Gentamicin-impregnated Collagen Research Articles

Pharmacokinetic study of local and systemic gentamicin concentrations after subcutaneous implantation of a gentamicin-impregnated collagen sponge in dogs

This study evaluated the pharmacokinetics of commercial gentamicin-impregnated collagen sponges (GICS) applied subcutaneously in dogs. In six healthy beagles, an 11 ×6 cm subcutaneous pocket was created, a folded 10×10 cm GICS was inserted, and saline was injected to mimic a seroma. Wound fluid samples were aspirated, and the gentamicin concentration was determined. Simultaneously, blood samples were collected to evaluate the corresponding systemic gentamicin concentration. All samples were collected before and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 18, 24, 36, 48, 72, 96, 120, and 168 hours after GICS placement. The local Cmax of gentamicin was reached after 0.5 hours (range, 0.5–1.0 hours) post-implantation in 5/6 dogs at a median concentration of 2053.3 µg/mL (range, 918.0–2791.9 µg/mL). Whitin 24 hours, the local concentration dropped below the MIC for Staphylococcus sp. (4 µg/mL) in 5/6 dogs. Plasma Cmax was achieved at a median of 1.2 hours post-implantation (range, 1.0–2.0 hours) and reached a median concentration of 10.3 µg/mL (range, 8.8–18.03 µg/mL). After 6 hours, the gentamicin concentration in the plasma was below 4 µg/mL in all dogs. The GICS provided a high local concentration of gentamicin in a short time with a local Cmax:MIC ratio of 513:1, largely sufficient to eliminate susceptible bacteria, including methicillin-resistant Staphylococcus pseudintermedius (MRSP) and Pseudomonas sp., in a clinical setting. The repeated administration of saline in the present study seemed to have induced a quicker gentamicin release from the GICS than described in previous studies that typically dealt with "drier" wounds.

Treatment with gentamicin-impregnated collagen sponges in reducing infection of implantable cardiac devices: 10-year analysis with propensity score matching

Introduction and ObjectivesThe incidence of device infection has increased over time and is associated with increased mortality in patients with cardiac implantable electronic devices (CIEDs). Gentamicin-impregnated collagen sponges (GICSs) are useful in preventing surgical site infection (SSI) in cardiac surgery. Nevertheless, to date, there is no evidence concerning their use in CIED procedures. Our study aims to determine the effectiveness of treatment with GICSs in preventing CIED infection. MethodsA total of 2986 adult patients who received CIEDs between 2010 and 2020 were included. Before device implantation, all patients received routine periprocedural systemic antibiotic prophylaxis. The study endpoints were the CIED infection rate at one year and the effectiveness of the use of GICSs in reducing CIED infection. ResultsAmong 1524 pacemaker, 942 ICD and 520 CRT implantations, CIED infection occurred in 36 patients (1.2%). Early reintervention (OR 9 [95% CI 3.180–25.837], p<0.001), pocket hematoma (OR 11 [95% CI 4.195–28.961], p<0.001), diabetes (OR 2.9 [95% CI 1.465–5.799], p=0.002) and prolonged procedural time (OR 1.02 [95% CI 1.008–1.034], p=0.001) were independent risk factors for CIED infection. Treatment with GICSs reduced CIED infections significantly ([95% CI −0.031 to −0.001], p<0.001). ConclusionsThe use of GICSs may help in reducing infections associated with CIED implantation.

Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus.

Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus.

Local Antibiotic Delivery Systems in Diabetic Foot Osteomyelitis: A Brief Review.

Diabetic foot osteomyelitis (DFO) is a severe, difficult to treat infection. Local antibiotic delivery has been studied as a potential therapeutic adjunct following surgery for DFO. This review aims to summarize the evidence on local antibiotic delivery systems in DFO. PubMed database was searched up to March 2020. Overall, 16 studies were identified and included: 3 randomized controlled trials (RCTs), 3 retrospective studies (RSs), and 10 case series. In the RCTs, gentamicin-impregnated collagen sponges significantly improved clinical healing rates and slightly improved duration of hospitalization. In the RSs, antibiotic-impregnated calcium sulfate beads non-significantly improved all healing parameters, but did not reduce post-operative amputation rates or time of healing. The majority of case series used calcium sulfate beads, achieving adequate rates of healing and eradication of infection. In conclusion, evidence for add-on local antibiotic delivery in DFO is still limited; more data are needed to assess this therapeutic measure.

Impact of Gentamicin-Impregnated Collagen on the Intra-Abdominal Adhesions and Integrity of Colonic Anastomosis: An Experimental Study.

