Prevention Of Pin Tract Infection Research Articles

The Role of Chlorhexidine in the Prevention of Pin Tract Infection as Compared to Povidone-Iodine in Patients Managed by Ilizarov Circular Fixator

Objective: To compare the efficacy of Chlorhexidine in the prevention of pin tract infection as compared to Povidone-iodine antiseptic. Study Design: Prospective, single blinded randomized trial. Study Setting and Duration: Liaquat University of Health Science (LUMHS), Jamshoro between July 2018 to November 2020. Methodology: All patients who underwent Ilizarov external fixation as per indications were eligible for the study. Individuals with a previous history of osteomyelitis were excluded from the study. Pin sites were cleansed with normal saline using clean applicators. In the group chlorhexidine, the antiseptic was applied on the pin skin interphases (1% chlorhexidine). Similarly, 10% povidone iodine was applied to patients in group C. The control group was cleansed with normal saline. Pin sites were either dressed daily or weekly. The primary outcome was the rate of pin site infection days. Results: Chlorhexidine group had significantly lesser pin-site infections as compared to the povidone-iodine group with a frequency of 13 (39.39%) and 19 (63.33%), p=0.04, respectively. The mean pin tract infection rate days ± SD were significantly lower in the chlorhexidine group as compared to the povidone-iodine group (1.35 ± 2.26 vs 3.54 ± 4.30, p=0.041). Similarly, the mean duration to onset of pin site infection was also significantly higher in the chlorhexidine group compared to povidone-iodine and control groups. Conclusion: Patients who used Chlorhexidine as the cleansing agent had significantly fewer pin-site infections as compared to the povidone-iodine group. Keywords: Chlorhexidine, Ilizarov fixator, fracture, Povidone-iodine

Application of jie you shen long-acting antimicrobial material in prevention of pin tract infection in percutaneously pinned pediatric distal humeral fractures

Objective To evaluate the curative effect of jie you shen (JUC) long-acting antimicrobila material (JUC) in preventing pin tract infection in pediatric distal humeral fractures treated with closed reduction and percutaneous Kirschner pin fixation. Methods A total of 160 pediatric patients were given distal humerus fracture surgery by fixation with percutaneous Kirschner pins. After Kischner pin fixation, the pintails and the affected limbs were sprayed with placebo/JUC first, and then wrapped with gauze immersed with placebo/JUC, followed by immobilization with plaster cast at flexion of the elbow. Pin tract infections were evaluated at the time of plaster removal 4-6 weeks after surgery. Results Postoperative Kirschner pin tract infection rate was 1.25% in JUC group, and Staphylococcus aureus was isolated from one patient. The postoperative Kirschner pin tract infection rate was 10.00% in placebo group, including 7 patients infected with Staphylococcus aureus and one patient with Pseudomonas aeruginosa. The infection rate in the JUC group was significantly lower than that in the control group (P=0.016). Conclusion JUC long-acting antimicrobila material can efficiently decrease postoperative pin tract infection after percutaneous Kirschner pin fixation surgeries in pediatric distal humerus fracture patients receiving closed reduction. Key words: Distal humerus fracture; Pin tract infection; Antimicrobial film; Jie you shen; Children

Chitosan-based sleeves loaded with silver and chlorhexidine in a percutaneous rabbit tibia model with a repeated bacterial challenge

Various strategies have been explored to prevent pin tract infections (PTI), including the use of antibacterial sleeves. However, an ideal animal model to evaluate the efficacy of antibacterial strategies is still lacking. This study aimed to construct an animal model with a consistent induction of infection after bacterial challenge. Further, the efficacy of silver and chlorhexidine loaded chitosan sleeves was evaluated to prevent PTI around a percutaneous implant. Titanium pins wrapped with sleeves were implanted in anterior lateral rabbit tibia. After 2 weeks, Staphylococcus aureus suspensions (1 × 106 CFU) were injected weekly to the exit site, and the clinical infection status was recorded. After 6 weeks, all rabbits were euthanized to evaluate the bacterial colonization microbiologically and histomorphometrically. Results showed that the implant screw bilaterally penetrated the tibia and kept the implant stable. A rod length of twice the thickness of the soft-tissue layer was necessary to maintain the percutaneous penetration of the implants. A 100% infection rate was obtained by the bacterial inoculation. Silver loaded sleeves reduced significantly the bacterial density and reduced the inflammatory symptoms of the percutaneous pin tract. However, the addition of chlorhexidine to the sleeves had no added value in terms of further reduction of bacteria and inflammation. In conclusion, a consistent animal model was designed to evaluate strategies to prevent PTI. In addition, the use of silver loaded chitosan sleeves can be pursued for further (pre-)clinical exploration for the prevention of PTI. Statement of SignificanceThis study constructed a bacterial challenged percutaneous rabbit tibia model to evaluate the potential of antibacterial strategies for the prevention of pin tract infections. The model was applied to evaluate a silver and chlorhexidine loaded membranes as an antibacterial sleeve. Our results demonstrate that the rabbit tibia model is suitable to evaluate antibacterial strategies for the prevention of pin tract infection as evidenced by the stable, bone fixed percutaneous implant and a 100% infection rate of the percutaneous pin tract. Silver loaded sleeves can lower the bacterial density of the percutaneous pin tract, but the addition of chlorhexidine to the silver-loaded sleeves does not contribute to an enhanced antibacterial effect. Such experiments are of considerable interest to those in the research community, industry, and clinicians involved the occurrence of infection of skin penetrating medical devices.

