Răzvan ENE

Abstract

Calcium Sulphate as a Biodegradable Antibiotic Carrier used in Osteomyelitis and Septic Arthritis Treatment

Razvan Ene^1,2, Elisa Popescu^1,2, Catalin Eduard Georgescu^1,2, Alexandru Lisias Dimitriu^1,2.

¹ Clinical Emergency Hospital Bucharest, Calea Floreasca no. 8, Bucharest, Romania, razvan77ene@yahoo.com 

² Carol Davila University of Medicine and Pharmacy, Blvd. Eroii Sanitari no. 8, Bucharest, Romania

Introduction: The management of a chronic osteomyelitis patient can be challenging and systemic oral or intravenous antibiotics are not enough for successfull results in this field. As anti-infection treatments often involve a long course of therapy, sufficient antibiotic exposure is needed to ensure the eradication of the microorganism. Given the complications and adverse effect (overall immunity disorders, divestive disorders – mouth sores, ulcers, blisters, metabolic disorders, increasing yeast infection risk, kidney failure, etc) and antibiotic penetration properties the management usually involves surgical chemical and mechanical debridement of the affected non-viable tissue and the use of local and systemic antibiotics [1,2]. Where surgical debridement weakens the bone and usually leads to cavity formation biocomposites have the advantage of not only offering structural support but can also be used as a longterm local drug delivery system [3,4,5], but PMMA (polymethylmethacrylate) being non-resorbable we decided to study the results of a bioresorbable calcium sulphate based product despite its weak mechanical strength for load bearing areas [6,7].

Experimental: We treated 17 patients (10 males, 7 females), mean age 45 y.o. with chronic osteomyelitis and arthritis (femur, tibia, knee). Variables recorded were number of previous surgeries and systemic treatments, recurrence of disease host health status type (normal and compromising factors) radiological features (bioresorbability), involved infectious microorganism, dynamic serology tests (white blood cell count-WBC), Erythrocyte Sedimentation Rate - ESR, C-Reactive Protein- CRP, Fibrinogen) and functional outcomes (pain visual analogue scale, lower extremity functional scale). The surgical management included local debridement, lavage with high volume(5-8L) antiseptic solutions and local delivery of biodegradable antibiotic impregnated calcium sulphate beads.

Results and Discussion: Out of the 17 patients 70.58% (12 cases) had postoperative infections and 29.41% (5 cases) had haematogenous non-surgical origin and 94.11% (16) of them had a history of surgery (such as local debridement involving the bone and soft tissue, arthroscopic lavage and synovectomy for knee osteoarthritis) and/or systemic treatment in order to eradicate the infection and only 5.88% (1) had no previous surgery (femoral osteomyelitis). All of the patients had 3 or 4 inflammation markers elevated before the surgery and their numbers dropped to normal values within 2-4 weeks. We encountered complications such as wound ooze, noted in 1(5.88%) patient that needed further intervention for wound closure, despite having no microorganism isolated from the wound ooze and no elevated inflammation markers and only 1 case of recurrence in a patient with a co-infection involving Acinetobacter baumannii Multi Drug Resistant and Pseudomonas aeruginosa, with the persistence of the former microorganism. All patients had improved functional scores within the 3,6 months follow-up visits.

Conclusions. The backbone of osteomyelitis treatment is surgical debridement. However, the other quintessential factors are identification of the causal organism and appropriate antibiotic therapy for adequate duration and relevant dead space management. In our case calcium sulphate beads impregnated with antibiotics proved to be an efficient antibiotic carrier.

References. 

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