Cannabis in drug-resistant infections in hospital, with special emphasis on orthopaedic surgery

A. Younes¹ and L. Contokristos²

¹Anesthesia and Rianimation Pain Therapy, Arcamedica, Pescara, Italy; ²Orthopaedic Surgery, Istituto Galeazzi, Milan, Italy

Key words: virus; orthpedics; drugs; cannabis; infections

Cannabis was used in the pre-modern civilization in the Middle East as well as in the Mediterranean area, to treat inflammatory diseases, wounds more or less infected with fungus, bacteria, and viruses. In recent years, due to the abuse and misuse of antibiotics, some bacteria, viruses and microorganisms have developed a biotic resistance, becoming a serious global health emergency.

The alarm was launched by Dr Kiji Fukuda  (Deputy Director General of the WHO World Health Security Department). In fact, he said that the world would be forced: “… to live a post-antibiotic era, whereby common infections and low injuries effectively treated for decades, could become lethal.” An example is the methicillin-resistant Staphylococus aurens (MRSA) belonging to the family of gram positive bacteria (resistant to penicillin, vancomycin and methicillin) Streptococcus and Enterococcus, able to infest wounds in the perioperative section of hospitals, increasing  the risk of death by about 50%.

During the multidisciplinary research, intensely conducted by the International Association for Fibromyalgia Research (AIRF) in cooperation with “No More Pain”, on diseases and symptoms concerning fibromyalgic syndrome (FMS), autism, psoriasis and epilepsy, non-psychotropic cannabinoids have been tested, first in vitro and later in vivo. Using CBG only, CBD only, and CBG + CBD demonstrated an exceptional affinity for the CB1 and CB2 receptors. This activation blocks the degranulation of the mast cell, therefore blocking the release of inflammatory factors [tumor necrosis factor (TNF), IL-1 and other cytokines]. Moreover, the CBD + CBG are able to cross the protein shield responsible for the resistance of the methicillin-resistant Staphylococcus aureus (MRSA), therefore killing them.

 Orthopaedic surgery

Infection in orthopaedic surgery is a common problem associated with significant financial and psychosocial costs, and increased morbidity. It increases the rate of nonunion, osteomyelitis, implant failure, sepsis, multiorgan dysfunction and even death (1). Surgical site infection is defined as pain, erythema, swelling and discharge from the wound site. Infections can prove to be extremely difficult to diagnose and treat. Un-recognized infections can be limb-threatening and even potentially fatal if not recognized and treated. The most important aspect of caring for patients with a musculoskeletal infection is to make a timely diagnosis (2). Numerous strategies have been employed to prevent orthopaedic infection, including the use of antibiotic-impregnated implant coatings. Biofilm formation on orthopaedic implants is attributed to the glycocalyx-mediated surface mode of bacterial growth and is usually treated by a secondary surgery involving irrigation, debridement and the appropriate use of antibiotics, or complete removal of the infected implant (3).

Systemic antibiotic treatment must always follow the results of pre-operative cultures. In case of culture-negative infection, a second generation cephalosporin appears advisable until the results of intra-operative cultures become available. Suggestions on duration of concomitant systemic antibiosis vary widely, from days to several months. All recommendations are empirical and it is questionable whether long-term therapy after surgical intervention provides any additional benefit (4).

REFERENCES

1. 1.      No authors listed. Section 1: Preventing and Managing Infection and Other Complications After Orthopaedic Trauma. J Orthop Trauma 2017; 31(S)1:S2. doi: 10.1097/BOT.0000000000000798.
2. Navarro M, Michiardi A, Castaño O, Planell JÁ. Biomaterials in orthopaedics. J R Soc Interface 2008; 5:1137-58. doi: 10.1098/rsif.2008.0151.
3. Oliveira NM, Martinez-Garcia E, Xavier J, et al. Biofilm formation and the biological response to ecological competition. PLoS Biol 2015; 13(7):e1002191.
4. Drago L, De Vecchi E, Cappelletti L, et al. Prolonging culture to 15 days improves bacterial detection in bone and joint infections. Eur J Clin Microbiol Infect Dis 2015; 34(9):1809-13.
5. Costerton JW. Biofilm theory can guide the treatment of device-related orthopaedic infections. Clin Orthop Relat Res 2005; 437:7-11.