ABx-loaded product-from Injury

Prophylaxis and treatment of implant-related infections by local application of antibiotics
Injury 2006

Basic concepts for Implant associated infection
．Bacteria on implant: decreased metabolic activity
．Higher MIC was needed to eradicate organism when metabolic activity was decreased (Pseudomonas aeruginosa 800X if reduced metabolic activity)
．Local application, like ABx impregnated spacer, could achieve 1000x concentration or higher

These article
Prophylaxis：Cement bead, Antibacterial coating implant
Treatment：Cement bead, GM-loaded collagen sheet, ABx-loaded spacer

Initially
．GM loaded cement beads
．higher local concentration, no systemic effect, gradual release
．disadvantage: select GM resistant bacteria
．should be removed 4-6 weeks later (became foreign body)

ABx-coating implant
．Synthes
．biodegradable GM, Chlorohexidine
．reduce the rate of osteomyelitis
．pending large, clinical trials

ABx loaded collagen sheet
．PMMA beads: another operation for removal
．Collagen sheet: biodegradable
．disadvantage: short T1/2

ABx loaded spacer
．prevent soft tissue contracture, arthrofibrosis, instability
．disadvantage: expensive