Abstract
The one-stage treatment of chronic osteomyelitis with S53P4 bioactive glass (BAG) granules has shown excellent results. However, these granules possess suboptimal handling properties. Therefore, new injectable S53P4 putty materials have been developed by the incorporation of a synthetic binder to contain glass granules. The goal of the current study was to assess their potential to eradicate five clinically relevant pathogens: methicillin sensitive Staphylococcus aureus (MSSA), methicillin resistant Staphylococcus aureus (MRSA), Enterococcus coli (E. coli), Enterococcus faecalis (E. faecalis), and Pseudomonas aeruginosa (P. aeruginosa). As a control, S53P4 granules (500–800 μm) and S66 glass (< 45 μm) were used. To evaluate the antimicrobial properties, the materials were cultured with the pathogens in a Müller-Hinton II broth for a week with daily colony forming unit (CFU) counting. One of the tested putty formulations was observed to reduce the number of CFU/mL compared to a negative control (no material, only pathogen in broth) for E. coli, E. faecalis and P. aeruginosa. However, none of the tested putty formulations was able to completely eradicate the pathogens in the broths, which would be needed for safe infection treatment. The results obtained for the control materials were unexpected. S66 glass showed full eradication of P. aeruginosa and reduced the number of CFUs of other pathogens, while the S53P4 granules did not show eradication. The observations on the loose S53P4 granules in this study contradict available literature, which needs further investigation. The results obtained in this study also stretch the importance for a better understanding of the underlying antimicrobial mechanism of S53P4 BAG and how this is related to the dosage. In addition, it should be elucidated how these antimicrobial properties are affected by changes in the material formulation, for example by addition of binders to improve the handling properties or by changing the surface area.
Highlights
Chronic bone infections, or chronic osteomyelitis, are a major problem in the field of orthopedic surgery
Novel S53P4 bioactive glass putty formulations have been developed. These formulations consist of S53P4 bioactive glass granules surrounded by a synthetic binder of poly(ethylene) glycol (PEG) and glycerol
This study was performed to determine the antimicrobial activity of four biomaterials on five different bacterial strains: methicillin sensitive Staphylococcus aureus (MSSA; ATCC 29213), methicillin resistant Staphylococcus aureus (MRSA; ATCC 12493), Enterococcus coli (ATCC 25922), Enterococcus faecalis (ATCC 29212), and Pseudomonas aeruginosa (ATCC 27853)
Summary
Chronic osteomyelitis, are a major problem in the field of orthopedic surgery. Invasive treatment is needed to prevent the loss of the affected limb, sepsis or even death (Parsons and Strauss, 2004). For years the gold standard treatment consisted of a two-stage surgical treatment. An excessive debridement of the infected tissues is performed, followed by the implantation of a local antibiotic carrier (e.g., poly- (methyl methacrylate) (PMMA) beads loaded with gentamycin). When the infection is completely eradicated, the antibiotic carrier is removed, and the bone defect is grafted with either autograft or allograft bone for reconstruction in a second surgery. In addition to the surgical treatment, systemic antibiotics, specific for the cultured strains, are administered for at least 6 weeks (2 weeks intravenously and 4 weeks orally) (Walenkamp et al, 1998; Geurts et al, 2016; Lindfors et al, 2016)
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