Antibiotic-Loaded Coatings to Reduce Fracture-Related Infections: Retrospective Case Series of Patients with Increased Infectious Risk
Daniele De Meo,
Gianluca Cera,
Roberta Pica,
Fabiano Perfetti,
Paolo Martini,
Beatrice Perciballi,
Giancarlo Ceccarelli,
Pietro Persiani,
Ciro Villani
Affiliations
Daniele De Meo
Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital—Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
Gianluca Cera
Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital—Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
Roberta Pica
Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital—Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
Fabiano Perfetti
Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital—Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
Paolo Martini
Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital—Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
Beatrice Perciballi
Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital—Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
Giancarlo Ceccarelli
M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy
Pietro Persiani
Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital—Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
Ciro Villani
Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital—Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
Local antibiotic delivery strategies have been increasingly employed for the prevention of fracture-related infections (FRIs). The aim of this study is to evaluate the efficacy and safety of antibiotic-coated implants in the prevention of FRIs after surgical treatment in patients with increased infectious risk. A retrospective observational study has been conducted on patients with upper and lower limb fractures treated with internal fixation or prosthetic replacements, using a gentamicin coated nail (CN) and/or antibiotic-loaded hydrogel applied to the implant of choice (ALH). The study included 37 patients (20 M, 17 F), with a mean age of 63 years. The mean estimated preoperative infectious risk score was 6.4%. ALH was used in 27 cases, tibial CNs were implanted in 4 cases, and both were employed in 6 cases. The antibiotics used locally were gentamicin in 72.97% of cases (27 patients) and a combination of gentamicin + vancomycin in 27.03% of cases (10 patients). Mean follow-up was 32 months. Only one case (2.94%) showed onset of FRI at 5 months after surgery. Local antibiotic prophylaxis by coating resulted in a reduction in the incidence FRI, as compared to the estimated preoperative risk. The use of ALH allows for the choice of antibiotic; however, the application of antibiotics seems more nonuniform when applied to a nail.