Carboxymethyl chitosan-zinc coating for prevention of pin tract infection: An animal model.

Pin tract infection is a common problem in orthopedic and traumatology surgery. The aim of this study was to investigate the efficacy of an implant coated with carboxymethyl chitosan-zinc (CMC-Zn2+) in prevention of pin tract infection. Twenty-four male New Zealand White rabbits were randomized into two equal groups ( n = 12, uncoated and CMC-Zn2+). The implants were colonized with 1 × 106 colony forming units of Staphylococcus aureus and inserted into the lateral right proximal tibia in each rabbit. In each group, at 2 and 4 weeks post-surgery, five and seven rabbits were killed, respectively, to harvest the soft tissues around the implant as well as the hard tissue for histological analysis. The bone cross-sectional view, X-ray, and micro-computed tomography (μCT) were performed. The surgical sites in each animal were evaluated individually at both time points. No evident signs of infections were found in the CMC-Zn2+ group, while a high rate of infection was observed in the uncoated group where minor infections were 85.71% ( n = 12) and major infections 14.29% ( n = 12). The radiography, μCT, and histological analysis showed no evident signs of infection in both groups at 2 weeks post-surgery. However, at 4 weeks, signs of infection were found in all the animals in the uncoated group, whereas in the CMC-Zn2+ group, no infections were observed. The difference between the two groups was highly significant ( p = 0.00). Our study showed that CMC-Zn2+-coated implants were effective in preventing pin tract infection.

Ineffectiveness of N-[(2-Hydroxyl-3-Trimethyl Ammonium)Propyl] Chitosan Chloride Coating in Prevention of Pin Tract Infection: An In Vivo Study

Ineffectiveness of N-[(2-Hydroxyl-3-Trimethyl Ammonium)Propyl] Chitosan Chloride Coating in Prevention of Pin Tract Infection: An In Vivo Study

Percutaneous external fixator pins with bactericidal micron-thin sol–gel films for the prevention of pin tract infection

Risk of infection is considerable in open fractures, especially when fracture fixation devices are used to stabilize the fractured bones. Overall deep infection rates of 16.2% have been reported. The infection rate is even greater, up to 32.2%, with external fixation of femoral fractures. The use of percutaneous implants for certain clinical applications, such as percutaneous implants for external fracture fixation, still represents a challenge today.Currently, bone infections are very difficult to treat. Very potent antibiotics are needed, which creates the risk of irreversible damage to other organs, when the antibiotics are administered systemically. As such, controlled, local release is being pursued, but no such treatments are in clinical use. Herein, the use of bactericidal micron-thin sol–gel films on metallic fracture fixation pins is reported. The data demonstrates that triclosan (2,4,4′-trichloro-2′-hydroxydiphenylether), an antimicrobial agent, can be successfully incorporated into micron-thin sol–gel films deposited on percutaneous pins. The sol–gel films continuously release triclosan in vitro for durations exceeding 8 weeks (longest measured time point). The bactericidal effect of the micron-thin sol–gel films follows from both in vitro and in vivo studies. Inserting percutaneous pins in distal rabbit tibiae, there were no signs of infection around implants coated with a micron-thin sol–gel/triclosan film. Healing had progressed normally, bone tissue growth was normal and there was no epithelial downgrowth. This result was in contrast with the results in rabbits that received control, uncoated percutaneous pins, in which abundant signs of infection and epithelial downgrowth were observed. Thus, well-adherent, micron-thin sol–gel films laden with a bactericidal molecule successfully prevented pin tract infection.

