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Treatment with Vancomycin Loaded Calcium Sulphate and Autogenous Bone in an Improved Rabbit Model of Bone Infection
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Allograft Bone as Antibiotic Carrier.

Heinz Winkler1, Peter Haiden2

  • 1Osteitis Centre, Privatklinik Döbling Wien, Heiligenstaedter Strasse 57-63, A-1190 Wien, AUSTRIA.

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Chronic bone infections are difficult to treat due to biofilms. Loading bone grafts with antibiotics can eliminate pathogens and improve healing, reducing patient disability and healthcare costs.

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Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Biomaterials Science

Background:

  • Chronic bone and joint infections pose significant treatment challenges due to persistent microorganisms and biofilm formation.
  • Biofilms render bacteria highly resistant to antibiotics, necessitating higher concentrations than systemic delivery can achieve.
  • Surgical debridement often results in osseous defects, complicating reconstruction and increasing infection recurrence risk.

Purpose of the Study:

  • To investigate the potential of antibiotic-loaded bone allografts for treating chronic bone infections.
  • To evaluate the efficacy of processed bone allografts as carriers for sustained local antibiotic delivery.
  • To explore the benefits of marrow removal for graft safety, revascularization, and antibiotic elution.

Main Methods:

  • Bone allografts were processed to remove bone marrow, creating a matrix for antibiotic loading.
  • Antibiotic elution kinetics were studied to ensure concentrations remained above the minimum biofilm eradication concentration (MBEC).
  • The potential for simultaneous implantation with internal fixation and infected endoprosthesis exchange was considered.

Main Results:

  • Processed bone allografts can serve as reservoirs for sustained release of antibiotics at concentrations effective against biofilms.
  • Marrow removal enhances graft safety, promotes revascularization, and facilitates controlled antibiotic elution.
  • Local antibiotic delivery can potentially eliminate sessile pathogens, enabling single-stage procedures.

Conclusions:

  • Antibiotic-loaded bone allografts offer a promising strategy for managing chronic bone and joint infections.
  • This approach facilitates effective local antimicrobial delivery, potentially leading to improved patient outcomes.
  • Optimized graft processing and antibiotic loading can reduce treatment duration, pain, and rehabilitation time.