Berberich CE, Josse J, Laurent F, Ferry T. Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence. World J Orthop 2021; 12(3): 119-128 [PMID: 33816139 DOI: 10.5312/wjo.v12.i3.119]
Corresponding Author of This Article
Christof Ernst Berberich, MSc, PhD, Lecturer, Senior Scientist, Department of Medical Training, Heraeus Medical GmbH, Philipp-Reis-Str. 8/11, Wehrheim 612173, Hessen, Germany. christof.berberich@heraeus.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Mar 18, 2021; 12(3): 119-128 Published online Mar 18, 2021. doi: 10.5312/wjo.v12.i3.119
Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence
Christof Ernst Berberich, Jérôme Josse, Frédéric Laurent, Tristan Ferry
Christof Ernst Berberich, Department of Medical Training, Heraeus Medical GmbH, Wehrheim 612173, Hessen, Germany
Jérôme Josse, Frédéric Laurent, Tristan Ferry, Institut des Sciences Pharmaceutiques et Biologiques de Lyon (ISPB), International Center for Research in Infectiology, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon 69008, France
Jérôme Josse, Frédéric Laurent, Tristan Ferry, Interregional Reference Center for the Management of Complex Osteo-Articular Infections, Hospices Civils de Lyon, Lyon 69008, France
Frédéric Laurent, Bacteriology Laboratory, Institute of Infectious Agents, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 69008, France
Tristan Ferry, Infectious and Tropical Diseases Department, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 69008, France
Author contributions: Berberich CE and Josse J have performed the literature and data analysis and have made substantial contributions to the drafting of the manuscript; Ferry T and Laurent F have made substantial contributions to the interpretation of the data and final approval of the manuscript.
Conflict-of-interest statement: All authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christof Ernst Berberich, MSc, PhD, Lecturer, Senior Scientist, Department of Medical Training, Heraeus Medical GmbH, Philipp-Reis-Str. 8/11, Wehrheim 612173, Hessen, Germany. christof.berberich@heraeus.com
Received: December 18, 2020 Peer-review started: December 18, 2020 First decision: January 11, 2021 Revised: January 20, 2021 Accepted: March 8, 2021 Article in press: March 8, 2021 Published online: March 18, 2021 Processing time: 83 Days and 23.1 Hours
Abstract
In view of the demographic changes and projected increase of arthroplasty procedures worldwide, the number of prosthetic joint infection cases will naturally grow. Therefore, in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance. In the absence of a “miracle weapon” priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks, the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen. Instead of a “one size fits all” philosophy, it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient- and procedure-related risk factors. A stronger focus on the local application mode via use of high dose dual antibiotic-loaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre. The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.
Core Tip: The objective of an effective antibiotic prophylaxis in arthroplasty may be best achieved through the combination of a systemic and local application route via antibiotic-loaded bone cement. Based on the observation of strong synergistic effects in antibiotic elution and antimicrobial efficacy of dual antibiotic-loaded bone cements, the hypothesis of a clinically more meaningful prophylaxis has been tested against gentamicin-only containing bone cements. Evidence is provided that this easy-to-apply strategy might be successful, if important comorbidities or procedure-related factors predispose patients to higher infection risks than usual.
