Abstract
The increasing number of implant-associated infections and of multiresistant pathogens is a major problem in the daily routine. In the field of osteomyelitis, it is difficult to manage a valid clinical study because of multiple influencing factors. Therefore, models of osteomyelitis with a simulation of the pathophysiology to evaluate treatment options for implant-associated infections are necessary. The aim of this study is to develop a standardized and reproducible osteomyelitis model in-vivo to improve treatment options. This study analyses the influence of a post-infectious implant exchange one week after infection and the infection progress afterward in combination with a systemic versus a local antibiotic treatment in-vivo. Therefore, the implant exchange, the exchange to a local drug-delivery system with gentamicin, and the implant removal are examined. Furthermore, the influence of an additional systemic antibiotic therapy is evaluated. An in-vivo model concerning the implant exchange is established that analyzes clinic, radiologic, microbiologic, histologic, and immunohistochemical diagnostics to obtain detailed evaluation and clinical reproducibility. Our study shows a clear advantage of the combined local and systemic antibiotic treatment in contrast to the implant removal and to a non-combined antibiotic therapy. Group genta/syst. showed the lowest infection rate with a percentage of 62.5% concerning microbiologic analysis, which is in accordance with the immunohistochemical, cytochemical, histologic, and radiologic analysis. Our in-vivo rat model has shown valid and reproducible results, which will lead to further investigations regarding treatment options and influencing factors concerning the therapy of osteomyelitis and implant-associated infections.
Highlights
The increasing number of implant-associated infections and of multiresistant pathogens is a major problem in the daily routine
Klemm and Wildfeuer could show in their studies that local antibiotic carriers like bone cement and PMMA-chains decrease the incidence of wound infections, especially in combination with a systemic perioperative antibiotic prophylaxis[22,24]
At day 28 the test group without any implant and just systemical antibiotic treatment showed most signs of infection in radiological as well in histological anaylsis, which leads to the conclusion, that the implant removal in combination with a systemic antibiotic treatment is not an efficient option as bacteria might survive and colonise the open drill channel plus mechanical stability is missing, which is one of the most important aspects in infection treatment
Summary
The increasing number of implant-associated infections and of multiresistant pathogens is a major problem in the daily routine. This study analyses the influence of a post-infectious implant exchange one week after infection and the infection progress afterward in combination with a systemic versus a local antibiotic treatment in-vivo. Our study shows a clear advantage of the combined local and systemic antibiotic treatment in contrast to the implant removal and to a non-combined antibiotic therapy. Our in-vivo rat model has shown valid and reproducible results, which will lead to further investigations regarding treatment options and influencing factors concerning the therapy of osteomyelitis and implant-associated infections. For the treatment of implant-associated and chronic stages of infection, a combined therapy becomes necessary, which includes a combination of local and systemic antibiotics to reach high local concentrations, surgical debridement, implant removal, fracture stabilization, and soft tissue management. The biofilm itself acts as a nutrition medium and promotes cell communication as well as the exchange of virulence factors[1–3,8,17–21]
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