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osteomyelitis; delivery

Konstantinos Markakis, Alan Robert Faris, Hamed Sharaf, Barzo Faris, Sharon Rees, Frank L Bowling
Foot infections are common among diabetic patients with peripheral neuropathy and/or peripheral arterial disease, and it can be the pivotal event leading to a minor or major amputation of the lower extremity. Treatment of diabetic foot infections, especially deep-seated ones, remains challenging, in part because impaired blood perfusion and the presence of biofilms can impair the effectiveness of systemic antibiotics. The local application of antibiotics is an emerging field in the treatment of diabetic foot infections, with demonstrable advantages...
February 1, 2018: International Journal of Lower Extremity Wounds
Mingmin Shi, Lei Chen, Yangxin Wang, Wei Wang, Shigui Yan
BACKGROUND Calcium phosphate cement (CPC) has been applied as a biodegradable antibiotic carrier in osteomyelitis. However, the drug delivery, antibacterial efficacy, and degradation rate of CPC are insufficient and require further improvement in clinical application. MATERIAL AND METHODS Vancomycin-loaded CPC columns were prepared, and eluted in simulated body fluid. The drug delivery was assessed in the ultrasound group and control group by fluorescence polarization immunoassay. The antibacterial efficacy of vancomycin in the ultrasound group and control groups was investigated by standard plate count method...
February 8, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Cagri Neyisci, Yusuf Erdem, Ahmet Burak Bilekli, Bahtiyar Demiralp, Ozkan Kose, Dogan Bek, Feza Korkusuz, Berna Kankilic
INTRODUCTION: The purpose of this present study is to investigate the efficacy of vancomycin-loaded VK100 silicone cement drug delivery system in the treatment of implant-related methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis in rats. MATERIALS AND METHODS: Thirty-six adult (18-20 weeks old) female Sprague-Dawley rats were included in the study. All rats underwent experimental osteomyelitis surgery via injecting 100 µL bacterial suspension of MRSA into the medullary canal...
January 2018: Journal of Orthopaedic Surgery
Efstathios Drampalos, Hasan Raza Mohammad, Chris Kosmidis, Moez Balal, Jason Wong, Anand Pillai
BACKGROUND: Chronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite. METHODS: The Silo method involves debridement of the dead bone and local delivery of antibiotic in drilled tunnels using the biocomposite. It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team...
November 23, 2017: Foot
Rossella Dorati, Antonella DeTrizio, Tiziana Modena, Bice Conti, Francesco Benazzo, Giulia Gastaldi, Ida Genta
A great deal of research is ongoing in the area of tissue engineering (TE) for bone regeneration. A possible improvement in restoring damaged tissues involves the loading of drugs such as proteins, genes, growth factors, antibiotics, and anti-inflammatory drugs into scaffolds for tissue regeneration. This mini-review is focused on the combination of the local delivery of antibiotic agents with bone regenerative therapy for the treatment of a severe bone infection such as osteomyelitis. The review includes a brief explanation of scaffolds for bone regeneration including scaffolds characteristics and types, a focus on severe bone infections (especially osteomyelitis and its treatment), and a literature review of local antibiotic delivery by the combination of scaffolds and drug-delivery systems...
December 12, 2017: Pharmaceuticals
S G Rotman, D W Grijpma, R G Richards, T F Moriarty, D Eglin, O Guillaume
No abstract text is available yet for this article.
January 10, 2018: Journal of Controlled Release: Official Journal of the Controlled Release Society
Tao Cheng, Haiyun Qu, Guoyou Zhang, Xianlong Zhang
Chronic osteomyelitis and infected bone defects are substantial challenges faced by orthopaedic surgeons. In this study, vancomycin was loaded into mesoporous bioactive glass (MBG) to form a local antibiotic delivery system and then a bone tissue-engineering scaffold combining MBG and poly-(L-lactic-co-glycolic acid) (PLGA) was prepared by freeze-drying fabrication. In vitro degradation and water contact angle analysis suggested that the MBG-incorporated PLGA scaffold exhibited controlled degradability, stabilizing the pH of the surrounding environment and improved the hydrophilicity...