BackgroundWe investigated the impact of collagen usage in colo-colonic anastomoses on intra-abdominal adhesion and anastomosis safety.Material/MethodsA total of 30 adult albino Wistar rats (aged 6–8 months) weighing 180–230 g in the laboratory setting were used in this study. Rats were divided into the 3 groups, consisting of 10 rats in each group: treated with gentamicin-impregnated collagen, treated with only collagen, and the control group. After 7 days, rats were sacrificed to evaluate adhesion scores and anastomosis bursting pressures. The Evans scoring system was used to rate adhesion levels. Bursting pressures were measured using a handheld tension device, and the scores obtained at the moment of tissue dissection were determined as the bursting pressure.ResultsThe mean adhesion scores were 2.86±0.37 in the control group, 1.80±0.91 in the collagen group, and 1.78±0.83 in the gentamicin-impregnated collagen group, with the control group showing significantly higher scores than the other groups (p=0.010 and p=0.011, respectively). The mean bursting pressure levels were 174.29±44.68 mmHg in the control group, 223±38.6 mmHg in collagen group, and 223.33±42 mmHg in the gentamicin-impregnated collagen group, showing that the mean bursting pressure levels were significantly lower in the control group than the other groups (p=0.027 and p=0.029, respectively).ConclusionsThis study suggests that colo-colonic anastomosis coverage using materials incorporating collagen alone or gentamicin-impregnated collagen increases the safety of anastomosis and reduces intra-abdominal adhesions.

First Description of a Mandibular Brodie Abscess in a Pediatric Patient: Case Report

Brodie abscesses can be considered to be a very rare condition, especially in pediatric patients. In 2019, the first cranial Brodie abscess was published in a 51-year-old female following a dental procedure. In this article, we present our case of a 13-year-old boy suffering from recurrent, painless swelling in the left mandibular molar region. MRI, CT, and histopathological examination revealed the diagnosis of a Brodie abscess. During the clinical course, several other differential diagnoses had to be excluded by CT, MRI, and histopathological examination, as a Brodie abscess was the by far least likely diagnosis. As no standard treatment protocols were available, we conducted a profound review of the current literature and the different therapeutic approaches described. The condition was subsequently treated by enucleation and implantation of a gentamicin-impregnated collagen sponge, accompanied by the administration of long-term oral antibiotics. In our postoperative aftercare, there was no clinical or radiological evidence for recurrence.

Gentamicin-impregnated collagen implants for the reduction of surgical site infections

Gentamicin-impregnated collagen implants for the reduction of surgical site infections

THE EFFECTS OF GENTAMICIN-IMPREGNATED COLLAGEN SPONGE VERSUS GENTAMICIN-IMPREGNATED POLYMETHYLMETHACRYLATE BEADS IN PATIENTS WITH OSTEOMYELITIS

Objective: The usage of antibiotic-impregnated polymethylmethacrylate (PMMA) beads is regarded as the gold standard for local antibiotic delivery. However, the relatively new antibiotic-impregnated collagen sponge has multiple advantages over it. The objective of this study is to compare the measurable effects between gentamicin-impregnated collagen sponge and gentamicin-impregnated (PMMA) beads in patients with osteomyelitis.Methods: This is a case–control study which involved 60 patients who were diagnosed with osteomyelitis between January 2014 and June 2015, and underwent first surgical debridement with application of either gentamicin-impregnated collagen sponge (n=28) or gentamicin-impregnated PMMA beads (n=32). The numbers of debridement, trend of blood parameters, duration of hospitalization, and total duration of systemic antibiotic therapy needed to be completed were reviewed from the patients’ file.Results: A total of 53 patients of 60 were diagnosed with osteomyelitis of the lower limbs, while the remaining seven were involving the upper limbs. The gentamicin-impregnated collagen sponge group has significant lower reoperative rate (p&lt;0.05) and also significant reduction of total white cell count in 6 weeks (p&lt;0.05). The two groups showed no statistical difference in regard of duration of hospital admission, duration of systemic antibiotic therapy completed, and the reduction of C-reactive protein at 6 weeks post-debridement.Conclusion: This study reiterates the efficacy of gentamicin-impregnated collagen sponge that results in lower reoperative rate as compared to conventional gentamicin-impregnated PMMA beads.

A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics.

Local antibiotics are used in the surgical management of foot infection in diabetic patients. This systematic review analyzes the available evidence of the use of local antibiotic delivery systems as an adjunct to surgery. Databases were searched to identify eligible studies and 13 were identified for inclusion. Overall, the quality of the studies was poor. A single trial suggested that wound healing is quicker when a gentamicin-impregnated collagen sponge was implanted at time of surgery, with no difference in length of stay or rate of amputation. Results from studies with high risk of bias indicated no change in wound healing when a gentamicin-impregnated sponge was implanted during transmetatarsal amputation, but a reduction in the incidence of wound breakdown (8% vs 25%, not statistically significant) was identified. A significant cost reduction was identified when using an antimicrobial gel to deliver antibiotics and anti-biofilm agents (quorum-sensing inhibitors) compared with routine dressings and systemic antibiotics. Analyses of case series identified 485 patients who were treated using local antibiotic delivery devices. The rates of wound healing, re-operation, and mortality were comparable to those that have been previously reported for the routine management of these infections. There is a lack of good-quality evidence to support the use of local antibiotic delivery devices in the treatment of foot infections in patients with diabetes. Cite this article: Bone Joint J 2018;100-B:1409-15.

