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A meta-analysis of bone cement mediated antibiotic release: Overkill, but a viable approach to eradicate osteomyelitis and other infections tied to open procedures
Biomaterials Advances ( IF 5.5 ) Pub Date : 2021-02-27 , DOI: 10.1016/j.msec.2021.111999
Lydia M. Mensah , Brian J. Love

A number of clinical studies have highlighted the success of antibiotics formulated at concentrations between 0 and 6% w/w into bone cements to address localized infections. Separately, some commercial manufacturers have produced gentamycin-infused bone cement mixtures as a countermeasure to infection. The anecdotal evidence suggests that antibiotic infused cements can help eradicate or delay the onset of infections. Quantifying the functionality of that response is more challenging. We have surveyed the literature to identify studies in which controlled drug release or mechanical behavioral assessments have been conducted on drug-infused cements. The focus here is on vancomycin (VAN) in part due to its higher potency relative to gentamycin and its more common usage for staph infections. Takeaways from the limited pool of research studies indicate that large fractions (>99%) of the infused vancomycin remain sequestered in the cement and aren't bioavailable after solidification. Antibiotic fluence ranged from 1 to 283 μg/cm2hr. The initial strength of the various antibiotic loaded samples as produced were 52–96 MPa. Simulated exposures in a fluid environment by submersion reduced the antibiotic loaded strengths between 3 and 29%. Some strength measurements were noted below the ASTM F451 standard for acrylic bone cement although drug releasing spacers likely have different requirements. The glassy behavior of the cured cement led to both vancomycin and gentamicin having low permeability and a burst response. Smaller drug molecules and more gel-like immobilization matrices with lower glass transition temperatures offer higher potential for larger and more comprehensive drug bioavailability.



中文翻译:

骨水泥介导的抗生素释放的荟萃分析:过度杀伤,但根除骨髓炎和其他与开放手术相关的感染的可行方法

许多临床研究强调了0至6%w浓度配制的抗生素的成功/ w注入骨水泥以解决局部感染。另外,一些商业制造商已经生产了注入庆大霉素的骨水泥混合物,以作为感染的对策。轶事证据表明,注入抗生素的水泥可帮助根除或延缓感染的发作。量化该响应的功能更具挑战性。我们已经对文献进行了调查,以找出对注入药物的水泥进行受控药物释放或机械行为评估的研究。这里的重点是万古霉素(VAN),部分原因是其相对于庆大霉素的效力更高,并且更常用于葡萄球菌感染。有限的研究成果表明,注入的万古霉素中有很大一部分(> 99%)仍被隔离在水泥中,并且没有被“吸收”。固化后可生物利用。抗生素通量范围为1至283μg/ cm2小时 所生产的各种载有抗生素的样品的初始强度为52-96 MPa。通过浸没在流体环境中进行的模拟暴露将抗生素负荷强度降低了3%至29%。尽管药物释放垫片可能有不同的要求,但在ASTM F451丙烯酸骨水泥标准下仍记录了一些强度测量值。固化水泥的玻璃态行为导致万古霉素和庆大霉素均具有低渗透性和爆裂响应。玻璃化转变温度较低的较小的药物分子和更多的凝胶状固定基质为更大,更全面的药物生物利用度提供了更高的潜力。

更新日期:2021-03-02
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