Systemic Administration Of Antibiotics Research Articles

N-Acetyl Cysteine-Decorated Nitric Oxide-Releasing Interface for Biomedical Applications.

Biomedical devices are vulnerable to infections and biofilm formation, leading to extended hospital stays, high expenditure, and increased mortality. Infections are clinically treated via the administration of systemic antibiotics, leading to the development of antibiotic resistance. A multimechanistic strategy is needed to design an effective biomaterial with broad-spectrum antibacterial potential. Recent approaches have investigated the fabrication of innately antimicrobial biomedical device surfaces in the hope of making the antibiotic treatment obsolete. Herein, we report a novel fabrication strategy combining antibacterial nitric oxide (NO) with an antibiofilm agent N-acetyl cysteine (NAC) on a polyvinyl chloride surface using polycationic polyethylenimine (PEI) as a linker. The designed biomaterial could release NO for at least 7 days with minimal NO donor leaching under physiological conditions. The proposed surface technology significantly reduced the viability of Gram-negative Escherichia coli (>97%) and Gram-positive Staphylococcus aureus (>99%) bacteria in both adhered and planktonic forms in a 24 h antibacterial assay. The composites also exhibited a significant reduction in biomass and extra polymeric substance accumulation in a dynamic environment over 72 h. Overall, these results indicate that the proposed combination of the NO donor with mucolytic NAC on a polymer surface efficiently resists microbial adhesion and can be used to prevent device-associated biofilm formation.

Advances in Hydrogels for Periodontitis Treatment.

Periodontitis is a common condition characterized by a bacterial infection and the disruption of the body's immune-inflammatory response, which causes damage to the teeth and supporting tissues and eventually results in tooth loss. Current therapy involves the systemic and local administration of antibiotics. However, the existing treatments cannot exert effective, sustained release and maintain an effective therapeutic concentration of the drug at the lesion site. Hydrogels are used to treat periodontitis due to their low cytotoxicity, exceptional water retention capability, and controlled drug release profile. Hydrogels can imitate the extracellular matrix of periodontal cells while offering suitable sites to load antibiotics. This article reviews the utilization of hydrogels for periodontitis therapy based on the pathogenesis and clinical manifestations of the disease. Additionally, the latest therapeutic strategies for smart hydrogels and the main techniques for hydrogel preparation have been discussed. The information will aid in designing and preparing future hydrogels for periodontitis treatment.

Eradication of Staphylococcus aureus in Implant-Associated Osteomyelitis by an Injectable in situ-Forming Depot Antibiotics Delivery System.

Bone infections from Staphylococcus aureus are notoriously difficult to treat and have high recurrence rates. Local antibiotic delivery systems hold the potential to achieve high in situ antibiotic concentrations, which are otherwise challenging to achieve via systemic administration. Existing solutions have been shown to confer suboptimal drug release and distribution. Here we present and evaluate an injectable in situ-forming depot system termed CarboCell. The CarboCell technology provides sustained and tuneable release of local high-dose antibiotics. CarboCell formulations of levofloxacin or clindamycin with or without antimicrobial adjuvants cis-2-decenoic acid or cis-11-methyl-2-dodecenoic acid were tested in experimental rodent and porcine implant-associated osteomyelitis models. In the porcine models, debridement and treatment with CarboCell-formulated antibiotics was carried out without systemic antibiotic administration. The bacterial burden was determined by quantitative bacteriology. CarboCell formulations eliminated S. aureus in infected implant rat models. In the translational implant-associated pig model, surgical debridement, and injection of clindamycin-releasing CarboCell formulations resulted in pathogen-free bone tissues and implants in 9/12, and full eradication in 5/12 pigs. Sustained release of antimicrobial agents mediated by the CarboCell technology demonstrated promising therapeutic efficacy in challenging translational models and may be beneficial in combination with the current standard of care.

Bacterial endogenous endophthalmitis : Spectrum of pathogens and drug therapy

Endogenous endophthalmitis represents an ophthalmological emergency requiring immediate diagnostics and treatment. Pathogens should be detected using appropriate methods, such as the Freiburg endophthalmitis set. In bacterial endophthalmitis both Gram-positive and Gram-negative bacteria can be detected. Frequent underlying sources include endocarditis, gastrointestinal or urogenital surgery, indwelling venous catheters, liver abscesses, skin or soft tissue infections, meningitis or less commonly, intravenous drug abuse. The treatment consists of systemic and intraocular administration of antibiotics and vitrectomy. Systemic or intraocular corticosteroids can additionally be considered.