Internal Fixation of 4-Part Proximal Humerus Fractures and Fracture Dislocations Using Extended Deltoid-splitting Approach, Locking Plates, and Calcium Sulfate Graft: Technical Details

Surgical treatment of 4-part proximal humerus fractures and fracture dislocations remain challenging because of difficulties in exposure, reduction, and achieving a stable internal fixation. We have treated these injuries using extended deltoid-splitting approach with internal fixation using locking plates, calcium sulfate graft, and tuberosity repair with polyethylene sutures. We have used this technique in 21 cases (20 patients) 7 male, 13 female with displaced 4-part fractures or fracture dislocations. The average age was 59 years (range, 27 to 74 y) and average length of follow-up 5 years (range, 3 to 7 y). Overall 19 cases (90%) achieved good or excellent results. All cases united without any serious complications such as loss of tuberosity fixation, humeral head perforation, avascular necrosis, or axillary nerve palsy. In 1 case there was varus malunion. In another varus malunion and infection, but this resolved satisfactorily with 1 episode of debridement and insertion of gentamicin-impregnated collagen sheets. The clinical result of both varus malunited cases was good as the tuberosity reconstruction remained anatomic. We have found the extended deltoid-splitting approach to ease exposure, especially in posterior fracture dislocations and enhance accuracy of tuberosity reduction. The use of locking plates, calcium sulfate graft, and tuberosity repair with polyethylene sutures has also given us a reliable means of achieving a stable fixation in these difficult cases, allowing early postoperative rehabilitation.

Efficiency and Safety of Topical Use of the Gentamicin-Impregnated Collagen Matrices in Surgical Treatment of Patients with Diabetic Foot Syndrome

Efficiency and Safety of Topical Use of the Gentamicin-Impregnated Collagen Matrices in Surgical Treatment of Patients with Diabetic Foot Syndrome

Surgical approach choice and efficiency of complementary therapies in treatment of pilonidal cyst: Meta-analysis and treatment algorithm

Abstract The article presents literature review (website PubMed is used) on the advantages and disadvantages of one-stage and two-stage surgical treatment of pylonidal cyst, meta -analysis of published data on the efficiency of gentamicin-impregnated collagen implants, vacuum-assisted wound closure and platelet growth factors in treatment of this pathology. Treatment results of 87 patients with pilonidal cyst with postoperative observation period from 1 to 5 years have been analyzed. Algorithm of therapeutic approach selection for such patients depends on the pathological process character.

Gentamicin-Impregnated Collagen Sponge: Effectiveness in Preventing Sternal Wound Infection in High-Risk Cardiac Surgery

Abstract non disponibile

Cost analysis of gentamicin-impregnated collagen sponges in preventing sternal wound infection post cardiac surgery.

The use of antibiotic-impregnated sponges (Collatamp) during cardiac surgery is controversial. We analysed the cost-effectiveness of its selective use in patients at high-risk of sternal wound infection (SWI). Postoperative costs were analysed in two groups of patients undergoing heart surgery between 2011 and 2013: those with SWI (group 1) and in high-risk patients without SWI (group 2). The potential cost of gentamicin-impregnated collagen sponges (GCS) use in high-risk patients was compared with our current practice. We identified 1,251 patients with at least one recognised risk factor for developing SWI in this period. Of these, 18 developed SWI (incidence 1.4%). The median postoperative cost per patient without SWI was £9,617. The additional cost per patient incurred by SWI was £4,860.75. The annual additional cost for treating patients with SWI was £43,749. With a 50% reduction in SWI, the annual additional cost of treating these patients would be reduced to £21,873. The cost of GCS is £80 per patient. Adding this to £21,873 gives a potential total cost of £71,913 in the treated high-risk cohort. In our practice the annual cost of treating SWI in high-risk patients without use of GCS is lower than the annual cost of using GCS in all high-risk patients (£43,749 versus £71,913) if it produces a 50% reduction in SWI. The reduction in the incidence of SWI poses no economic benefit when the cost of the product is factored in.

