THE EFFECTS OF GENTAMICIN-IMPREGNATED COLLAGEN SPONGE VERSUS GENTAMICIN-IMPREGNATED POLYMETHYLMETHACRYLATE BEADS IN PATIENTS WITH OSTEOMYELITIS
DOI:
https://doi.org/10.22159/ajpcr.2018.v11i12.26910Keywords:
Osteomyelitis, Local antibiotics, Gentamicin impregnated, Collagen sponge, Polymethylmethacrylate beadsAbstract
Objective: The usage of antibiotic-impregnated polymethylmethacrylate (PMMA) beads is regarded as the gold standard for local antibiotic delivery. However, the relatively new antibiotic-impregnated collagen sponge has multiple advantages over it. The objective of this study is to compare the measurable effects between gentamicin-impregnated collagen sponge and gentamicin-impregnated (PMMA) beads in patients with osteomyelitis.
Methods: This is a case–control study which involved 60 patients who were diagnosed with osteomyelitis between January 2014 and June 2015, and underwent first surgical debridement with application of either gentamicin-impregnated collagen sponge (n=28) or gentamicin-impregnated PMMA beads (n=32). The numbers of debridement, trend of blood parameters, duration of hospitalization, and total duration of systemic antibiotic therapy needed to be completed were reviewed from the patients' file.
Results: A total of 53 patients of 60 were diagnosed with osteomyelitis of the lower limbs, while the remaining seven were involving the upper limbs. The gentamicin-impregnated collagen sponge group has significant lower reoperative rate (p<0.05) and also significant reduction of total white cell count in 6 weeks (p<0.05). The two groups showed no statistical difference in regard of duration of hospital admission, duration of systemic antibiotic therapy completed, and the reduction of C-reactive protein at 6 weeks post-debridement.
Conclusion: This study reiterates the efficacy of gentamicin-impregnated collagen sponge that results in lower reoperative rate as compared to conventional gentamicin-impregnated PMMA beads.
Downloads
References
Malizos KN, Kirketerp-Moller K. Incidence and socioeconomic impact of bone and joint infections (BJIs): The European perspective. In: Periprosthetic Joint Infections, Part 1. Switzerland: Springer; 2016. p. 3-18.
Poultsides LA, Liaropoulos LL, Malizos KN. The Socioeconomic impact of musculoskeletal infections. J Bone Joint Surg Am 2010;2:e13.
Lowenberg DW. A technotheoretical approach to the management of osteomyelitis. Tech Orthop 2015;30:209-14.
Beaudoin T, Waters V. Infections with biofilm formation: Selection of antimicrobials and role of prolonged antibiotic therapy. Paed Infect Dis J 2016;35:695-7.
Cierny G. Surgical treatment of osteomyelitis. Plast Reconstr Surg 2011;127:190S-204.
Buchholz HW, Engelbrecht H. Depot effects of various antibiotics mixed with Palacos resins (translated). Chirurg 1970;41:511-5.
Kala P, Rani RJ, Sangeetha R. Prescription pattern of prophylactic antimicrobial agents used in preoperative patients at a tertiary care teaching hospital. Int J Pharm Pharm Sci 2018;10:128-31.
Klemm K. Gentamicin-PMMA-beads in treating bone and soft tissue infections (author’s translation). Zentralbl Chir 1979;104:934-42.
Nelson CL. The current status of material used for depot delivery of drugs. Clin Orthop Relat Res 2004;427:72-7.
El-Husseiny M, Patel S, MacFarlane RJ, Haddad FS. Biodegradable antibiotic delivery systems. J Bone Joint Surg Br 2011;93:71.
Hanssen AD. Local antibiotic delivery vehicles in the treatment of musculoskeletal infection. Clin Orthop Related Res 2005;437:91-6.
Patzakis MJ, Mazur K, Wilkins J, Sherman R, Holtom P. Septopal beads and autogenous bone grafting for bone defects in patients with chronic osteomyelitis. Clin Orthop Relat Res 1993;295:112-8.
Gitelis S, Brebach GT. The treatment of chronic osteomyelitis with a biodegradable antibiotic impregnated implant. J Orthop Surg 2002;10:53-60.
Hoff SF, Fitzgerald RH Jr., Kelly PJ. The depot administration of penicillin g and gentamicin in acrylic bone cement. J Bone Joint Surg Am 1981;63:798-804.
