In this systematic review, the antimicrobial effect of ion-substituted calcium phosphate biomaterials was quantitatively assessed.The literature was systematically searched up to the 6th of... Show moreIn this systematic review, the antimicrobial effect of ion-substituted calcium phosphate biomaterials was quantitatively assessed.The literature was systematically searched up to the 6th of December 2021. Study selection and data extraction was performed in duplo by two independent reviewers with a modified version of the OHAT tool for risk of bias assessment. Any differences were resolved by consensus or by a referee. A mixed effects model was used to investigate the relation between the degree of ionic substitution and bacterial reduction.Of 1016 identified studies, 108 were included in the analysis. The methodological quality of included studies ranged from 6 to 16 out of 18 (average 11.4). Selenite, copper, zinc, rubidium, gadolinium, silver and samarium had a clear antimicrobial effect, with a log reduction in bacteria count of 0.23, 1.8, 2.1, 3.6, 5.8, 7.4 and 10 per atomic% of substitution, respectively. There was considerable between-study variation, which could partially be explained by differences in material formulation, study quality and microbial strain. Future research should focus on clinically relevant scenarios in vitro and the translation to in vivo prevention of PJI. Show less
Dun, S.C.J. van; Verheul, M.; Pijls, B.G.C.W.; Prehn, J. van; Scheper, H.; Galli, F.; ... ; Boer, M.G.J. de 2023
Introduction: One of the main causes of treatment failure in bacterial prosthetic joint infections (PJI) is biofilm formation. The topography of the biofilm may be associated with susceptibility to... Show moreIntroduction: One of the main causes of treatment failure in bacterial prosthetic joint infections (PJI) is biofilm formation. The topography of the biofilm may be associated with susceptibility to antimicrobial treatment. The aims of this study were to assess differences in topography of biofilms on different implant materials and the correlation thereof with susceptibility to antimicrobial treatment. Methods: Methicillin-resistant Staphylococcus aureus (MRSA) 7-day mature biofilms were generated on disks made from titanium alloys (Ti-6Al-7Nb and Ti-6Al-4V), synthetic polymer and orthopedic bone cement, commonly used in implant surgery. The surface topography of these implant materials and the biofilms cultured on them was assessed using atomic force microscopy. This provided detailed images, as well as average roughness (Ra) and peak-to-valley roughness (Rt) values in nanometers, of the biofilm and the material surfaces. Bacterial counts within biofilms were assessed microbiologically. Antimicrobial treatment of biofilms was performed by 24-h exposure to the combination of rifampicin and ciprofloxacin in concentrations of 1-, 5- and 10-times the minimal bactericidal concentration (MBC). Finally, treatment-induced differences in bacterial loads and their correlation with biofilm surface parameters were assessed. Results: The biofilm surfaces on titanium alloys Ti-6Al-7Nb (Ra = 186 nm) and Ti-6Al-4V (Ra = 270 nm) were less rough than those of biofilms on silicone (Ra = 636 nm). The highest roughness was observed for biofilms on orthopedic bone cement with an Ra of 1,551 nm. Interestingly, the roughness parameters of the titanium alloys themselves were lower than the value for silicone, whereas the surface of the bone cement was the roughest. Treatment with 1- and 5-times the MBC of antibiotics resulted in inter-material differences in colony forming units (CFU) counts, ultimately showing comparable reductions of 2.4-3.0 log CFU/mL at the highest tested concentration. No significant differences in bacterial loads within MRSA biofilms were observed between the various implant materials, upon exposure to increasing concentrations of antibiotics. Discussion: The surface parameters of MRSA biofilms were determined by those of the implant materials on which they were formed. The antibiotic susceptibility of MRSA biofilms on the various tested implant materials did not differ, indicating that the efficacy of antibiotics was not affected by the roughness of the biofilm. Show less
In dit proefschrift heb ik onderzocht wat de klinische waarde is van migratie van totale knie protheses (TKP) en totale heup protheses (THP) gemeten met Radiostereometrische Analyse (RSA)in de... Show moreIn dit proefschrift heb ik onderzocht wat de klinische waarde is van migratie van totale knie protheses (TKP) en totale heup protheses (THP) gemeten met Radiostereometrische Analyse (RSA)in de context van een gefaseerde klinische introductie. De studies in dit proefschrift tonen aan dat onveilige (hoog revisie percentage voor loslating) TKP en THP met RSA studies kunnen worden ge_dentificeerd in slechts 2 jaar follow-up. Vroege identificatie met RSA van deze onveilige TKP en THP voorkomt wijdverbreide gebruik. De gefaseerde klinische introductie van nieuwe implantaten op basis van RSA studies met 2 jaar follow-up kan leiden tot betere en veiligere pati_ntzorg en tot een reductie van de kosten in de zorg ten gevolge van revisie van TKP en THP. Follow-up in nationale implantaten registers is noodzakelijk om de resultaten van de implantaten te blijven vervolgen, nadat deze op de markt zijn gekomen. Show less