EFFECT OF LOW LEVEL LASER OF 650NM ON VIALBILITY OF PREVOTELLA INTERMEDIAWITH AND WITHOUT PHOTOSENSITISERS: AN IN VITRO STUDY

Background: Prevotella intermedia is commonly associated with various forms of periodontal disease. Conventional treatment involves a combination of mechanical therapy and systemic antibiotics administration, which comes with its own set of challenges and disadvantages. An alternative treatment modality is low-level laser therapy with and without photosensitizers. Purpose: This study aimed to evaluate the effectiveness of low-level laser therapy with and without the use of photosensitizers, specifically Methylene blue and Toluidine blue, on the viability of Prevotella intermedia. Methods: The study utilized in vitro experiments to assess the impact of low-level laser therapy alone and in combination with photosensitizers on the viability of Prevotella intermedia. Results: The findings indicate that Methylene blue, when combined with low-level laser therapy, exhibits bactericidal effects similar to or greater than low-level laser therapy alone on Prevotella intermedia. Additionally, the use of Toluidine blue as a photosensitizer in combination with low-level laser therapy also led to a reduction in the viability of Prevotella intermedia, although it was not as effective as Methylene blue. Conclusion: Low-level laser therapy, particularly when combined with Methylene blue as a photosensitizer, shows promise as a potential treatment modality for controlling Prevotella intermedia in periodontal diseases.

Management of Grade 1 Open Distal Radius Fractures: A Survey of Practicing Surgeons.

Introduction Standard of care management for open fractures historically mandates emergent systemic antibiotic administration, followed by urgent irrigation and debridement in the operating room, regardless of injury severity. However, significant controversy exists regarding the specific implementation and importance of these commonly accepted guidelines. We aimed to define differences in the management of grade 1 open distal radius fractures. Methods An anonymous online survey was distributed to attendingsurgeon members of either the Orthopaedic Trauma Association (OTA) between January 2019 and April 2019 or the New York Society for Surgery of the Hand (NYSSH) in January 2019. Results A total of 68 attending surgeons responded to the survey. A total of 24 OTA members and 40 NYSSH members replied and were included in the study. Several factors influenced management in addition to the level of contamination. Of the surgeons,68% stated that litigation was not a major factor of concern. When compared to surgeons who trained in trauma fellowships, more surgeons who trained in hand/upper extremity fellowships considered closed reduction alone as reasonable definitive treatment (when excluding antibiotic administration and debridement considerations, p = 0.024) and oral antibiotics as a supplement to IV antibiotics (p < 0.001). Of the surgeons,90% would nonoperatively treat a patient who presented with a grade 1 open distal radius fracture greater than 72 hours after injury with stable and acceptable alignment on X-rays. Conclusion Some surgeons are willing to deviate from standard-of-care management protocols.

Clinical and microbiological efficacy of intra-pocket application of diode laser in grade C periodontitis: a randomized controlled clinical trial

BackgroundPeriodontitis is a microbially induced disease destroying structures anchoring teeth to jaw bones. Although metronidazole in combination with spiramycin is the effective conventional treatment of stage III grade C periodontitis, it has several systemic side effects. Laser therapy is widely used nowadays as an adjunct to scaling and root planing (SRP) to modulate inflammatory host response and eradicate microbes, due to bactericidal and detoxifying effects. Since microbiological analysis is one of the diagnostic methods identifying periodontal risk; our research aimed to investigate the efficacy of intra-pocket application of diode laser (980 nm) versus antibiotic therapy in enhancing clinical and microbiological parameters in stage III grade C periodontitis.MethodsA randomized controlled clinical trial was conducted on fifty patients with stage III grade C periodontitis, divided equally into two groups. We managed test group by SRP with intra-pocket application of diode laser (980 nm) and the control group by SRP with systemic antibiotic administration (spiramycin and metronidazole). Then, we measured periodontal pocket depth (PPD) and clinical attachment loss (CAL) for both groups, before treatment (baseline), four and twelve weeks after. Moreover, we collected gingival crevicular fluid from both groups at baseline, four and twelve weeks after treatment and analyzed by real-time polymerase chain reaction to detect the relative count of Aggregatibacter actinomycetemcomitans and Porhyromonas gingivalis.ResultsCompared to baseline, all assessed clinical and microbiological parameters attested improvement at the end of the study period in each group individually with no significant difference between the two studied groups. Although, at twelve weeks, flare up of bacterial levels was detected with systemic antibiotic administration.ConclusionLaser therapy can be considered as an effective treatment modality in stage III grade C periodontitis, avoiding the systemic antibiotic side effects and solving the recurrence problems due to bacterial resistance by long term usage.Trial registrationNCT05222737 retrospectively on 03/02/2022, Clinicaltrial.gov.

