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The use of antibiotic-containing bead chains in the treatment of chronic bone infections

K Klemm1

  • 1Klemm-Bad-Vilbel@t-online.de

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|April 4, 2001
PubMed

Insights

Gentamicin polymethylmethacrylate (PMMA) chains offer effective local antibiotic therapy for osteomyelitis, achieving high infection site concentrations with minimal systemic side effects. This method supports primary wound healing and reduces the need for prolonged systemic antibiotics, showing a 90.4% success rate.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Pharmacology

Background:

  • Osteomyelitis is a challenging bone infection often requiring surgical debridement and antibiotic treatment.
  • Local antibiotic delivery systems aim to achieve high drug concentrations at the infection site while minimizing systemic toxicity.
  • Gentamicin polymethylmethacrylate (PMMA) chains are utilized for localized antibiotic therapy in orthopedic infections.

Purpose of the Study:

  • To evaluate the efficacy and safety of gentamicin PMMA chains as an adjunct to debridement in treating chronic osteomyelitis.
  • To assess the antibiotic concentrations achieved locally and systemically.
  • To determine the impact on wound healing and the necessity of concurrent systemic antibiotic therapy.

Main Methods:

  • Implantation of gentamicin PMMA chains or minichains into infected osteomyelitic cavities following radical debridement.
  • Measurement of gentamicin concentrations at the infection site, serum, and urine.
  • Clinical assessment of primary wound healing and patient outcomes over a series of 405 cases.

Main Results:

  • Gentamicin concentrations at the infection site significantly exceeded the minimum inhibitory concentrations (MICs) for common osteomyelitis pathogens.
  • Serum and urine gentamicin concentrations remained low, indicating minimal systemic absorption.
  • No significant nephrotoxic or ototoxic side effects were observed.
  • Primary wound healing, comparable to aseptic surgery, was achieved in most cases.
  • A high success rate of 90.4% was recorded in the series of 405 patients.

Conclusions:

  • Gentamicin PMMA chains provide effective local antibiotic therapy for chronic osteomyelitis, achieving therapeutic concentrations with a favorable safety profile.
  • This local antibiotic approach facilitates primary wound healing and obviates the need for prolonged systemic antibiotic administration.
  • The high success rate supports the use of gentamicin PMMA chains as a valuable therapeutic option in managing infected osteomyelitic cavities.

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