Table 3.
Summary of general results on infection evolution and bone remodeling for experimental groups and for antibiotic and biomaterial used.
| Author | Antibiotic Characteristics | Ceramic Used | Discussion | |||||
|---|---|---|---|---|---|---|---|---|
| Antibiotic Used | Formulation | Amount | Material | Form | Amount/Animal | Infection | Bone Formation | |
| Dahners [58] | Gentamicin | Powder | 50 mg per cm3 of calcium sulfate | Calcium sulfate | Powder | 1 cm3 | Cure rate of 2/10; clinical and radiographic improvement in all other animals | NI |
| Eitenmuller [59] | Povidone-iodine | NI | 10% wt | Hydroxyapatite | Granules | NI | Resolution of clinical and radiological signs of infection | Good osteointegration of material at 10 weeks |
| Flucloxacillin | NI | 10% wt | Hydroxyapatite | Granules | NI | Resolution of clinical and radiological signs of infection | Only peripheral osteointegration of material at 10 weeks | |
| Cornell [32] | Gentamicin | Gentamicin sulfate and gentamicin crobefat | NI | Hydroxyapatite | Beads | 40 mg | Infection eradication in 16/22 animals | NI |
| Korkusuz [46] | Gentamicin | Powder | 5 mg/block | Hydroxyapatite | Blocks (4 × 3 × 3 mm) | One block | Eradication of infection without removal of the metal implants in all animals | NI |
| Itokazu [36] | Arbekacin | Powder | 0.84 mg/block | Hydroxyapatite | Blocks (2 × 2 × 3 mm) | One block | Cure in 5/7 rats | New bone formation was visible at the surface of the block and complete contact without fibrous tissue was evident at the interface between the bone and implant at 7 weeks |
| Nelson [19] | Tobramycin | Powder | 10% wt | Calcium sulfate | Pellets (3.4 mm diameter × 4.7 mm length, average weight of 100 mg) | Six pellets (average) | Infection cure in 11/13 animals | Rabbits showed 96% of the pellets resorbed and 51% bone formation in the original defect |
| Shirtliff [49] | Vancomycin | Powder | 10% wt | Hydroxyapatite | Powder | 2–7 g | Infection cure rate of 81.8% | NI |
| Joosten [40] | Gentamicin | Powder | 3.2% wt | Hydroxyapatite (1) | Paste | 1.4–2.5 g (average 2.0 g) | No evidence of infection in all animals | Little evidence of resorption |
| Faber [33] | Gentamicin | Powder | 5% wt | Calcium phosphate (2) | Paste | 2.4 ± 0.3 g | Absence of bacteria in 6/8 animals; imagiological signs of infection present in 5/8 | NI |
| hLF1-11 | NI | 5% wt | Calcium phosphate (2) | Paste | 2.2 ± 0.2 g | Infection cure in 5/8 animals; significantly reduced bacterial load in 2/8 | NI | |
| Joosten [41] | Vancomycin | Powder | 16% wt | Hydroxyapatite (1) | Cylinders (6 mm diameter × 12 mm length) | NI | No evidence of infection in all animals | Little evidence of resorption |
| Vancomycin | Powder | 16% wt | Hydroxyapatite (1) | Cylinders (6 mm diameter × 12 mm length) | NI | No evidence of infection in all animals | Little evidence of resorption | |
| Koort [45] | Ciprofloxacin | Powder | 7.6% wt | Bioactive glass (3) | Pellets (1 mm diameter × 0.9 mm length) | NI | Successful for eradication of the bone pathogen; soft tissue infections need systemic antimicrobial treatment | Need to perform a long-term follow-up of the osteoconductive response |
| Hui [35] | Gentamicin | Loaded liposomes | NI | Calcium sulfate | Powder | NI | Complete sterilization of bone (100% cure) | NI |
| Gentamicin | Powder | NI | Calcium sulfate | Powder | NI | More effective than controls, but did not sterilize all bone tissues | NI | |
| Kanellakopoulou [42] | Moxifloxacin | Powder | 10% wt | Calcium sulfate | Cylinder (50 mg) | One cylinder | Complete eradication of infection | NI |
| Xie [52] | Vancomycin | Powder | 8% wt | Borate glass | Pellets (6 mm × 6 mm) | NI | Treatment rate of 73.3% | Borate glass mostly reabsorbed and replaced by new bone |
| Jia [37] | Teicoplanin | Powder | 10% wt | Calcium sulfate | Pellets (4.7 mm diameter × 3.5 mm length) | NI | Lower radiological and histological scores and lower rate of MRSA culture, but did not resolve bone infection in all animals | Newly formed bone remodeled and restored to its original structural integrity |
| Jia [38] | Teicoplanin | Powder | 8% wt | Borate glass (4) | Pellets (4.7 mm diameter × 3.5 mm length) | NI | Lower rate of MRSA culture | Degradation of pellets and new bone formation |