Prenatal Exposure to Air Pollution and Respiratory Distress in Term Newborns: Results from the MIREC Prospective Pregnancy Cohort.

Respiratory distress is the leading cause of neonatal morbidity and mortality worldwide, and prenatal exposure to air pollution is associated with adverse long-term respiratory outcomes; however, the impact of prenatal air pollution exposure on neonatal respiratory distress has not been well studied. We examined associations between prenatal exposures to fine particular matter () and nitrogen dioxide () with respiratory distress and related neonatal outcomes. We used data from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a prospective pregnancy cohort () recruited in the first trimester from 10 Canadian cities. Prenatal exposures to () and () were estimated using land-use regression and satellite-derived models coupled with ground-level monitoring and linked to participants based on residential location at birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between air pollution and physician-diagnosed respiratory distress in term neonates in hierarchical logistic regression models adjusting for detailed maternal and infant covariates. Approximately of newborns experienced respiratory distress. Neonates received clinical interventions including oxygen therapy (6%), assisted ventilation (2%), and systemic antibiotics (3%). Two percent received multiple interventions and 4% were admitted to the neonatal intensive care unit (NICU). Median and concentrations during pregnancy were and , respectively. Prenatal exposures to air pollution were not associated with physician-diagnosed respiratory distress, oxygen therapy, or NICU admissions. However, exposures were strongly associated with assisted ventilation (OR per increase in ; 95% CI: 1.02, 1.35), multiple clinical interventions (OR per increase in ; 95% CI: 1.07, 1.26), and systemic antibiotics, (OR per increase in ; 95% CI: 1.04, 1.21). These associations were consistent across exposure periods-that is, during prepregnancy, individual trimesters, and total pregnancy-and robust to model specification. exposure was associated with administration of systemic antibiotics (OR per 1-ppb increase in ; 95% CI: 1.00, 1.06). Prenatal exposures to increased the risk of severe respiratory distress among term newborns. These findings support the development and prioritization of public health and prenatal care strategies to increase awareness and minimize prenatal exposures to air pollution. https://doi.org/10.1289/EHP12880.

The Effect of Topical Antibiotic Powder Application in the Emergency Department on Deep Fracture-Related Infection in Type III Open Lower Extremity Fractures.

Despite advances in management, open fractures are at an elevated risk for deep fracture-related infection (FRI). Time to systemic antibiotic (ABX) administration and intraoperative topical administration of ABX powder have been used to decrease FRI risk. The purpose of this study was to determine whether topical application of antibiotic powder to type III open lower extremity fractures immediately on presentation to the emergency department (ED) reduces the rate of FRI. Prospective cohort compared with retrospective historical control. Level I trauma center. Application of 1 g of vancomycin and 1.2 g of tobramycin powder directly to open fracture wounds on presentation to the ED. Patients with type III open lower extremity fractures treated from July 1, 2019, to September 17, 2022, who received topical ABX powder in the ED were compared with patients from a 4-year historical cohort from July 1, 2015, to June 30, 2019, who were treated without topical ABX powder. Development of a FRI within 6 months of follow-up. Patient demographics, injury characteristics, and postoperative data were analyzed as risk factors for FRI. Sixty-six patients received topical ABX powder in the ED and were compared with 129 patients who were treated without topical ABX powder. The rate of FRI in the trial group was 6/66 (9.09%) versus 22/129 (17.05%) in the control cohort ( P = 0.133). Multivariate analysis demonstrated higher body mass index as a risk factor for development of FRI ( P = 0.036). No statistically significant difference in rates of FRI in open lower extremity fractures treated with immediate topical ABX administration in the ED versus standard-of-care treatment without topical ABX was found. These findings may have been limited by insufficient power. Further large-scale study is warranted to determine the significance of topical antibiotic powder application in the ED. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Chitosan- A Promising agent for site specific drug delivery in periodontics

