Antimicrobial Biomaterials for the Healing of Infected Bone Tissue: A Systematic Review of Microtomographic Data on Experimental Animal Models.

Bone tissue infection is a major clinical challenge with high morbidity and a significant healthcare burden. Therapeutic approaches are usually based on systemic antibacterial therapies, despite the potential adverse effects associated with antibiotic resistance, persistent and opportunistic infections, hypersensitivity, and toxicity issues. Most recently, tissue engineering strategies, embracing local delivery systems and antibacterial biomaterials, have emerged as a promising alternative to systemic treatments. Despite the reported efficacy in managing bacterial infection, little is known regarding the outcomes of these devices on the bone healing process. Accordingly, this systematic review aims, for the first time, to characterize the efficacy of antibacterial biomaterials/tissue engineering constructs on the healing process of the infected bone within experimental animal models and upon microtomographic characterization. Briefly, a systematic evaluation of pre-clinical studies was performed according to the PRISMA guidelines, further complemented with bias analysis and methodological quality assessments. Data reported a significant improvement in the healing of the infected bone when an antibacterial construct was implanted, compared with the control-construct devoid of antibacterial activity, particularly at longer time points. Furthermore, considering the assessment of bias, most included studies revealed an inadequate reporting methodology, which may lead to an unclear or high risk of bias and directly hinder future studies.