title: Bioactive glass BAG-S53P4 for the adjunctive treatment of chronic osteomyelitis of the long bones: an in vitro and prospective clinical study.
abstract: BACKGROUND
  This study aimed to explore the in vitro antibacterial activity of the bioglass BAG S53P4 against multi-resistant microorganisms commonly involved in osteomyelitis and to evaluate its use in surgical adjunctive treatment of osteomyelitis.
  
  
  METHODS
  In vitro antibacterial activity of BAG-S53P4 against methicillin resistant Staphylococcus aureus and Staphylococcus epidermidis, Pseudomonas aeruginosa and Acinetobacter baumannii isolates was evaluated by means of time kill curves, with colony counts performed after 24, 48 and 72 hours of incubation. In vivo evaluation was performed by prospectively studying a cohort of 27 patients with a clinically and radiologically diagnosed osteomyelitis of the long bones in an observational study. Endpoints were the absence of infection recurrence/persistence at follow-up, no need for further surgery whenever during follow-up and absence of local or systemic side effects connected with the BAG use.
  
  
  RESULTS
  In vitro tests regarding the antibacterial activity of BAG S53P4 showed a marked bactericidal activity after 24 hrs against all the tested species. This activity continued in the subsequent 24 hrs and no growth was observed for all strains after 72 hrs. Results of the clinical study evidenced no signs of infection in 24 patients (88.9%) at the follow-up, while 2 subjects showed infection recurrence at 6 months from index operation and one more needed further surgical procedures. BAG-S53P4 was generally well tolerated.
  
  
  CONCLUSIONS
  The in vitro and in vivo findings reinforce previous observations on the efficacy of BAG-S53P4 for the treatment of chronic osteomyelitis of the long bones, also in the presence of multi-resistant strains and in immunocompromised hosts, without relevant side effects and without the need for locally adding antibiotics.
  
  
  BACKGROUND
  Deutschen Register Klinischer Studien (DRKS) unique identifier: DRKS00005332.
authors: Laboratory of Clinical Chemistry and Microbiology, I,R,C,C,S, Galeazzi Orthopaedic Institute, Via R, Galeazzi 4, Milan 20161, Italy. lorenzo.drago@unimi.it.
authors: Lorenzo
authors: L
authors: Drago
authors: Delia
authors: D
authors: Romanò
authors: Elena
authors: E
authors: De Vecchi
authors: Christian
authors: C
authors: Vassena
authors: Nicola
authors: N
authors: Logoluso
authors: Roberto
authors: R
authors: Mattina
authors: Carlo Luca
authors: CL
authors: Romanò
mesh_terms: D040981:Acinetobacter baumannii / Q000254:growth & development; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018786:Bone Substitutes / Q000737:chemistry / Q000627:therapeutic use*; D001842:Bone and Bones / Q000382:microbiology*; D005260:Female; D005898:Glass / Q000737:chemistry*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000254:growth & development; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology / Q000601:surgery*; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000254:growth & development; D013212:Staphylococcus epidermidis / Q000254:growth & development; D055815:Young Adult
chemical_list: D018786:Bone Substitutes; C403922:bioactive glass S53P4