| Jiang [39] | Vancomycin | Powder | 16% wt | Nanohydroxyapatite | Cylinders (3.2 mm diameter × 10 mm length) | NI | Bacteria count decreased significantly | Normal bone after 12 weeks |
| Kaya [44] | Tigecycline | Powder | 5% wt | Hydroxyapatite | Powder | 0.5–2 g | Decline in all clinical and imagological signs of infection | NI |
| Beenken [27] | Daptomycin | Powder | 15% wt | Calcium sulfate | Cylinders (4 mm diameter × 10 mm length) | One cylinder | Reduction in bacteria count was not different from controls | NI |
| Daptomycin | Powder | 15% wt | Calcium sulfate (5) | Cylinders (4 mm diameter × 10 mm length) | One cylinder | Significant reduction in bacteria count | NI | |
| Chung [31] | Vancomycin | Shells (6) | 20% wt | Calcium phosphate | Paste | NI | Highly effective local antibacterial activity | NI |
| Vancomycin | Powder | 5% wt | Calcium phosphate | Paste | NI | Reduction in inflammation signs | NI | |
| Kankilic [43] | Vancomycin | Beads | 10% wt | Calcium phosphate (7) | 1.5 mm diameter beads | NI | Cure of infection in all animals | Biocompatibility and osteointegration |
| Vancomycin | Coated beads | 10% wt | Calcium phosphate (7) | PLLA-coated 1.5 mm diameter beads | NI | Cure of infection in all animals | Biocompatibility and osteointegration | |
| Yan [53] | Rifapentine | Microspheres (8) | 4% wt | Hydroxyapatite (9) | Cylinders (5 mm diameter × 15 mm length) | One cylinder | Bacterial colony counts were extremely low, suggesting eradication of infection | Most of the material was degraded and new trabecular bone formed; bone shape gradually improved and returned to normal |
| Cao [29] | Vancomycin | Microspheres (10) | 8% wt | Hydroxyapatite (9) | Cylinders (5 mm diameter × 15 mm length) | 3 g | Progressive disappearance of imagological signs of infection | Scaffold almost integrated with complete healing of all bone defects |
| Vancomycin | Microspheres (10) | 8% wt | Hydroxyapatite (9) | Cylinders (5 mm diameter × 15 mm length) | 3 g | Progressive disappearance of imagological signs of infection | Scaffold almost integrated with complete healing of all bone defects | |
| Cao [30] | Vancomycin | Microspheres (10) | 8% wt | Hydroxyapatite (9) | Cylinders (5 mm diameter × 15 mm length) | 3 g | Curative ratio reached 75% | NI |
| Vancomycin | Microspheres (10) | 8% wt | Hydroxyapatite (9) | Cylinders (5 mm diameter × 15 mm length) | 3 g | Curative ratio reached 66.7% | NI | |
| Melicherčík [48] | Antimicrobial peptides (AMP) | NI | 5% wt | Calcium phosphate | Paste | NI | Reduced infection | Minimal signs of the presence of the carrier, probably as a result of its resorption |
| Egawa [54] | Cefazolin | Powder | 2% wt | Hydroxyapatite (11) | Sponges (3 × 3 × 4 mm) | One sponge | MSSA proliferation was prevented at week 2 | Some degradation of ceramic, without complete osteointegration |
| Vancomycin | Powder | 2% wt | Hydroxyapatite (11) | Sponges (3 × 3 × 4 mm) | One sponge | MSSA proliferation was prevented at week 1 | Implanted material was maintained and replaced with new bone at week 4 | |
| Liu [57] | Vancomycin | Powder | 16% wt | Hydroxyapatite | Cylinders (6 mm diameter × 20 mm length) | One cylinder | Progressive disappearance of radiographic and histological signs of infection | Lamellar bone was formed |
| Dvorzhinskiy [56] | Gentamicin | Powder | 0.29 mg (12) | Hydroxyapatite/calcium sulfate | Cylinders (3 mm diameter × 3 mm length) | One cylinder | No infection was detectable at both 6 weeks and 6 months | New bone growth was detected |
NI: No information. (1) Equimolar mixture of amorphous calcium phosphate and dicalcium phosphate; (2) composition of 62.5% α-TCP, 26.8% dicalcium phoshate dihydrate, 8.9% calcium carbonate, and 1.8% precipitated hydroxyapatite; (3) racemic poly(DL)-lactide (PDLLA) and microspheres of bioactive glass; (4) pellets of borate glass/chitosan composite; (5) with chitosan coating; (6) shells of poly(D,L-lactic-co-glycolic acid) (PLGA) and aqueous cores of vancomycin and sodium bicarbonate (NaHCO3); (7) BetaTCP mixed with PLLA; (8) rifapentine-encapsulated poly(lactic-co-glycolic acid) microspheres; (9) hydroxyapatite/poly amino acid (BHA/PAA) scaffold; (10) vancomycin-encapsulated poly(lactic-co-glycolic acid) microspheres; (11) with collagen; (12) 0.29 mg per cylinder, though cylinder weight not available.