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Beitragstitel Patients at high risk for PJI – can we reduce the incidence of infections using dual antibiotic-loaded bone cements?
Beitragscode P57
Autoren
  1. Christof Berberich Heraeus Medical GmbH Vortragender
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 2 | Infekte
Abstract Introduction
Despite the widespread clinical practice of preoperative patient optimization a considerable proportion of patients remains at higher risk for prosthetic joint infections (PJI). This has become most evident, if operating on frail and multimorbid patients as well as in revision and hemiarthroplasty procedures. Prior patient stratification according to presumed infection risks, followed by a more potent local antibiotic prophylaxis protocol, may be an interesting strategy to decrease the burden of PJI. Instead of following a “one size fits all” prophylactic approach, it has been hypothesized that such patients may benefit from selective use of dual antibiotic loaded bone cement ((DALBC) consisting of combinations of premixed antibiotics.

Methods
The PubMed & EMBASE databases were screened for publications pertaining to the utilization of DALBC in cement for infection prophylaxis & prosthesis fixation. 6 preclinical & 7 clinical studies were identified which met the inclusion criteria and were stratified by level of clinical evidence (I-IV). The combination of gentamicin & clindamycin in bone cement (product COPAL G+C) was the only referenced dual ALBC in these studies.

Results
(1)DALBC - in particular the DALBC COPAL G+C (loaded with gentamicin & clindamycin) - has been shown to exert a much stronger and longer lasting inhibition of biofilm formation on many PJI relevant bacteria (gram-positive and gram-negative pathogens) than single gentamicin-only containing cements.
(2) COPAL G+C use in the intervention arm of 7 clinical studies has led to a significant reduction of PJI cases in a) cemented hemiarthroplasty procedures (3 studies, evidence level I and III), in b) cemented septic revision surgeries (2 studies, evidence level III), in c) cemented aseptic knee revisions (1 study, evidence level III) and in d) cemented primary arthroplasties in multi-morbid patients (1 study, evidence level III-IV). These benefits were not associated with more systemic side effects or a higher prevalence of broad antimicrobial resistancies.

Conclusion
The idea of a reinforced local AB prophylactic strategy according to higher PJI risks may be an effective option to further mitigate the burden of PJI. The preliminar findings so far may encourage clinicians to consolidate this hypothesis on a wider clinical range.