycin bound to Ti rods reduces periprosthetic infection: preliminary study. Clin Orthop Relat Res 2007; 461:88-95. [PMID: 17549034 DOI: 10.1097/blo.0b013e318073c2b2] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A major challenge in treating periprosthetic infection is the predilection of certain bacteria to colonize implants, form biofilms, and resist treatment. We engineered an innovative self-protective implant with covalently bound antibiotics that prevents bacterial colonization and remains stable for extended periods of time. To test this surface in vivo, we developed a rat periprosthetic infection model with an intramedullary implant in S. aureus-infected femora. Using the model, we then evaluated the effect of vancomycin-modified titanium rods on the clinical presentation of bone infection. Finally, assuming delayed and chronic periprosthetic infections originate from biofilms atop contaminated implants, the numbers of surface adherent bacteria were measured to assess the capability of the implant to prevent biofilms. S. aureus (1.5 x 10(3) colony forming units) with no known resistance were injected into the femoral canal of Wistar rats, followed by the implant. Signs of infection were assessed weekly by direct clinical observation of the animals, radiograph, and microCT, and counts of bacteria adherent to the implant. Vancomycin-modified implants showed superior inhibition of bacterial attachment and proliferation compared to control titanium surfaces.
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Affiliation(s)
- Valentin Antoci
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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99
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Ofluoglu EA, Zileli M, Aydin D, Baris YS, Kuçukbasmaci O, Gonullu N, Ofluoglu O, Toplamaoglu H. Implant-related infection model in rat spine. Arch Orthop Trauma Surg 2007; 127:391-6. [PMID: 17522873 DOI: 10.1007/s00402-007-0365-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The rate of postoperative infections is approximately 1% in spine surgery. However, when metal implants are used, postoperative infection rates significantly increase and were reported between 2.1 and 8.5%. This study aim to set up an infection model in the rat spine with a metal implant. MATERIALS AND METHODS Forty white male Sprague Dawley rats were randomly divided in four groups. In all rats, under operation microscope, a 3 mm titanium microscrew was implanted in the thoracolumbar area (T10-L1) after laminar decortication. In Group I (control group), sterile isotonic solution and in other three groups, different concentrations of Staphylococcus aureus [Group II: (10(2)), Group III: (10(3)), Group IV: (10(6))] were squirted on the decorticated lamina site. All animals were sacrificed after 2 weeks, and then blood cultures and cultures from fascia, muscle and bone were obtained. Bacterial number in each tissue was measured as colony-forming unit per gram tissue. Titanium microscrews were placed in 0.5 ml tryptic soy broth and vortexed than plated on trypticase soy agar to determine bacterial growth. Two animals from each group were subjected to histological examination. RESULTS Blood cultures obtained by intra-atrial puncture after 2 weeks were negative in all groups indicating no systemical infection developed. Bacterial cultures were negative in all specimens of Group I (control group). A significant osseous infection was confirmed in Groups II, III and IV. Comparison of bacterial counts in bone cultures showed no significant difference between Group III (10(3) CFU/10 microl) and Group IV (10(6) CFU/10 microl) (P > 0.05), while both groups had significantly higher counts than Group II (10(2) CFU/10 microl) (P > 0.05). Microscopic findings of supurrative inflammation were present only in Group IV (10(6) CFU/10 microl). CONCLUSIONS This study shows that inoculation of S. aureus in 10(6) CFU/10 microl concentration at the decorticated lamina after implantation of a titanium screw in rat spine is a reproducible model for spinal infection and can be used for the animal model of prophylaxis and treatment and of postoperative infection.
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Affiliation(s)
- Ender Ali Ofluoglu
- Department of Neurosurgery, Bakirkoy Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.
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100
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Fuchs T, Schmidmaier G, Raschke MJ, Stange R. Bioactive-Coated Implants in Trauma Surgery. Eur J Trauma Emerg Surg 2007; 34:60-8. [DOI: 10.1007/s00068-006-6110-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 06/27/2006] [Indexed: 10/23/2022]
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