Local antibiotic delivery with demineralized bone matrix
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Local antibiotic delivery with demineralized bone matrix Christine S. Lewis • Peter R. Supronowicz • Rasa M. Zhukauskas • Elise Gill • Ronald R. Cobb
Received: 31 August 2010 / Accepted: 11 December 2010 / Published online: 1 January 2011 Ó Springer Science+Business Media B.V. 2010
Abstract A method of care for these infected nonunions is prolonged intravenous systemic antibiotic treatment and implantation of methyl methacrylate antibiotic carrier beads to delivery high local doses of antibiotics. This method requires a second surgery to remove the beads once the infection has cleared. Recent studies have investigated the use of biodegradable materials that have been impregnated with antibiotics as tools to treat bone infections. In the present study, human demineralized bone matrix (DBM) was investigated for its ability to be loaded with an antibiotic. The data presented herein demonstrates that this osteoinductive and biodegradable material can be loaded with gentamicin and release clinically relevant levels of the drug for at least 13 days in vitro. This study also demonstrates that the antibiotic loaded onto the graft has no adverse effects on the osteoinductive nature of the DBM as measured in vitro and in vivo. This bone void filler may represent a promising option for local antibiotic delivery in orthopedic applications. Keywords Antibiotic Demineralized bone matrix Osteomyelitis Staphylococcus aureus
C. S. Lewis (&) P. R. Supronowicz R. M. Zhukauskas E. Gill R. R. Cobb Research and Development Group, RTI Biologics, 11621 Research Circle, Alachua, FL 32616, USA e-mail: [email protected]
Introduction Fracture healing usually does not require additional treatment beyond possible open reduction, fixation with respect to the mechanical properties of the treated bone, appropriately approximated wound closure and a possible period of immobilization. A diminished tissue repair response can result in nonunion of the involved bone. Infected nonunions are difficult to treat in providing a solution for infection as well as bone healing. Infected bone nonunions are usually treated with systemic antibiotics, debridement of the surrounding tissue and bone, and either immediate or eventual treatment with a variety of grafting techniques (Deirmengian et al. 2003; Waldman et al. 2000; Costerton et al. 1999; Gilbert et al. 1997). Autologous bone transplants are currently considered the gold standard for use in these cases. Device-associated infections are especially difficult to eliminate. This is due, in part, by the adherence of pathogenic bacteria and their subsequent colonization and biofilm formation which greatly increases a bacterium’s resistance to antibiotic therapy (Costerton et al. 1999; Gilbert et al. 1997). The outcome in patients who develop an infection is poor and often requires either a two-stage revision (Alexeeff et al. 1996; Dick and Strauch 1994; McGann et al. 1986) or amputation (Delloye et al. 1988; Dick and Strauch 1994). Treatment with systemic antibiotics alone suffers from several draw
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