Microbial resistance related to antibiotic-loaded bone cement: a historical review

Knee Surg Sports Traumatol Arthrosc. 2017 Dec;25(12):3808-3817. doi: 10.1007/s00167-016-4309-5. Epub 2016 Sep 12.

Abstract

Purpose: 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.

Conclusion: 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.

Keywords: Bone cement; Joint infection; Microbials; Periprosthetic; Resistance.

Publication types

  • Review

MeSH terms

  • Animals
  • Anti-Bacterial Agents / administration & dosage*
  • Bone Cements*
  • Drug Resistance, Microbial*
  • Humans
  • Joints / microbiology
  • Orthopedics

Substances

  • Anti-Bacterial Agents
  • Bone Cements