Topical Use of Antimicrobial Agents in the Treatment of Bone Infections

Abstract

Bacterial infections in orthopedic and reconstructive surgery are associated with significant morbidity and poor functional outcomes. Surgical management (excision of infected and devascularized tissues, obliteration of dead space, restoration of blood supply and soft tissue, stabilization and reconstruction of the damaged bone), removal of all foreign bodies, and systemic antimicrobial therapy are three crucial components of the treatment of these infections. A long-term systemic antimicrobial therapy has been considered essential, but may result in adverse reactions. In order to achieve therapeutic drug concentration in the affected area, high systemic doses are generally required which can further worsen toxic effects. Antibiotic treatment may be inadequate or ineffective in patients with poorly vascularized infected tissues and osteonecrosis, which is often present in osteomyelitis. Moreover, normal doses of systemic antibiotics may be insufficient to breach the glycocalyx or biofilm produced by the infecting bacteria. Despite intensive therapy, advances in surgical techniques, and development of new antimicrobials, relapse rate are still significant and treatment of bone and soft tissue infections remain challenging. New methods such as local delivery of antibiotics have evolved in an attempt to improve the in such patients. The use of local antibiotic delivery system has become an accepted treatment method that continues to evolve for a variety of reasons.