Prevention of pin tract infection with iodine-supported titanium pins

BackgroundPin tract infection is one of the most common complications of external fixation. We developed techniques to coat titanium implant surfaces with iodine. This study clinically evaluated the infection-preventive effects and biological safety of iodine-coated external fixation pins. Patients and methodsIodine-supported pins were placed in 39 limbs of 38 patients. The mean age of the patients was 33.6 years. Twenty-six patients were men and 12 were women. In all patients, the iodine-coated pins were used to prevent infection. There were 476 pin insertion sites. Pin sites were classified according to the Checketts–Otterburn classification (grade 1–6). White blood cells (WBC) and C-reactive protein (CRP) were measured pre- and postoperatively in all patients. To confirm whether iodine from the implant affected physiological functions, thyroid hormone levels in the blood were monitored. The change in the amount of iodine deposited in the body over time was calculated by examining the removed pins. ResultsExternal fixation was used for a mean duration of 6 months. Grade 1 infection was found in 2.5 % of patients, and grade 2 infection in 1.1 %. There was no patient with an infection of grade 3 or higher. Median WBC levels were in the normal range, and median CRP levels returned to <0.3 mg/dl within 3 weeks after surgery. Abnormalities of thyroid gland function were not detected. The amount of iodine was maintained for a long time, with approximately 40 % remaining after 1 year. ConclusionsIodine-supported titanium pins were able to decrease the pin tract infection rate and had no impact on thyroid function. These results suggest that iodine-coated titanium pins are biologically safe and effective at preventing pin tract infections.

Commentary: Antibiotic-Coated Pins for Prevention of Pintract Infection: A Rabbit Study

during limb lengthening involving external fixation,1 with an incidence as high as 85%.2 The most appropriate pin-site care is controversial; one study even justifies a nihilistic approach.3 Pin sites near joints are more prone to sepsis, as they are subject to greater movement.4 Minor inflammation or superficial infection is usually treated with antibiotics, local wound care, and occasionally pin removal. Osteomyelitis warrants surgical intervention.5 In this issue, Rahimnia et al.6 used antibioticcoated pins to prevent pin-tract infection in 4 out of 5 rabbits. However, the study sample was small. The results should be corroborated by those of larger randomised controlled studies to negate possible biases. It is uncertain how long antibiotic-coated pins are effective. Silver-coated pins and stainless steel Commentary: Antibiotic-coated pins for prevention of pin-tract infection: a rabbit study

Prevention of pin tract infection with titanium‐copper alloys

The most frequent complication in external fixation is pin tract infection. To reduce the incidence of implant-associated infection, many published reports have looked at preventing bacterial adhesion by treating the pin surface. This study aimed to evaluate the antibacterial activity of a Titanium-Copper (Ti-Cu) alloy on implant infection, and to determine the potential use of the Ti-Cu alloy as a biomaterial. Two forms of Ti-Cu alloys were synthesized: one with 1% Cu and the other with 5% Cu. For analyzing infectious behavior, the implants were exposed to Staphylococcus aureus and Escherichia coli. The reaction of pathogens to the Ti-Cu alloys was compared with their reaction to stainless steel and pure titanium as controls. Both Ti-Cu alloys evidently inhibited colonization by both bacteria. Conversely, cytocompatibility studies were performed using fibroblasts and colony formation on the metals was assessed by counting the number of colonies. Ti-1% Cu alloy showed no difference in the number of colonies compared with the control. External fixator pins made of Ti-Cu alloys were evaluated in a rabbit model. The tissue-implant interactions were analyzed for the presence of infection, inflammatory changes and osteoid-formation. Ti-1% Cu alloy significantly inhibited inflammation and infection, and had excellent osteoid-formation. Copper blood levels were measured before surgery and at 14 days postoperatively. Preoperative and postoperative blood copper values were not statistically different. Overall, it was concluded that Ti-Cu alloys have antimicrobial activity and substantially reduce the incidence of pin tract infection. Ti-1% Cu alloy shows particular promise as a biomaterial.

Prevention of pin tract infection in external stainless steel fixator frames using electric current in a goat model

Pin tract infections of external fixators used in orthopaedic reconstructive bone surgery are serious complications that can eventually lead to periostitis and osteomyelitis. In vitro experiments have demonstrated that bacteria adhering to stainless steel in a biofilm mode of growth detach under the influence of small electric currents, while remaining bacteria become less viable upon current application. Therefore, we have investigated whether a 100 μA electric current can prevent signs of clinical infection around percutaneous pins, implanted in the tibia of goats. Three pins were inserted into the lateral right tibia of nine goats, of which one served for additional frame support. Two pins were infected with a Staphylococcus epidermidis strain of which one pin was subjected to electric current, while the other pin was used as control. Pin sites were examined daily. The wound electrical resistance decreased with worsening of the infection from a dry condition to a purulent stage. After 21 days, animals were sacrificed and the pins taken out. Infection developed in 89% of the control pin sites, whereas only 11% of the pin sites in the current group showed infection. These results show that infection of percutaneous pin sites of external fixators in reconstructive bone surgery can be prevented by the application of a small DC electric current.