Применение имплантатов с антибактериальным покрытием в ортопедии и травматологии: современное состояние проблемы

Current prophylactic and hygienic measures notwithstanding, implant-related infection remains among leading reasons for failure in orthopaedics and trauma surgery, resulting in extremely high social and economic costs. Various antibacterial coating technologies have been proven safe and effective both in preclinical and in clinical settings and able to reduce post-surgical infections up to 90%, depending on the type of the coating and on the experimental setup. In spite of this findings, the widespread use of these technologies is still limited by several factors. After reviewing the latest evidence on currently available antibacterial coatings, an algorithm is proposed to calculate the impact of the delayed introduction of these technologies in the clinical practice. When applied to joint arthroplasties, our calculator shows that each year of delay to implement an antibacterial coating, able to reduce post-surgical infection by 80% at a final user’s cost price of €600, causes an estimated 35 200 new cases of periprosthetic joint infection in Europe and additional annual hospital costs of approximately €440 million. Faster and more affordable regulatory pathways for antibacterial coating technologies and an adequate reimbursement policy for their clinical use appear a feasible solution to mitigate the impact of implant-related infections and may benefit patients, healthcare systems, and related research.All patients provided written informed consent.Competing interests: the authors declare that there are no competing interests.Несмотря на современные достижения профилактики и гигиены, имплант-ассоциированная инфекция остается одной из основных причин несостоятельных результатов ортопедических и травматологических вмешательств, что приводит к чрезвычайно высоким социальным и экономическим издержкам. Различные технологии антибактериального покрытия имплантатов зарекомендовали себя как безопасное и эффективное решение проблемы инфицирования в процессе как доклинических исследований, так и в клинической практике, что способствует снижению частоты послеоперационной инфекции до 90% в зависимости от типа покрытия и условий использования. Несмотря на такие выводы, широкое внедрение подобных технологий по-прежнему ограничено несколькими факторами. Изучив наиболее актуальные данные по доступным антибактериальным покрытиям, авторы предлагают алгоритм для расчета влияния несвоевременного внедрения таких технологий в клиническую практику. Применение предлагаемого калькулятора к операциям по эндопротезированию суставов демонстрирует, что каждый год отсрочки внедрения антибактериальных покрытий, который позволил бы снизить частоту послеоперационной инфекции на 80% при стоимости для конечного пользователя в размере 600 евро, приведет примерно к 35 200 новых случаев возникновения перипротезной инфекции в странах Европы и к дополнительным ежегодным госпитальным расходам в размере около 440 млн евро. Ускоренные и более доступные с точки зрения затрат процессы нормативного регулирования в отношении технологий антибактериального покрытия имплантатов, а также адекватная политика возмещения расходов по клиническому использованию таких технологий представляются возможным решением для снижения частоты имплант-ассоциированной инфекции, улучшения качества лечения пациентов, снижения нагрузки на систему здравоохранения и для стимулирования научных изысканий

Two-bands effect on the superconducting fluctuating diamagnetism in MgB&#8322

The field dependence of the magnetization above the transition temperature Tc in MgB₂ is shown to evidence a diamagnetic contribution consistent with superconducting fluctuations reflecting both the σ and π bands. In particular, the upturn field Hup in the magnetization curve, related to the incipient effect of the magnetic field in quenching the fluctuating pairs, displays a double structure, in correspondence to two correlation lengths. The experimental findings are satisfactorily described by the extension to the diamagnetism of a recent theory for paraconductivity, in the framework of a zero-dimensional model for the fluctuating superconducting droplets above Tc

Effect of two gaps on the flux lattice internal field distribution: evidence of two length scales from muSR in Mg1-xAlxB2

We have measured the transverse field muon spin precession in the flux lattice (FL) state of the two gap superconductor MgB2 and of the electron doped compounds Mg1-xAlxB2 in magnetic fields up to 2.8T. We show the effect of the two gaps on the internal field distribution in the FL, from which we determine two coherence length parameters and the doping dependence of the London penetration depth. This is an independent determination of the complex vortex structure already suggested by the STM observation of large vortices in a MgB2 single crystal. Our data agrees quantitatively with STM and we thus validate a new phenomenological model for the internal fields.Comment: now in press Phys. Rev. Lett., small modifications required by the edito

Clinical and Virological Features and Course of Acute Hepatitis B (AHB) in Italy

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Phenotypic and genomic identification of Staphylococcus epidermidis GOI1153754-03-14 isolated from an infected orthopedic prosthesis

