Local, bioabsorbable antibiotic ceramic carrier effectively treated chronic osteomyelitis
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A single-stage protocol using a high-delivery, bioabsorbable gentamicin-loaded ceramic carrier yielded low rates of long-term infection recurrence for patients with chronic osteomyelitis, according to published results.
Researchers from the Nuffield Orthopaedic Centre at Oxford University Hospitals prospectively analyzed 100 patients with 105 cases of Cierny-Mader types III and type IV chronic osteomyelitis. All patients were treated with a single-stage protocol of debridement, deep tissue sampling, local antibiotic treatment with a bioabsorbable gentamicin-loaded ceramic carrier (Cerament G, Bonesupport), stabilization and immediate skin closure. The primary outcome was infection eradication, and failure was defined as recurrent infection.
At a mean follow-up 6.05 years, 94% of patients were infection-free, with six patients (six cases) experiencing recurrent infection. Researchers noted three infections recurred at 1 year, two infections recurred at 2 years and one infection recurred at 4.5 years postoperatively. They also noted no associations between physiological class of the patient, etiology of the infection, organisms cultured or preoperative nonunion and infection recurrence.
According to the study, organisms resistant to gentamicin were more often found in polymicrobial infections compared with monobacterial osteomyelitis; however, researchers noted recurrence just as frequent when a resistant organism was present compared with a microbiologically sensitive infection.
“As our patients now present with more complex infections and comorbidities, we need forms of treatment which can be applied widely,” the researchers wrote in the study. “Single-stage management, facilitated by the bioabsorbable antibiotic carrier, was robust, giving effective treatment in all these groups in the mid[term] to long-term,” they wrote.
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