Microbial resistance related to antibiotic-loaded bone cement: a historical review.
OBJECTIVE
The use of antibiotic-loaded bone cement (ALBC) has a range of indications for use in orthopaedics. It has the advantage of delivering high loads of antibiotics to a targeted site, thereby avoiding the side effects associated with systemic administration. However, there is concern that the use of ALBC may precipitate the development of antibiotic-resistant bacteria.


METHODS
This review focuses on (1) the published research using both animal and human models examining the association between ALBC and the induction of microbial resistance (2) the mechanisms by which antimicrobial resistance develop (3) the research pertaining to specific classes of antibiotics commonly used in orthopaedic practice (4) the recent developments in calcium sulphate beads, nanoparticles and chitosan, as alternative antimicrobial treatments for periprosthetic joint infections.


CONCLUSIONS
The literature for and against a link between ALBC and the development of microbiological resistance is reviewed and presented. It is concluded that further research is needed to develop a defined set of indications for the use of ALBC in the management of periprosthetic joint infection. In addition, further research into alternative antimicrobial therapies in this area should be encouraged.
James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK. lcwalker86@gmail.com.
Lucy C
LC
Walker
James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
Paul
P
Baker
Northumbria Specialist Emergency Care Hospital, Northumbrian Road, Cramlington, NE23 6NZ, UK.
Richard
R
Holleyman
Freeman Hospital, Freeman Road, High Heaton, Newcastle-upon-Tyne, NE7 7DN, UK.
David
D
Deehan
D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001843:Bone Cements; D004352:Drug Resistance, Microbial; D006801:Humans; D007596:Joints / Q000382:microbiology; D009985:Orthopedics
D000900:Anti-Bacterial Agents; D001843:Bone Cements
Bone cement; Joint infection; Microbials; Periprosthetic; Resistance