Introduction: Staphylococcus epidermidis GOI1153754-03-14 is able to colonize orthopedic implants and to cause septic non-unions, as validated in a recent in vivo study (Lovati, 2016). To pore over the mechanisms leading to the biofilm formation on metallic implants, in the present study, we carried out the phenotypic and genotypic characterization of the clinical isolate S. epidermidis GOI1153754-03-14.Materials and Methods: The antimicrobial susceptibility and minimum inhibitory concentration (MIC) of the strain were evaluated through the Vitek2 System (Biomerieux), as well as its ability to form biofilm in vitro through a spectrophotometric assay (Stepanovich, 2000).The genomic DNA was extracted by Bacterial Genomic DNA Isolation Kit (Norgen Biotek Corp.). Libraries were prepared with the ThruPLEX DNA-seq (Rubicon Genomics) and then sequenced on the Illumina MiSeq platform through the MiSeq Reagent Kit v3 (600-cycles) to produce 300 bp paired-end reads (Illumina Inc.). Reads were quality-trimmed and gene annotated thanks to the RAST software (Aziz, 2008).Results: The antimicrobial susceptibility along with the MIC values are reported in Table 1. The outputs resulted in 51 contigs (Average = 50,720.6 Mb) with 396X fold average coverage. The total genome is 2,586,753 bp long with a GC content of 31.84% and an N50 value of 7 bp. The whole genome is composed by 2,467 protein-encoding genes and 64 RNAs (55 tRNAs and 9 rRNAs). The entire genome sequence has been deposited in the European Nucleotide Archive (ENA) under the accession no. FWCG01000000 (Bottagisio, 2017).Discussion: The genotypic and phenotypic characterization of the S. epidermidis GOI1153754-03-14 will enable a better comprehension of the mechanisms involved in the biofilm formation on orthopedic implants paving the way for innovative preventative and therapeutic strategies. Moreover, the sequence of this clinical strain is mandatory to develop dedicated proteomics analysis in order to highlight functional mechanism of biofilm formation

Bone and joint infections in adults: a comprehensive classification proposal

Ten currently available classifications were tested for their ability to describe a continuous cohort of 300 adult patients affected by bone and joint infections. Each classification only focused, on the average, on 1.3\u2009\ub1\u20090.4 features of a single clinical condition (osteomyelitis, implant-related infections, or septic arthritis), being able to classify 34.8\u2009\ub1\u200924.7% of the patients, while a comprehensive classification system could describe all the patients considered in the study. RESULT AND CONCLUSION: A comprehensive classification system permits more accurate classification of bone and joint infections in adults than any single classification available and may serve for didactic, scientific, and clinical purposes

Antibacterial Bioactive Glass, S53P4, for Chronic Bone Infections - A Multinational Study

Correction: Volume: 971 Pages: 115-116 DOI: 10.1007/5584_2017_13 Published: 2017 WOS:000446017300010Osteomyelitis is an infectious process in bone that occasionally leads to bone destruction. Traditionally, the surgical treatment procedure is performed in combination with systemic and local antibiotics as a two-stage procedure that uses autograft or allograft bone for filling of the cavitary defect. Bioactive glass (BAG-S53P4) is a bone substitute with proven antibacterial and bone bonding properties. One hundred and sixteen patients who had verified chronic osteomyelitis was treated using BAG-S53P4 as part of the treatment. Most of the patients had previously undergone numerous procedures, sometimes for decades. A register of patient data obtained from 11 centers from Finland, Italy, the Netherlands, Germany, Azerbaijan and Poland was set-up and continuously maintained at Helsinki University Central Hospital. The location of the osteomyelitis was mainly in the tibia followed by the femur and then the calcaneus. The median age of the patients was 48 years (15-87). The patients were either treated according to a one-stage procedure without local antibiotics (85 %) or by a two-stage procedure using antibiotic beads in the first procedure (15 %). The minimum follow-up was 1 year (12-95 months, median 31). The cure rate was 104/116, the total success rate 90 % and most of the patients showed a rapid recovery. The study shows that (BAG-S53P4) can be used in a one-stage procedure in treatment of osteomyelitis with excellent results.Peer reviewe

Prevention of implant-related infections by a resorbable, antibacterial-loaded coating: a new approach

Currently studied antibacterial coatings are far from having large-scale applications, due to various limitations. A recently developed fast resorbable, antibacterial-loaded, hydrogel coating may provide a new approach to offer an effective antibacterial and antibiofilm protection to orthopedic implants