Abstract
BackgroundSurgical site infections (SSI) are a significant risk in cranioplasty, with reported rates of around 8–9%. The most common bacteria associated with these nosocomial infections are of the Staphylococcus species, which have the ability to form biofilm. The possibility to deliver antibiotics, such as gentamicin, locally rather than systemically could potentially lower the early postoperative SSI. Various antibiotic dosages are being applied clinically, without any true consensus on the effectiveness.MethodsDrug release from calcium phosphate (CaP), polyetheretherketone (PEEK), and titanium (Ti) samples was evaluated. Microbiological studies with Staphylococcus aureus (SA) and Staphylococcus epidermidis (SE) including strains from clinical infection were used to establish clinically relevant concentrations.ResultsThe CaP samples were able to retain and release gentamicin overtime, whereas the Ti and PEEK samples did not show any drug uptake or release. A gentamicin loading concentration of 400 μg/ml was shown to be effective in in vitro microbiological studies with both SA and SE.ConclusionsOut of the three materials studied, only CaP could be loaded with gentamicin. An initial loading concentration of 400 μg/ml appears to establish an effective gentamicin concentration, possibly translating into a clinical benefit in cranioplasty.
Highlights
Surgical site infections (SSI) in cranioplasty pose a significant risk with reported rates of around 8–9% [1,2,3,4,5,6,7]
Agar diffusion tests for calcium phosphate (CaP) showed that there was a slight difference in the inhibition zone at low concentrations but not significant (p > 0.05), as expected, the higher the concentration, the wider the inhibition zone
For the Staphylococcus epidermidis (SE) strain, both gentamicin concentrations used for loading the CaP were effective
Summary
Surgical site infections (SSI) in cranioplasty pose a significant risk with reported rates of around 8–9% [1,2,3,4,5,6,7]. The most predominant are Staphylococcus epidermidis (SE) and Staphylococcus aureus (SA) [4, 8, 9] They are generally carried asymptomatically on the skin, especially in moist skin regions [4, 8,9,10]. Surgical site infections (SSI) are a significant risk in cranioplasty, with reported rates of around 8–9%. Various antibiotic dosages are being applied clinically, without any true consensus on the effectiveness
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