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    Adjuvant antibiotic-loaded bone cement: Concerns with current use and research to make it work

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    Author
    Schwarz, E.M.
    Joshi, M.
    Hospital for Special Surgery 2019 Biofilm Symposium Workgroup
    Date
    2020
    Journal
    Journal of Orthopaedic Research
    Publisher
    John Wiley and Sons Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1002/jor.24616
    Abstract
    Antibiotic-loaded bone cement (ALBC) is broadly used to treat orthopaedic infections based on the rationale that high-dose local delivery is essential to eradicate biofilm-associated bacteria. However, ALBC formulations are empirically based on drug susceptibility from routine laboratory testing, which is known to have limited clinical relevance for biofilms. There are also dosing concerns with nonstandardized, surgeon-directed, hand-mixed formulations, which have unknown release kinetics. On the basis of our knowledge of in vivo biofilms, pathogen virulence, safety issues with nonstandardized ALBC formulations, and questions about the cost-effectiveness of ALBC, there is a need to evaluate the evidence for this clinical practice. To this end, thought leaders in the field of musculoskeletal infection (MSKI) met on 1 August 2019 to review and debate published and anecdotal information, which highlighted four major concerns about current ALBC use: (a) substantial lack of level 1 evidence to demonstrate efficacy; (b) ALBC formulations become subtherapeutic following early release, which risks induction of antibiotic resistance, and exacerbated infection from microbial colonization of the carrier; (c) the absence of standardized formulation protocols, and Food and Drug Administration-approved high-dose ALBC products to use following resection in MSKI treatment; and (d) absence of a validated assay to determine the minimum biofilm eradication concentration to predict ALBC efficacy against patient specific micro-organisms. Here, we describe these concerns in detail, and propose areas in need of research.
    Keyword
    antibiotic-loaded bone cement (ALBC)
    Biofilm Meeting
    local antibiotics
    musculoskeletal infection (MSKI)
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081232301&doi=10.1002%2fjor.24616&partnerID=40&md5=53fc792a32faa8110e385287723ad712; http://hdl.handle.net/10713/12327
    ae974a485f413a2113503eed53cd6c53
    10.1002/jor.24616
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