antibiotic loaded ceramic sternum for ......antibiotic loaded ceramic sternum for sternal...

ANTIBIOTICLOADEDCERAMICSTERNUMFORSTERNALREPLACEMENTDURINGREFRACTORYDEEPSTERNALWOUNDINFECTION

JérémyTRICARD,AnaëlleCHERMAT,EricDENES,SouleimanELBALKHI,FrançoisBERTIN

ThoracicandCardiovascularSurgerydepartmentLIMOGESUniversityHospital,France

Objective:Sternumreconstructionafteritsdestructionduringrefractorydeepsternalwoundinfection(DSWI)mainlyreliesonvacuum-assistedclosuretherapy(VAC)andmuscleflapswhichhassome pitfalls. We report here the use of an antibiotic loaded prosthesis for sternalreplacementduringDSWI(CERAMIL®).Thedeviceisaporousaluminasternumloadedwithgentamicin.Theaimistoobtainamechanicalreplacementofthesternumassociatedtoitsbacterialprotectionduringimplantationthankstoantibioticlocalrelease.

Table2:Localgentamicinconcentrationexceededtheoneneededforitsefficacywhilenoantibioticwasfoundintheblood

Conclusions:ThesethreeimplantationsarepromisingforpatientswithsternaldestructionafterDSWI,offeringaprotectionagainstbacteria.

Methods:ThisdevicewasimplantedinthreemalepatientswithDSWIandpersistentinfectedsternaldehiscencefollowingcoronaryheartby-pass.

H1 H24 FromH1toH48Antibiotic Loaded

dose(mg)

Localconcentration(mg/L)

Comparisontotheneededconcentration

Localconcentration(mg/L)

Comparisontotheneededconcentration

Antibioticsampledinblood(mg/L)

#2 Gentamicin 320 1500 >175folds 395 >50folds 260folds 37 >5folds