Periodontal diseases are chronic infectious illnesses that have become a significant burden on oral health. Several new treatment targets have been found because of advances in the study of the epidemiology, aetiology, and pathophysiology of periodontitis, as well as the analysis of the polymicrobial interaction in the oral bacterial communities. Efforts to limit growth of bacteria and the formation of substances that eventually damage the tissues supporting the teeth have been the foundation of periodontal therapy. Systemic antibiotic administration for periodontitis has significant shortcomings, attracting attentiontowards the advancement of localized drug delivery systems capable ofmaintaining effective antibiotic concentrations at the intended site throughout the course of treatment with minimum side effects. A controlled release system that can be placed within the periodontal pocket so as to extend therapeutic concentrations at the desired site at a considerably lesser dosage is a pressing priority. Chitosan, a potential carbohydrate biopolymer, is receiving scientific interest in a diverse range of biomedical fields due to its exceptional chemical and pharmacokinetic attributes. Chitosan is a biocompatible and biodegradable naturally occurring polysaccharide with several uses in dentistry owing to its functional versatility and easy accessibility. The applications of chitosan are vast, exciting, and still unexplored. Thisreviewfocusesonthe potential uses of chitosan in periodontology.

Additively manufactured Ti–Ta–Cu alloys for the next-generation load-bearing implants

Bacterial colonization of orthopedic implants is one of the leading causes of failure and clinical complexities for load-bearing metallic implants. Topical or systemic administration of antibiotics may not offer the most efficient defense against colonization, especially in the case of secondary infection, leading to surgical removal of implants and in some cases even limbs. In this study, laser powder bed fusion was implemented to fabricate Ti3Al2V alloy by a 1:1 weight mixture of CpTi and Ti6Al4V powders. Ti-Tantalum (Ta)–Copper (Cu) alloys were further analyzed by the addition of Ta and Cu into the Ti3Al2V custom alloy. The biological, mechanical, and tribo-biocorrosion properties of Ti3Al2V alloy were evaluated. A 10 wt.% Ta (10Ta) and 3 wt.% Cu (3Cu) were added to the Ti3Al2V alloy to enhance biocompatibility and impart inherent bacterial resistance. Additively manufactured implants were investigated for resistance against Pseudomonas aeruginosa and Staphylococcus aureus strains of bacteria for up to 48 h. A 3 wt.% Cu addition to Ti3Al2V displayed improved antibacterial efficacy, i.e. 78%–86% with respect to CpTi. Mechanical properties for Ti3Al2V–10Ta–3Cu alloy were evaluated, demonstrating excellent fatigue resistance, exceptional shear strength, and improved tribological and tribo-biocorrosion characteristics when compared to Ti6Al4V. In vivo studies using a rat distal femur model revealed improved early-stage osseointegration for alloys with 10 wt.% Ta addition compared to CpTi and Ti6Al4V. The 3 wt.% Cu-added compositions displayed biocompatibility and no adverse inflammatory response in vivo. Our results establish the Ti3Al2V–10Ta–3Cu alloy’s synergistic effect on improving both in vivo biocompatibility and microbial resistance for the next generation of load-bearing metallic implants.

Approaches to surgical treatment and antibacterial therapy in patients with chronic infection after war injuries

Fracture-related infection following orthopedic surgery, especially in cases of war-related trauma, represents a grave complication. The injuries sustained in war often entail severe damage to soft tissues, including significant impairment of vessels, nerves, tendons, muscles, and result in substantial bone defects. Complicating matters further, these infections often involve multidrug-resistant pathogens, making effective treatment a significant challenge. Optimal management of patients with combat-related trauma and signs of infection necessitates specialized care in dedicated centers. The approach to treatment should be guided by a well-defined algorithm that incorporates appropriate surgical interventions alongside systemic and localized antibiotic administration. In instances where chronic infection manifests after war-related injuries and specific causative agents are not definitively identified, initiating empiric therapy is advisable. A combination of meropenem, colistin, and vancomycin can be a suitable choice for initial treatment. Subsequently, once the causative microbes are identified, targeted treatment can be prescribed based on the susceptibility patterns. This article delves into the primary pathogens commonly found in war-related wounds and provides effective antibiotic regimens based on the specific microorganisms. One promising approach for managing severe war injuries is suppressive antibiotic therapy, which enhances the prospects of successful treatment. The comprehensive strategy outlinedhere aims to mitigate the serious risks posed by fracture-related infections in the context of war-induced trauma, ultimately improving patient outcomes and prognosis.

