New Strategies for Bone Infection Management
20 July 2020 (online)
Bone infection associated with open fractures and internal fixation implants in human patients is the focus of multidisciplinary research initiatives by the AO Foundation, due to the serious morbidity of this complication. An early study published in 1980 reported an incidence of osteomyelitis in canine fractures of approximately 31%. However, apart from the complication of bone infection after elective tibial osteotomy for cranial cruciate disease, there is a shortage of more contemporary studies about fracture-related infections in veterinary patients.
The classic work of Rittman and Perren using an infected sheep tibial model demonstrated that bone could heal in the face of infection, provided stable internal fixation was maintained. However following the achievement of clinical union, biofilm formation on implants, causing recurrence of infection usually requires implant removal. Strategies to enhance the efficacy of local antimicrobial drug administration in chronic osteomyelitis include the use of sustained release carriers. Furthermore, using a rat tibial model of implant-related bone infection with methicillin-resistant Staphylococcus aureus, the co-administration of leech saliva with erythromycin was evaluated recently. This treatment reduced the severity of histopathological scores for bone infection. However, neither leech saliva alone, or in combination with erythromycin, had any effect on reducing bacterial load in the infected tibial tissue. Previous studies report that leech saliva has anti-bacterial effects; but its clinical use in veterinary patients with chronic bone infections cannot not be currently recommended. It does however highlight the need to build on the research findings of the AO focus group on fracture-related infection using animal models, to improve upon the documentation and treatment of these problems in our clinical veterinary patients.
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