November 7, 2017: Artificial Cells, Nanomedicine, and Biotechnology
Vuk Uskoković, Shreya Ghosh, Victoria M Wu
Bone grafting is one of the commonest surgical procedures, yet all bone substitutes developed so far suffer from specific weaknesses and the search for a bone graft material with ideal physical and biological properties is still ongoing. Calcium phosphate pastes are the most frequently used synthetic bone grafts, yet they (a) often take an impractically long time to set, (b) release the drug content too fast, and (c) do not form pores large enough to accommodate host cells and foster osseointegration. To make up for these deficiencies, we introduced gelatin and silica to pastes composed of 5-15 nm sized hydroxyapatite nanoparticles and yielded a bioresorbable composite that is compact, yet flowing upon injection; that prevents setting at room temperature, but sets promptly, in minutes, at 37 °C; that displays an increase in surface porosity following immersion in physiological fluids; that allows for sustained release of antibiotics; and that sets in a tunable manner and in clinically relevant time windows: 1-3 minutes at its fastest...
August 14, 2017: Journal of Materials Chemistry. B, Materials for Biology and Medicine
Akos Zahar, György Kocsis, Mustafa Citak, Gábor Puskás, Mónika Domahidy, Mária Hajdú, István Antal, Miklós Szendrői
BACKGROUND: Both osteomyelitis and prosthetic joint infection can be treated surgically with the use of antibiotic loaded bone grafts, as part of local antimicrobial therapy. OBJECTIVE: The purpose of the study was to evaluate and to report on a novel, biodegradable, long-acting (4-6 weeks) antibiotic-impregnated bone graft (AIBG). A novel drug delivery system, containing vancomycin, was utilized in a rabbit osteomyelitis model in order to evaluate the antimicrobial efficacy of the antibiotic bone graft...
October 23, 2017: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
Dan Li, Pengfei Lv, Linfeng Fan, Yaoyi Huang, Fei Yang, Xifan Mei, Decheng Wu
Implant-associated infections in orthopaedic surgeries are very critical as they may hinder bone healing, cause implant failure and even progress to osteomyelitis. Drug-eluting implants for local delivery of antibiotics at surgical sites are thought to be promising in preventing infections. Herein, the antibiotic vancomycin was encapsulated in a poly(ethylene glycol) (PEG)-based hydrogel film that was covalently bound to Ti implants and subsequently covered by a PEG-poly(lactic-co-caprolactone) (PEG-PLC) membrane...
October 24, 2017: Biomaterials Science
Caleb A Ford, James E Cassat
Osteomyelitis, a common and debilitating invasive infection of bone, is a frequent complication following orthopedic surgery and causes pathologic destruction of skeletal tissues. Bone destruction during osteomyelitis results in necrotic tissue, which is poorly penetrated by antibiotics and can serve as a nidus for relapsing infection. Osteomyelitis therefore frequently necessitates surgical debridement procedures, which provide a unique opportunity for targeted delivery of antimicrobial and adjunctive therapies...
September 2017: Expert Review of Anti-infective Therapy
Roberto Berebichez-Fridman, Pablo Montero-Olvera, Ricardo Gómez-García, Enrique Berebichez-Fastlicht
Among various infections, chronic osteomyelitis is one of the most challenging in terms of treatment. This infection is more common among patients with open fractures and those who have undergone elective orthopedic procedures. The treatment of osteomyelitis requires high antibiotic doses and an aggressive and multifaceted surgical approach. The use of parenteral antibiotics alone, without debridement, is not sufficiently effective, due to the formation of sequestra and the low vascularity of the affected area...
August 2017: Medical Hypotheses
Molly Stapleton, Kazuki Sawamoto, Carlos J Alméciga-Díaz, William G Mackenzie, Robert W Mason, Tadao Orii, Shunji Tomatsu
The skeletal system, comprising bones, ligaments, cartilage and their connective tissues, is critical for the structure and support of the body. Diseases that affect the skeletal system can be difficult to treat, mainly because of the avascular cartilage region. Targeting drugs to the site of action can not only increase efficacy but also reduce toxicity. Bone-targeting drugs are designed with either of two general targeting moieties, aimed at the entire skeletal system or a specific cell type. Most bone-targeting drugs utilize an affinity to hydroxyapatite, a major component of the bone matrix that includes a high concentration of positively-charged Ca(2+)...
