Neut D, van de Belt H, Stokroos I, van Horn J R, van der Mei H C, Busscher H J
Department of Orthopaedic Surgery, University Hospital Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
J Antimicrob Chemother. 2001 Jun;47(6):885-91. doi: 10.1093/jac/47.6.885.
In two-stage orthopaedic revision surgery, high local levels of antibiotics are achieved after removal of an infected prosthesis through temporary implantation of gentamicin-loaded beads. However, despite their antibiotic release, these beads act as a biomaterial surface to which bacteria preferentially adhere, grow and potentially develop antibiotic resistance. Gentamicin-loaded beads were retrieved from 20 patients with prosthesis-related infections. Excised tissue samples were taken for routine culture, while beads were analysed in an extensive laboratory procedure. Extensive culture procedures indicated the presence of bacteria on gentamicin-loaded beads in 18 of the 20 patients involved, while 12 of these 18 patients were considered free of infection by routine culture. Nineteen of 28 bacterial strains isolated were gentamicin resistant and cultures from three patients yielded highly gentamicin-resistant sub-populations. It is concluded that routine culture of excised tissues in orthopaedic revision surgery is inadequate to ascertain full eradication of infection, especially as infecting, antibiotic-resistant bacteria preferentially adhere to and grow on gentamicin-loaded beads. Extensive examination of the bead surfaces is proposed as a more reliable indication that infection has been eradicated.
在两阶段骨科翻修手术中，通过临时植入载有庆大霉素的珠子来移除感染的假体后，可实现较高的局部抗生素水平。然而，尽管这些珠子能释放抗生素，但它们作为生物材料表面，细菌会优先附着、生长并可能产生抗生素耐药性。从20例假体相关感染患者中取出载有庆大霉素的珠子。切除的组织样本用于常规培养，而珠子则通过广泛的实验室程序进行分析。广泛的培养程序表明，在涉及的20例患者中有18例的载有庆大霉素的珠子上存在细菌，而这18例患者中有12例通过常规培养被认为没有感染。分离出的28株细菌中有19株对庆大霉素耐药，三名患者的培养物产生了高度耐庆大霉素的亚群。得出的结论是，骨科翻修手术中切除组织的常规培养不足以确定感染是否已完全根除，特别是因为感染的耐药细菌优先附着在载有庆大霉素的珠子上并在其上生长。建议对珠子表面进行广泛检查，作为感染已被根除的更可靠指标。
