Name:
The Role of Dual ALBC in PJI
Description:
The Role of Dual ALBC in PJI
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T00H05M33S
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Upload Date:
2024-08-23T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
IAN KENNEDY: Related to this webinar, which I'll put up just now.
CHRISTOF BERBERICH: Thank you for the invitation to speak here quickly on the role of dual antibiotic loaded bone cement in PJI. Of course, we do not speak about its routine use, but about selective situations where the risk for infections or reinfections is high.
CHRISTOF BERBERICH: What is the idea behind the hypothesis that antibiotic combinations in bone cement fight bacterial colonization better than single antibiotic loaded PMMA? Cemented prostheses are particularly prone to bacterial colonization in fragile patients with a weak immune system, and, or if, a priori gentamicin-resistant bacteria have contaminated the joint space.
CHRISTOF BERBERICH: The claim is two antibiotics are better than one. The reasons why antibiotic combinations are more effective are the following. First, with several antibiotic combinations in PMMA, for example with gentamicin and clindamycin, or with chencovancomycin [BACKGROUND NOISE], A much enhanced mutual release rate of the drugs out of the carrier material.
CHRISTOF BERBERICH: Second, the combination of many antimicrobial drugs broadens the spectrum of activity against gram positive and gram negative bugs. Third, the combination of drugs with different targets in the bacterial cells may overcome single resistances and reduces the risk of concomitant resistance development against both agents. Indeed so-called biofilm inhibition studies have repeatedly shown a stronger and longer sustained antimicrobial action of antibiotic combinations in the cement.
CHRISTOF BERBERICH: This is particularly visible at day 9 in this graph, comparing the effects of plain gentamicin only and dual antibiotic combination containing cement. INVIVO, it was further shown that antibiotic combination therapy in bone cement spacers during staged septic PGI treatment was an independent factor for higher treatment success compared to monotherapy. On a microbiological level,
CHRISTOF BERBERICH: monotherapy spacers were associated with much less growth negative biopsies taken at the moment of reimplantation than the combination therapy. Now, most importantly, is there a clinical, albeit preliminary evidence from clinical studies that the use of dual antibiotic loaded bone cement is associated with less infections or reinfections? Yes, there is a summarized in this review.
CHRISTOF BERBERICH: The infection rates were significantly lower in the dual high dose antibiotic loaded bone cement group compared to single low dose gentamycin group. In the fragile group of hip fracture patients, in aseptic knee revision procedures, in septic one stage arthroplasties and even in primary joint replacements with high risk patients. However, the previous findings of a lower PJI rate in the dual gender and clindamycin loaded cement group have been challenged by the recently published randomized WHiTE 8 trial.
CHRISTOF BERBERICH: Despite the tendency to a lower infection rate in the dual antibiotic loaded bone cement group, the P values in the differences between both groups did not reach the level of significance. Whether this is also influenced by the lower than assumed overall infection cases or by the in this trial relatively short observation period of three months remains to be determined. On basis of the chest sharing experience, we may conclude, dual antibiotic loaded bone cement supports a stronger and more sustained inhibition of bacteria than single antibiotic loaded cement with a wider coverage.
CHRISTOF BERBERICH: First, clinical studies indicate superiority of dual antibiotic loaded bone cement. However, the strength of its clinical and health economic impact is still not fully conclusive and may also depend on the overall infection risk. Thank you for your attention.
IAN KENNEDY: OK well, that brings the webinar to a close.
IAN KENNEDY: Thank you to all our speakers. Jason Webb, Elizabeth Darley, Lee Jeys. My co-host Dominic Meekin. Everyone who signed in to watch the webinar, it's going to be available to watch subsequent to this in OrthoTV and OrthoMedia. And finally, just consider signing up to BAJIS via the website so you can be notified of our next webinar in the series and kept up to date regarding any of our upcoming conferences.
IAN KENNEDY: Thank you very much. [VIDEO ENDS]
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