Is coating of titanium implants effective at preventing Staphylococcus aureus infections? A meta-analysis of animal model studies

Aim of the study To assess the effects of the available coating methods against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) biofilm development on titanium implants. Methods We searched the MEDLINE, Embase, and CENTRAL databases until May 18, 2019,...

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Published in:International orthopaedics 2021-04, Vol.45 (4), p.821-835
Main Authors: Tsikopoulos, Konstantinos, Sidiropoulos, Konstantinos, Kitridis, Dimitrios, Hassan, Anas, Drago, Lorenzo, Mavrogenis, Andreas, McBride, Donald
Format: Article
Language:English
Subjects:
Animals
Anti-Bacterial Agents - therapeutic use
Medicine
Medicine & Public Health
Methicillin-Resistant Staphylococcus aureus
Orthopedics
Prostheses and Implants
Review Article
Staphylococcal Infections - drug therapy
Staphylococcal Infections - prevention & control
Staphylococcus aureus
Titanium
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Summary:Aim of the study To assess the effects of the available coating methods against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) biofilm development on titanium implants. Methods We searched the MEDLINE, Embase, and CENTRAL databases until May 18, 2019, for studies that used animal models of infections to evaluate various titanium implant coating methods to prevent S. aureus infection. Twenty-seven studies were eligible for inclusion in qualitative synthesis. Of those, twenty-three were considered in pair-wise meta-analysis. In addition, subgroup analysis of implant protection strategies relative to uncoated controls was performed, and any adverse events stemming from the coating applications were reported. Quality assessment was performed using SYRCLE’s risk of bias tool for animal studies. Results Meta-analysis showed that active coating with antibiotics was favoured over uncoated controls (standardised mean differences [SMD] for MRSA and MSSA were – 2.71 [95% CI, − 4.24 to − 1.18], p  = 0.0005, and − 2.5 [− 3.79 to − 1.22], p  = 0.0001, respectively). Likewise, large effect sizes were demonstrated when a combination of active and conventional non-degradable passive coatings was compared with controls (SMDs for MRSA and MSSA were – 0.62 [95% CI, − 1.15 to − 0.08], p  = 0.02, and − 1.93 [95% CI, − 2.87 to − 0.98], p  
ISSN:0341-2695
1432-5195
DOI:10.1007/s00264-020-04660-4