{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:22:13Z","timestamp":1792070533898,"version":"4.4.0"},"reference-count":31,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Local antibiotic delivery strategies have been increasingly employed for the prevention of fracture-related infections (FRIs). The aim of this study is to evaluate the efficacy and safety of antibiotic-coated implants in the prevention of FRIs after surgical treatment in patients with increased infectious risk. A retrospective observational study has been conducted on patients with upper and lower limb fractures treated with internal fixation or prosthetic replacements, using a gentamicin coated nail (CN) and\/or antibiotic-loaded hydrogel applied to the implant of choice (ALH). The study included 37 patients (20 M, 17 F), with a mean age of 63 years. The mean estimated preoperative infectious risk score was 6.4%. ALH was used in 27 cases, tibial CNs were implanted in 4 cases, and both were employed in 6 cases. The antibiotics used locally were gentamicin in 72.97% of cases (27 patients) and a combination of gentamicin + vancomycin in 27.03% of cases (10 patients). Mean follow-up was 32 months. Only one case (2.94%) showed onset of FRI at 5 months after surgery. Local antibiotic prophylaxis by coating resulted in a reduction in the incidence FRI, as compared to the estimated preoperative risk. The use of ALH allows for the choice of antibiotic; however, the application of antibiotics seems more nonuniform when applied to a nail.<\/jats:p>","DOI":"10.3390\/antibiotics12020287","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T02:52:02Z","timestamp":1675219922000},"page":"287","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Antibiotic-Loaded Coatings to Reduce Fracture-Related Infections: Retrospective Case Series of Patients with Increased Infectious Risk"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1914-5413","authenticated-orcid":false,"given":"Daniele","family":"De Meo","sequence":"first","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital\u2014Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy"},{"name":"M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8464-7642","authenticated-orcid":false,"given":"Gianluca","family":"Cera","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital\u2014Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Pica","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital\u2014Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiano","family":"Perfetti","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital\u2014Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2702-9060","authenticated-orcid":false,"given":"Paolo","family":"Martini","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital\u2014Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy"},{"name":"M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Perciballi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital\u2014Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy"},{"name":"M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5921-3180","authenticated-orcid":false,"given":"Giancarlo","family":"Ceccarelli","sequence":"additional","affiliation":[{"name":"M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy"},{"name":"Department of Public Health and Infectious Diseases\u2014Sapienza, University of Rome, Piazzale A. Moro 5, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Persiani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital\u2014Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Villani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Policlinico Umberto I Hospital\u2014Sapienza, University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy"},{"name":"M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102228","DOI":"10.1016\/j.cis.2020.102228","article-title":"Bacterial Adhesion on Orthopedic Implants","volume":"283","author":"Dahmane","year":"2020","journal-title":"Adv. Colloid Interface Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"10443","DOI":"10.1038\/s41598-021-90008-w","article-title":"The Epidemiology of Fracture-Related Infections in Germany","volume":"11","author":"Walter","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/j.injury.2013.02.027","article-title":"Predictors of Poor Outcomes Following Deep Infection after Internal Fixation of Ankle Fractures","volume":"44","author":"Ovaska","year":"2013","journal-title":"Injury"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1016\/j.injury.2006.04.016","article-title":"Prophylaxis and Treatment of Implant-Related Infections by Antibiotic-Coated Implants: A Review","volume":"37","author":"Schmidmaier","year":"2006","journal-title":"Injury"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s00068-016-0694-1","article-title":"The Role of Biofilm on Orthopaedic Implants: The \u201cHoly Grail\u201d of Post-Traumatic Infection Management?","volume":"42","author":"Mauffrey","year":"2016","journal-title":"Eur. J. Trauma Emerg. Surg. Off. Publ. Eur. Trauma Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.injury.2020.06.044","article-title":"The Influence of Biomechanical Stability on Bone Healing and Fracture-Related Infection: The Legacy of Stephan Perren","volume":"52","author":"Foster","year":"2021","journal-title":"Injury"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Corrigan, R.A., Sliepen, J., Dudareva, M., IJpma, F.F.A., Govaert, G., Atkins, B.L., Rentenaar, R., Wouthuyzen-Bakker, M., and McNally, M. (2022). Causative Pathogens Do Not Differ between Early, Delayed or Late Fracture-Related Infections. Antibiotics, 11.","DOI":"10.3390\/antibiotics11070943"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Tan, G., Xu, J., Chirume, W.M., Zhang, J., Zhang, H., and Hu, X. (2021). Antibacterial and Anti-Inflammatory Coating Materials for Orthopedic Implants: A Review. Coatings, 11.","DOI":"10.3390\/coatings11111401"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s10195-017-0442-2","article-title":"Fast-Resorbable Antibiotic-Loaded Hydrogel Coating to Reduce Post-Surgical Infection after Internal Osteosynthesis: A Multicenter Randomized Controlled Trial","volume":"18","author":"Malizos","year":"2017","journal-title":"J. Orthop. Traumatol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"De Meo, D., Ceccarelli, G., Iaiani, G., Lo Torto, F., Ribuffo, D., Persiani, P., and Villani, C. (2021). Clinical Application of Antibacterial Hydrogel and Coating in Orthopaedic and Traumatology Surgery. Gels Basel Switz., 7.","DOI":"10.3390\/gels7030126"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Baertl, S., Walter, N., Engelstaedter, U., Ehrenschwender, M., Hitzenbichler, F., Alt, V., and Rupp, M. (2022). What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?. Antibiotics, 11.","DOI":"10.3390\/antibiotics11030287"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3311","DOI":"10.1007\/s11999-014-3558-1","article-title":"Does Implant Coating with Antibacterial-Loaded Hydrogel Reduce Bacterial Colonization and Biofilm Formation in Vitro?","volume":"472","author":"Drago","year":"2014","journal-title":"Clin. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1007\/s00264-013-2237-2","article-title":"Efficacy of Antibacterial-Loaded Coating in an in Vivo Model of Acutely Highly Contaminated Implant","volume":"38","author":"Giavaresi","year":"2014","journal-title":"Int. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1016\/j.injury.2015.09.028","article-title":"The Use of Gentamicin-Coated Nails in Complex Open Tibia Fracture and Revision Cases: A Retrospective Analysis of a Single Centre Case Series and Review of the Literature","volume":"46","author":"Metsemakers","year":"2015","journal-title":"Injury"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1016\/j.arth.2018.01.057","article-title":"Economic Evaluation of Antibacterial Coatings on Healthcare Costs in First Year Following Total Joint Arthroplasty","volume":"33","author":"Trentinaglia","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"De Meo, D., Calogero, V., Are, L., Cavallo, A.U., Persiani, P., and Villani, C. (2020). Antibiotic-Loaded Hydrogel Coating to Reduce Early Postsurgical Infections in Aseptic Hip Revision Surgery: A Retrospective, Matched Case-Control Study. Microorganisms, 8.","DOI":"10.3390\/microorganisms8040571"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"De Meo, D., Cannari, F.M., Petriello, L., Persiani, P., and Villani, C. (2020). Gentamicin-Coated Tibia Nail in Fractures and Nonunion to Reduce Fracture-Related Infections: A Systematic Review. Mol. Basel Switz., 25.","DOI":"10.3390\/molecules25225471"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"453","DOI":"10.2106\/00004623-197658040-00004","article-title":"Prevention of Infection in the Treatment of One Thousand and Twenty-Five Open Fractures of Long Bones: Retrospective and Prospective Analyses","volume":"58","author":"Gustilo","year":"1976","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/BOT.0000000000001513","article-title":"A Predictive Score for Determining Risk of Surgical Site Infection After Orthopaedic Trauma Surgery","volume":"33","author":"Wise","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.injury.2020.10.016","article-title":"Reconstruction of Infected Post-Traumatic Bone Defects of the Distal Femur with the Compress\u24c7 Implant. Preliminary Results of a Staged Non-Biological Strategy","volume":"52","author":"Corona","year":"2021","journal-title":"Injury"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00264-014-2293-2","article-title":"Systematic Review and Meta-Analysis of the Additional Benefit of Local Prophylactic Antibiotic Therapy for Infection Rates in Open Tibia Fractures Treated with Intramedullary Nailing","volume":"38","author":"Craig","year":"2014","journal-title":"Int. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Perisano, C., Greco, T., Polichetti, C., Inverso, M., and Maccauro, G. (2021). Antibiotic-Coated Nail in Open Tibial Fracture: A Retrospective Case Series. J. Funct. Morphol. Kinesiol., 6.","DOI":"10.3390\/jfmk6040097"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"7421582","DOI":"10.1155\/2021\/7421582","article-title":"Uncoated vs. Antibiotic-Coated Tibia Nail in Open Diaphyseal Tibial Fracture (42 According to AO Classification): A Single Center Experience","volume":"2021","author":"Greco","year":"2021","journal-title":"BioMed Res. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1186\/s13018-021-02411-8","article-title":"Treatment of Severely Open Tibial Fractures, Non-Unions, and Fracture-Related Infections with a Gentamicin-Coated Tibial Nail\u2014Clinical Outcomes Including Quality of Life Analysis and Psychological ICD-10-Based Symptom Rating","volume":"16","author":"Walter","year":"2021","journal-title":"J. Orthop. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Patel, K.H., Galanis, A., Balasubramanian, P., Iliadis, A.D., Heidari, N., and Vris, A. (2022). A Major Trauma Centre Experience with Gentamicin-Coated Tibial Intramedullary Nails (ETN PROtectTM) in Acute Primary Open Fracture Fixation and Complex Revision Surgery. Eur. J. Orthop. Surg. Traumatol., 94.","DOI":"10.1007\/s00590-022-03338-4"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1016\/j.injury.2021.04.053","article-title":"Use of Antibiotic Coated Intramedullary Nails in Open Tibia Fractures: A European Medical Resource Use and Cost-Effectiveness Analysis","volume":"52","author":"Franz","year":"2021","journal-title":"Injury"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1016\/j.arth.2017.01.037","article-title":"Complications After Revision Total Hip Arthroplasty in the Medicare Population","volume":"32","author":"Badarudeen","year":"2017","journal-title":"J. Arthroplasty"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-1381.R1","article-title":"The EBJIS Definition of Periprosthetic Joint Infection","volume":"103-B","author":"McNally","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1302\/2058-5241.5.190072","article-title":"Definition and Diagnosis of Fracture-Related Infection","volume":"5","author":"McNally","year":"2020","journal-title":"EFORT Open Rev."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Schmolders, J., Hischebeth, G.T.R., Friedrich, M.J., Randau, T.M., Wimmer, M.D., Kohlhof, H., Molitor, E., and Gravius, S. (2014). Evidence of MRSE on a Gentamicin and Vancomycin Impregnated Polymethyl-Methacrylate (PMMA) Bone Cement Spacer after Two-Stage Exchange Arthroplasty Due to Periprosthetic Joint Infection of the Knee. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-144"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/2\/287\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:20:34Z","timestamp":1760120434000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/2\/287"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,1]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["antibiotics12020287"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12020287","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,1]]}}}