Prophylactic Intrawound Antibiotics Significantly Reduce the Risk of Deep Infections in Fracture Fixation: Subgroup Metanalyses of the Type of Fracture, Antibiotics, and Organism.

To analyze the efficacy of subgroups of various intrawound local antibiotics in reducing the rate of fracture-related infections (FRI). and study selection: PubMed, MEDLINE via Ovid, Web of Science, Cochrane database, and Science Direct were searched for articles in English on July 5, 2022 and December 15, 2022. All clinical studies comparing the incidence of FRI between administration of prophylactic systemic and topical antibiotics in fracture repair were analyzed. Cochrane collaboration's assessment tool and the methodological bias and the methodological index for nonrandomized studies were used to detect bias and evaluate the quality of included studies, respectively. Data synthesis: RevMan 5.3 software. (Nordic Cochrane Centre, Denmark) was used to conduct the meta-analyses and generate forest plots. From 1990 to 2021, 13 Studies included 5,309 patients. Non-stratified meta-analysis showed that intrawound administration of antibiotics significantly decreased the overall incidence of infection in both open and closed fractures, regardless of the severity of open fracture and antibiotics class [OR= 0.58, P= 0.007)] [OR= 0.33, P<0.00001)], respectively. The stratified analysis revealed that prophylactic intrawound antibiotics significantly lowered infection rate in open fracture patients with Gustilo-Anderson Type I (OR=0.13, p=0.004), Type II (OR=0.29, p=0.0002), Type III (OR=0.21, p<0.00001), when either Tobramycin PMMA beads (OR=0.29, p<0.00001), or vancomycin powder (OR=0.51, p=0.03) was applied. This study demonstrates prophylactic administration of intrawound antibiotics significantly decreases the overall incidence of infection in all subgroups of surgically fixated fractures but does not affect. Level II. See Instructions for Authors for a complete description of levels of evidence.

Prompt antibacterial activity of silver nanoparticle decorated on HAp embedded NiFe2O4 nanocomposite (NiFe2O4@HAp-Ag) against pathogenic strains and investigation of its photocatalytic activity towards degradation of antibiotics

Local bacterial infection in clinics is still a difficult task and poses serious health threats to human. Systemic antibiotic administration typically results in negative side-effects and bacterial resistance and only has transient antibacterial activity. Several biomedical applications immensely prefer modified hydroxyapatite with excellent biocompatibility and antibacterial characteristics. Herein, we fabricate hydroxyapatite-embedded NiFe2O4 using in situ hydrothermal method and used as a support for silver nanoparticle onto its surface to achieve an effective biological response. The properties of the as-synthesized materials were characterized using several spectroscopic techniques which include X-ray diffraction spectroscopy, Fourier transform infrared spectroscopy, ultraviolet–diffuse reflectance spectroscopy spectroscopy, X-ray photoelectron spectroscopy, field emission scanning electron microscopy, high resolution transmission electron microscopy. In addition, the magnetic behavior of these nanocomposites was examined using the vibrating sample magnetometer technique. This ternary nanocomposite exhibits potent antimicrobial activity against both Gram-negative bacteria (Pseudomonas aeruginosa and klebsiella pneumoniae) as well as Gram-positive bacteria (Staphylococcus aureus and Bacillus cereus). The MIC or minimum inhibitory concentration, MBC or minimum bactericidal concentration, the disc diffusion, bacterial growth rate, and inhibition rate tests were utilized for the examination of the antimicrobial effect of this synthesized nanocomposite against pathogenic strains. Along with this, we have also investigated its photocatalytic activity toward degradation of cefixime antibiotic under solar light and it shows excellent photodegradation performance. The fabricated nanocomposite demonstrated high reusability with good photostability. Notably, using magnetic decantation this prepared nanocomposite can be easily eliminated from the disinfected medium.

Risk factor analysis for anti-epidermal growth factor receptor monoclonal antibody-induced skin toxicities in real-world metastatic colorectal cancer treatment.

Anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibodies are effective in treating RAS wild-type metastatic colorectal cancer (mCRC). However, their administration induces skin toxicity, markedly reducing patients' quality of life. This study is aimed at identifying the risk factors associated with anti-EGFR monoclonal antibody-induced skin toxicities. Patients with mCRC (n = 116) who received anti-EGFR monoclonal antibody treatment were retrospectively evaluated. Primary endpoint was evaluation of the risk factors for grade ≥ 2 overall skin toxicities during all the treatment periods. Furthermore, factors associated with each grade ≥ 2 skin symptoms were assessed. Incidence of total grade ≥ 2 skin toxicity symptoms was 61.2%, and those of grade ≥ 2 rash, dry skin, fissures, and paronychia were 34.5%, 25.9%, 20.7%, and 25.0%, respectively. Multivariate logistic regression analyses revealed that liver metastasis was an independent risk factor for overall grade ≥ 2 skin toxicities (adjusted odds ratio [OR], 2.88; 95% confidence interval [CI], 1.22-6.78; P = 0.02) and prophylactic administration of antibiotics as a preventive factor (OR 0.10; 95%CI 0.01-0.91; P = 0.04). For grade ≥ 2 rash, prophylactic use of systemic antibiotics and topical steroid ointment was a preventive factor (OR 0.37; 95%CI 0.16-0.89; P = 0.03). Moreover, liver metastasis (OR 8.37; 95%CI 1.98-35.47; P = 0.004) and prophylactic administration of antibiotics (OR 0.15; 95%CI 0.03-0.76; P = 0.02) were significantly associated with grade ≥ 2 paronychia. Liver metastasis was suggested to be a risk factor for the incidence of overall grade ≥ 2 skin toxicities; moreover, preemptive systemic antibiotic administration drastically decreased this risk during all periods of anti-EGFR treatment for mCRC.

Total Knee Arthroplasty in Unrecognized Septic Arthritis-A Descriptive Case Series Study.

Synovitis, like that associated with chronic bacterial arthritis, is a very rare finding during the implantation of knee endoprostheses. In such cases, we fix the knee prostheses with cement containing two antibiotics and carry out a course of systemic antibiotic administration. The aim was to analyze these cases for incidence, detection of bacteria, risk factors, and outcome. Out of 7534 knee replacements between January 2013 and December 2020, 25 cases were suspected during the surgical procedure to have suffered from bacterial arthritis and were treated accordingly. Total synovectomy was carried out, whereby five intraoperative synovial samples were examined bacteriologically, and the complete synovitis was analyzed histologically. The mean follow-up was 65.3 ± 27.1 (24-85) months. In nine cases (0.12%), the diagnosis of bacterial arthritis was made histologically and by clinical chemistry (elevated CRP), and in two of these cases, pathogen verification was performed. Eight of these nine patients had previously had injections or surgery associated with the corresponding knee joint or had an underlying immunomodulatory disease. None of the patients developed a periprosthetic infection at a later stage. With an incidence of 0.12%, it is rare to unexpectedly detect bacterial synovitis during surgery. Total synovectomy, use of bone cement with two antibiotics, and immediate systemic antibiotic therapy seem to keep the risk of periprosthetic infection low.

Innovative biomaterials for the treatment of periodontal disease

Periodontitis is a multifactorial disease that involves the destruction of hard and soft tissues surrounding the tooth. Routine periodontal treatment includes mechanical debridement (surgical and non-surgical) and the systemic administration of antibiotics. In contrast, severe and chronic periodontitis involves aggressive tissue destruction and bone resorption, and the damage is usually irreversible. In these severe cases, bone grafts, the delivery of growth hormones, and guided tissue regeneration can all be used to stimulate periodontal regeneration. However, these approaches do not result in consistent and predictable treatment outcomes. As a result, advanced biomaterials have evolved as an adjunctive approach to improve clinical performance. These novel biomaterials are designed to either prolong the release of antibacterial agents or osteogenic molecules, or to act as immunomodulators to promote healing. The first half of this review briefly summarizes the key immune cells and their underlying cellular pathways implicated in periodontitis. Advanced biomaterials designed to promote periodontal regeneration will be highlighted in the second half. Finally, the limitations of the current experimental design and the challenges of translational science will be discussed.

Bone regeneration as treatment of peri-implant disease: A narrative review.