Gentamicin-Impregnated Collagen Sponge: Effectiveness in Preventing Sternal Wound Infection in High-Risk Cardiac Surgery

Sternal wound infections represent one of the most frequent complications after cardiac surgery and are associated with high postoperative mortality. Several preventive methods have been introduced, and recently, gentamicin-impregnated collagen sponges (GICSs) have shown a promising effect in reducing the incidence of this type of complications. Gentamicin is an aminoglycoside antibiotic that has been widely used to treat infections caused by multiresistant bacteria; despite its effectiveness, its systemic use carries a risk of toxicity. GICSs appear to overcome this side effect, topically delivering high antibiotic concentrations to the wound and thus reducing the toxic-related events. Although several retrospective analyses and randomized controlled trials have studied the use of GICSs in cardiac surgery, conclusions regarding their efficacy in preventing sternal wound infection are inconsistent. We have reviewed the current literature focusing on high-risk patients.

The Use of Gentamicin-Impregnated Collagen Sponge for Reducing Surgical Site Infection after Spine Surgery.

ObjectiveSurgical site infection (SSI) is the one of the most frequent complications in hospitalized patients, and it extends hospital stays and causes extra morbidities. To reduce SSI after spine surgery, we applied the gentamicin-impregnated collagen sponge (Collatamp G) during the operation and analyzed the results retrospectively.MethodsBetween October 2012 and December 2015, we collected data who applied the Collatamp G in spine surgery at a single institution. Demographic data of patients and another possible risk factors of SSI were also included, and we assessed the correlation between the risk factors and the developing of SSI by reviewing electronic medical records retrospectively.ResultsThree percent of all patients (10 of 280) developed the SSI and only 0.8% of patients who applied Collatamp G developed SSI (1 of 119). Otherwise, 5% of patients who did not apply Collatamp G developed SSI (9 of 161) (p=0.034). We also analyzed the correlation between SSI and other potential risk factors but nothings showed statistical correlation with SSI.ConclusionIn this study, there were statistically significant results that SSI rate was decreased in the group of patients using Collatamp G in spine surgery generally. However, further studies are required to resolve some limitations in the future.

Infections After Breast Surgery: Potential Ways to Reduce Infection Rates

SUMMARY Breast infection rates are higher than expected for clean cases and are decreased with the use of prophylactic preoperative antibiotics. Surgical care bundles include evidence-based measures such as selection of preoperative antibiotics to cover skin flora, skin preparation, stopping antibiotics within 24 h, normothermia and hair removal. Glycemic control should be addressed but there is no additional benefit with tight control. Drain antisepsis provides a promising new approach to reducing infections in breast operations that use surgical drains. Other surgical disciplines have shown benefit with methicillin-resistant Staphylococcus aureus decolonization, vancomycin powder application and use of gentamicin-impregnated collagen plugs.

Scoring system to guide decision making for the use of gentamicin-impregnated collagen sponge to prevent deep sternal wound infection

The effectiveness of the routine retrosternal placement of a gentamicin-impregnated collagen sponge (GICS) implant before sternotomy closure is currently a matter of some controversy. We aimed to develop a scoring system to guide decision making for the use of GICS to prevent deep sternal wound infection. Fast backward elimination on predictors, including GICS, was performed using the Lawless and Singhal method. The scoring system was reported as a partial nomogram that can be used to manually obtain predicted individual risk of deep sternal wound infection from the regression model. Bootstrapping validation of the regression models was performed. The final populations consisted of 8750 adult patients undergoing cardiac surgery through full sternotomy during the study period. A total of 329 patients (3.8%) received GICS implant. The overall incidence of deep sternal wound infection was lower among patients who received GICS implant (0.6%) than patients who did not (2.01%) (P=.02). A nomogram to predict the individual risk for deep sternal wound infection was developed that included the use of GICS. Bootstrapping validation confirmed a good discriminative power of the models. The scoring system provides an impartial assessment of the decision-making process for clinicians to establish if GICS implant is effective in reducing the risk for deep sternal wound infection in individual patients undergoing cardiac surgery through full sternotomy.

Gentamicin-impregnated collagen implants for the reduction of surgical site infections

Gentamicin-impregnated collagen implants for the reduction of surgical site infections

Gentamicin-impregnated collagen sponge for preventing sternal wound infection after cardiac surgery.

The frequency of sternal wound infection (SWI) after cardiac surgery ranges from 0.5% to 8% and is associated with significant morbidity, mortality, and treatment cost. Perioperative antibiotic prophylaxis is not sufficient to fully prevent the contamination of the surgical access site. One of the most effective methods for the prevention of wound infection seems to be the use of gentamicin-impregnated collagen sponge, which is successfully used in abdominal and orthopedic surgery. Surgically implantable topical antibiotics can reduce wound infection in cardiac patients as well, but the efficacy of SWI prevention in cardiac surgery still raises many questions.