title: Antimicrobial delivery systems for local infection prophylaxis in orthopedic- and trauma surgery.
abstract: Infectious complications occur in a minor but significant portion of the patients undergoing joint replacement surgery or fracture fixation, particularly those with severe open fractures, those undergoing revision arthroplasty or those at elevated risk because of poor health status. Once established, infections are difficult to eradicate, especially in the case of bacterial biofilm formation on implanted hardware. Local antibiotic carriers offer the prospect of controlled delivery of antibiotics directly in target tissues and implant, without inducing toxicity in non-target organs. Polymeric carriers have been developed to optimize the release and targeting of antibiotics. Passive polymeric carriers release antibiotics by diffusion and/or upon degradation, while active polymeric carriers release their antibiotics upon stimuli provided by bacterial pathogens. Additionally, some polymeric carriers gelate in-situ in response to physiological stimuli to form a depot for antibiotic release. As antibiotic resistance has become a major issue, also other anti-infectives such as silver and antimicrobial peptides have been incorporated in research. Currently, several antibiotic loaded biomaterials for local infection prophylaxis are available for use in the clinic. Here we review their advantages and limitations and provide an overview of new materials emerging that may overcome these limitations.
authors.affiliation: AO Research Institute Davos, Clavadelerstrasse 8, CH7270 Davos, Switzerland; Department of Biomaterials Science and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
authors.forename: Gert-Jan A
authors.initials: GJ
authors.lastname: ter Boo
authors.affiliation: Department of Biomaterials Science and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; Department of Biomedical Engineering, W.J. Kolff Institute, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands.
authors.forename: Dirk W
authors.initials: DW
authors.lastname: Grijpma
authors.affiliation: AO Research Institute Davos, Clavadelerstrasse 8, CH7270 Davos, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Moriarty
authors.affiliation: AO Research Institute Davos, Clavadelerstrasse 8, CH7270 Davos, Switzerland.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Richards
authors.affiliation: AO Research Institute Davos, Clavadelerstrasse 8, CH7270 Davos, Switzerland. Electronic address: david.eglin@aofoundation.org.
authors.forename: David
authors.initials: D
authors.lastname: Eglin
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003692:Delayed-Action Preparations / Q000737:chemistry*; D016503:Drug Delivery Systems / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D011108:Polymers / Q000737:chemistry*; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000890:Anti-Infective Agents; D003692:Delayed-Action Preparations; D011108:Polymers
keywords: Antimicrobial; Biofilm; Controlled release; Medical device-associated infection; Prophylaxis; Responsive materials