3D printing drug delivery systems to prevent orthopedic infections

The use of orthopedic devices has increased significantly over the last decade due to the aging population. However, the risk of infection after implantation of an orthopedic device is a great obstacle and one of the main causes of implant removal. Staphylococcal species, especially the biofilm-forming Staphylococcus aureus and Staphylococcus epidermidis are the most common bacterial species causing orthopedic infections. The background on the pathogenesis of orthopedic-associated infections, the current strategies in the prevention of these infections and the use of additive manufacturing in orthopedics is provided in chapter 1.
The source of infection in trauma surgery is under discussion. Bacteria may come from the air contaminating the surgical wound or bacteria from the skin may colonize the wound after cutting. Therefore, in chapter 2, we isolated, quantified and identified bacteria from the skin of 99 patients undergoing trauma surgery, before and after skin disinfection, from the knife blades and from the wound directly after the first cut. Interestingly, 20 % of the patients had a positive culture after cutting the skin. Despite disinfection, bacterial colonization remains an issue. Therefore, in chapters 3, 5, 6 and 7, we focused in the development of 3D-printed antimicrobial delivery systems to prevent orthopedic infections.
In chapter 8, a critical analysis of the usage of additive manufacturing to create antimicrobial delivery systems to prevent orthopedic infections is discussed. In summary, the results of the work described novel applications of additive manufacturing in the development of antimicrobial delivery systems to prevent orthopedic infections.