CORR Insights^®: Local Gentamicin Delivery From Resorbable Viscous Hydrogels Is Therapeutically Effective

Excerpt

Orthopaedic infection can be a devastating consequence of traumatic injuries and surgical interventions, including prosthetic joint replacements and revisions [9]. The risk of persistent, recurrent, or new infection in revision total joint arthroplasty may be as high as 20% when the indication for revision is infection [4]. Attachment of bacteria or fungi to implants to form biofilm presents a tremendous challenge to clinical treatment, particularly when polymicrobial contamination is present [8]. Due to the senescent phenotypic state of biofilm microorganisms, as well as to the secretion of protective mucopolysaccharide matrices, biofilm microorganisms evade common microbicidal strategies. These are only eradicated by antibiotic concentrations 100 to 1000 times the minimum inhibitory concentration for planktonic microorganisms [7], and because of this, at present, most of these infections are treated by removal of the infected implant followed by aggressive débridement of necrotic tissue. In most cases, systemic antibiotic delivery to poorly vascularized orthopaedic injuries cannot achieve concentrations high enough to treat biofilm infection, so local drug delivery strategies have become essential in the treatment of these challenging infections. Commonly used clinically local delivery strategies vary from antibiotic-loaded bone cement [10], antibiotic-loaded calcium-based beads [6], resorbable polymer delivery systems [5], to simply sprinkling powdered antibiotics into the surgical site [3]. There are no ideal local delivery systems for antibiotics, as many of these common clinical delivery systems have inadequate or uncharacterized release patterns, poor degradation profile, or biocompatibility issues. …