Ipsen T, Jorgensen PS, Damholt V, Torholm C. Gentamicin-collagen sponge for local applications: 10 cases of chronic osteomyelitis followed for 1 year. Acta Orthop Scand 1991;62:592-4.
Kanellakopoulou K, Galanakis N, Giamarellos-Bourboulis EJ, Rifiotis C, Papakostas K, Andreopoulos A, et al. Treatment of experimental osteomyelitis caused by methicillin-resistant Staphylococcus aureus with a biodegradable system of lactic acid polymer releasing pefloxacin. J Antimicrob Chemother 2000;46:311-4.
Chang WK, Srinivasa S, MacCormick AD, Hill AG. Gentamicin-collagen implants to reduce surgical site infection: Systematic Review and meta-analysis of randomized trials. Ann Surg 2013;258:59-65.
Bennett-Guerrero E, Pappas TN, Koltun WA, Fleshman JW, Lin M, Garg J, et al. Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery. N Engl J Med 2010;363:1038-49.
Ciampolini J, Harding KG. Pathophysiology of chronic bacterial osteomyelitis: Why do antibiotics fail so often? Postgrad Med J 2000;76:479-83.
Tam VH, Kabbara S, Vo G, Schilling AN, Coyle EA. Comparative pharmacodynamics of gentamicin against Staphylococcus aureus and Pseudomonas aeruginosa. Antimicrob Agents Chemother 2006;50:2626-31.
Kumar SL, Ashutosh SR, Gokulshankar S, Ranjith MS, Mohanty BK, Lim MY. Is bacteriology a contributing factor in unsalvageable nature of diabetic foot infections?–a study in a district hospital in Malaysia. Int J Pharm Pharm Sci 2015;8:262-5.
Klemm K. The use of antibiotic-containing bead chains in the treatment of chronic bone infections. Clin Microbiol Infect 2001;7:28-31.
Hayes G, Gibson T, Moens NM, Nykamp S, Wood D, Foster R, et al. Intra-articular implantation of gentamicin impregnated collagen sponge causes joint inflammation and impaired renal function in dogs. Vet Comp Orthop Traumatol 2016;29:159-63.
Lipsky BA, Kuss M, Edmonds M, Reyzelman A, Sigal F. Topical application of a gentamicin-collagen sponge combined with systemic antibiotic therapy for the treatment of diabetic foot infections of moderate severity: A randomized, controlled, multicenter clinical trial. J Am Podiatr Med Assoc 2012;102:223-32.
Mendel V, Simanowski HJ, Scholz HC, Heymann H. Therapy with gentamicin-PMMA beads, gentamicin-collagen sponge, and cefazolin for experimental osteomyelitis due to Staphylococcus aureus in rats. Arch Orthop Trauma Surg 2005;125:363-8.
Letsch R, Rosenthal E, Joka T. Local antibiotic application in the treatment of osteomyelitis – A comparative study of two different carriers (translated). Aktuelle Traumatol 1993;23:324-9.
Tsourvakas S. Local antibiotic therapy in the treatment of bone and soft tissue infections. In: Selected Topics in Plastic Reconstructive Surgery. Croatia: In Tech; 2012. p. 18-34.
Mehta S, Humprey JS, Schenkman DI, Seaber AV, Vail TP. Gentamicin distribution from a collagen carrier. J Orthop Res 1996;14:749-54.
Kilian O, Hossain H, Flesch I, Sommer U, Nolting H, Chakraborty T, et al. Elution kinetics, antimicrobial efficacy, and degradation and microvasculature of a new gentamicin-loaded collagen fleece. J Biomed Mater Res B Appl Biomater 2009;90:210-22.
Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med 1999;17:1019-25.
Pepys MB, Hirschfield GM. C-reactive protein: A critical update. J Clin Invest 2003;111:1805-12.
Blaha JD, Calhoun JH, Nelson CL, Henry SL, Seligson D, Esterhai JL, et al. Comparison of the clinical efficacy and tolerance of gentamicin PMMA beads on surgical wire versus combined and systemic therapy for osteomyelitis. Clin Orthop Relat Res 1993;295:8-12.
Spellberg B, Lipsky BA. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin Infect Dis 2012;54:393-407.
Published
How to Cite
Issue
Section
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.