June 23, 2017: International Journal of Molecular Sciences
Shahnaz Qadri, Yousef Haik, Eric Mensah-Brown, Ghada Bashir, Maria J Fernandez-Cabezudo, Basel K Al-Ramadi
Treatment of osteomyelitis by conventional antibiotics has proven to be challenging due to limited accessibility to this unique location. Inorganic routes against bacterial infection have been reported for external and topical applications, however in vivo application of these antimicrobials has not been fully explored. Targeted delivery of metallic nanoparticles with inherent antimicrobial activity represents an alternative means of overcoming the challenges posed by multidrug-resistant bacteria and may potentially reduce overall morbidity...
October 2017: Nanomedicine: Nanotechnology, Biology, and Medicine
Patricia Comeau, Mark Filiaggi
Local delivery systems have taken on a greater clinical focus for osteomyelitis therapy owing to their ability to overcome many disadvantages of systemic delivery. This study reports for the first time the capacity to fabricate strontium- and vancomycin-doped calcium polyphosphate beads using a two-stage cold isostatic pressing and gelling approach. The fabricated beads were of uniform shape and diameter, and upon gelling exhibited reduced porosity. Of greatest significance in the subsequent in vitro study was the improvement of bead long-term structural stability upon vancomycin incorporation; a characteristic that further encourages the extended release of therapeutically relevant levels of antibiotic...
January 1, 2017: Journal of Biomaterials Applications
M Mahmoudian, F Ganji
Antibiotic use is an essential method for the treatment of bacterial infections. In certain cases, antibiotics are not effective because of the distribution problems caused by physiological barriers in the body. Such problems are thought to be minimized by development of sustained release systems which involve implantation of antibiotic loaded polymeric systems directly to the site of infection. In this work, a new composite vancomycin hydrochloride release system based on HPMC microparticles and chitosan/glycerophosphate (Ch/Gp) thermosensitive hydrogel was designed for the aim of local treatment of osteomyelitis...
May 2017: Progress in biomaterials
John W Hudson, Austin P Daly, Michael Foster
PURPOSE: To evaluate the response of mandibular osteomyelitis treated by surgical decortication with disruption of the affected adjacent periosteum in concert with long-term targeted antibiotic therapy. The hypothesis is that, by removing the buccal cortical plate and disrupting the hypertrophically inflamed adjacent periosteum, the medullary bone will be brought in contact with bleeding tissue and circulating immunologic factors and antibiotics, which will promote definitive resolution...
October 2017: Journal of Oral and Maxillofacial Surgery
Kenneth L Koury, John S Hwang, Michael Sirkin
Antibiotic cement nails provide a useful and relatively simple technique to treat intramedullary osteomyelitis of the long bones. These devices provide stability as well as local, targeted antibiotics, which are both critical aspects of osteomyelitis management. Additionally, the use of a threaded core is a critical component of successful cement nail assembly. With adherence to the simple principles outlined in this review, surgeons can expect reliably good results using these drug-delivery implants.
April 2017: Orthopedic Clinics of North America
Zhidong Cao, Dianming Jiang, Ling Yan, Jun Wu
Antibiotic-loaded carriers were developed to fill cavities and locally deliver antibiotics following implantation. However, the most commonly used antibiotic carrier, polymethyl methacrylate (PMMA), has many disadvantages including that it does not promote bone regeneration or conduction. Vancomycin-loaded bone-like hydroxyapatite/poly amino acid (V-BHA/PAA) was successfully fabricated by a homogeneous method, certified as biosafe and known to promote osteogenesis. To evaluate its drug-release features, the quantity of the vancomycin in the elution was obtained every 2 days after in vitro simulated body fluid immersion...
2017: International Journal of Nanomedicine
Yang Zhang, Ruo-Jia Liang, Jiao-Jiao Xu, Li-Feng Shen, Jian-Qing Gao, Xu-Ping Wang, Na-Ni Wang, Dan Shou, Ying Hu
Surgery and the local placement of an antibiotic are the predominant therapies to treat chronic osteomyelitis. Vancomycin-loaded N-trimethyl chitosan nanoparticles (VCM/TMC NPs) as a potential drug delivery system have high intracellular penetration and effective intracellular antibacterial activity. This study investigated the effects of a biocompatible material, poly(trimethylene carbonate) (PTMC), to increase the sustained effectiveness of an intracellular antibiotic and its potential application in antibiotic delivery...
2017: International Journal of Nanomedicine
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