Analysis of the 3-dimensional implant position, the bone defect morphology, and the soft tissue situation guides the decision to preserve or to remove an implant with a severe peri-implantitis lesion. The aim of this narrative review was to analyze and to comprehensively illustrate the treatment options focusing on peri-implant bone regeneration in presence of severe peri-implant bone loss. A database search was performed independently by the two reviewers to identify case reports, case series, cohort, retrospective, and prospective studies about peri-implant bone regeneration with a follow-up of at least 6 months. Of the 344 studies issued during the database analysis, 96 publications were selected by the authors for this review. Deproteinized bovine bone mineral remains the best documented material for defect regeneration in peri-implantitis in combination with or without a barrier membrane. While studies using autogenous bone in peri-implantitis therapy are rarely found, they do report favorable potential of vertical bone regeneration. Moreover, while membranes are an inherent part of the guided bone regeneration, a 5-year follow-up study demonstrated clinical and radiographic improvements with and without a membrane. The administration of systemic antibiotics is frequently performed in clinical studies observing regenerative surgical peri-implantitis therapy, but the analysis of the literature does not support a positive effect of this medication. Most studies for regenerative peri-implantitis surgery recommend the removal of the prosthetic rehabilitation and the use a marginal incision with a full-thickness access flap elevation. This allows for a good overview for regenerative procedures with a certain risk of wound dehiscences and incomplete regeneration. An alternative approach referring to the poncho technique may reduce the risk of dehiscence. The effectiveness of implant surface decontamination might have an impact on peri-implant bone regeneration without any clinical superiority of a certain technique. The available literature reveals that the success of peri-implantitis therapy is limited to the reduction of bleeding on probing, the improvement of the peri-implant probing depth and a small amount of vertical defect fill. On this basis, no specific recommendations for bone regeneration in surgical peri-implantitis therapy can be made. Innovative approaches for flap design, surface decontamination, bone defect grafting material, and soft tissue augmentation should be followed closely to find advanced techniques for favorable peri-implant bone augmentation.

Vancomycin-loaded bone substitute as a ready-to-use drug delivery system to treat osteomyelitis

Affecting annually millions of people worldwide, osteomyelitis is a critical bone infection caused by pathogenic organisms which poses a serious health issue. The standard treatment involves debridement of infected bone, systemic administration of antibiotics and subsequent bone reconstruction. However, the systemic route of administration can be ineffective and associated with severe side effects. This work focused on the development of lyophilized vancomycin-loaded heparinized nanohydroxyapatite/collagen granules to facilitate clinical application, addressing infection eradication and bone regeneration. A local bone substitute delivery system was developed as an attractive alternative solution not yet commercially available. The lyophilization process has proven to be effective with a controlled release of the antibiotic for a longer period, above minimum inhibitory concentration for methicillin-resistant Staphylococcus aureus (MRSA), when compared to non-lyophilized granules. This system totally inhibits the growth of planktonic and sessile MRSA. Moreover, the material promoted osteoblasts metabolic activity and proliferation, while inducing neovascularization. Overall, this work advanced towards the deployment of a reliable solution in clinical practice developing a ready-to-use drug delivery system avoiding the process of antibiotic handling and preparation before surgery.

State of the Union: Timeliness to Antibiotics in Open Fractures.

In open fractures, early administration of systemic antibiotics has recently been recognized as a universal recommendation, with the current American College of Surgeons Trauma Center Verification recommendation for administration within one hour of facility arrival. We sought to quantify the baseline rate of timely antibiotic administration and the various factors associated with delay. Data from the National Trauma Data Bank (NTDB) were obtained for all patients treated for open fractures in 2019. 65,552 patients were included. Univariate and multivariate analyses were performed, first for patient, prehospital and hospital factors compared to rate of antibiotic administration within one hour of hospital arrival, then with a multivariate analysis of factors affecting these times. The overall rate of antibiotic administration within one hour of arrival was 47.6%. Patient factors associated with lower rates of timely antibiotics include increased age, Medicare status, and a higher number of comorbidities. Associated prehospital factors included non-work related injuries, fixed-wing air or police transport, and walk-in arrival method. Patients with lower extremity open fractures were more likely to receive antibiotics within one hour of arrival than those with upper extremity open fractures. Traumatic amputations had a higher rate of timely administration (67.3%). ACS trauma level II (52.5%) centers performed better than Level III (48.3%), Level I (45.5%) and Level IV (34.5%) centers. Multivariate analysis confirmed the findings of the univariate analysis. Despite current clinical standards, rates of adherence to rapid antibiotic administration are low. Certain patient, facility, and environmental factors are associated with delays in antibiotic administration, and can be a focus for quality improvement processes. We plan to use this data to evaluate how focus on antibiotic administration as this quality standard changes practice over time. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.