Experimental study of antimicrobial polymeric composition with hemostatic effect in treatment of implant associated infection

Kochish A.A., Bozhkova S.A., Netylko G.I., Anisimova L.I.

Abstract


Introduction
Management of infection associated with surgical implants comprise local application of antimicrobial agents.
The purpose of the in vivo experimental study was identification of an optimal antimicrobial polymeric composition with hemostatic effect for local wound application and assessment of its influence on clinical and morphological changes in implant-associated infection caused by staphylococcus in rabbit femur.
Materials and methods
A composition exhibiting minimal bleeding time was identified in the first experiment using six experimental samples with different concentration of tranexamic acid (TXA) and polyvinylpyrrolidone (PVP) implanted in the soft tissue wound of the rat liver (n = 18). Peri-implant infection caused by staphylococcus was simulated in the rabbit femur in the second experiment. Infected wire was implanted in the intramedullary canal of control animals (n = 9). The wire was steeped in gentamicin-containing sample selected in the first experiment before it was used for experimental animals (n = 9). Histologic assessment of the wire placement site was performed at 14, 21 and 28 days.
Results
Minimal bleeding time was recorded with the sample containing 25 mg of TXA in 1 mL of 10 % PVP aqueous solution. 8 mg/mL of gentamicin was added to the sample tested. Both groups showed histological signs of inflammation at 14 days of implantation being more evident in controls with fibrinopurulent inflammation and microabscesses. Inflammatory infiltration was more expressed in controls at 21 days and was characterized by a great number of plethoric vessels. A capsule with leucocytes and fibrin clots was observed in the intramedullary canal. Experimental animals exhibited fading signs of inflammation with delicate fibrous tissue and moderate mononuclear infiltration formed. Signs of bone regeneration were detected in both groups at 28 days apart from persistent inflammation being secondary to decompactization. However, bone trabeculae were noted to recover in controls with evident inflammation featuring extensive erythrocyte clusters, necrotic bone fragments, granulated tissue and evident leucocyte infiltration.
Conclusion
The experimental study allowed identifying PVP and TXA based composition as most effective for hemostasis estimating dynamics in perifocal reactions with the use of gentamicin-containing sample to prevent osteomyelitis in implantation of experimental animals. The findings showed prospectiveness of further research of the polymeric composition with antimicrobial and hemostatic effects.

Keywords


implant-associated infection, periprosthetic joint infection, deep surgical site infection, polymeric composition, local antimicrobial therapy, hemostatic effect

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DOI: http://dx.doi.org/10.18019/1028-4427-2019-25-2-180-187

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