Trampuz Andrej, Osmon Douglas R, Hanssen Arlen D, Steckelberg James M, Patel Robin
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Clin Orthop Relat Res. 2003 Sep(414):69-88. doi: 10.1097/01.blo.0000087324.60612.93.
The majority of patients with prosthetic joint replacement (arthroplasty) experience dramatic relief of pain and restoration of satisfactory joint function. In the United States, more than.5 million people have a primary arthroplasty each year. Less than 10% of prosthesis recipients have complications develop during their lifetime, commonly as a result of aseptic biomechanical failure, followed by prosthetic joint infection. The pathogenesis of prosthetic joint infection is related to bacteria in biofilms, in which they are protected from antimicrobial killing and host responses rendering these infections difficult to eradicate. Current microbiology laboratory methods for diagnosis of prosthetic joint infection depend on isolation of a pathogen by culture. However, these methods have neither ideal sensitivity nor ideal specificity. Therefore, culture-independent molecular methods have been used to improve the diagnosis of prosthetic joint infection. In the research setting, detection of 16S ribosomal deoxyribonucleic acid by polymerase chain reaction has been used in the molecular diagnosis of prosthetic joint infection. Various antibiofilm strategies directed at disruption of adherent bacteria are the focus of intense research to improve the detection of biofilm organisms and their eradication. In this article, molecular and antibiofilm approaches to prosthetic joint infection are reviewed.
大多数接受人工关节置换术（关节成形术）的患者疼痛得到显著缓解，关节功能恢复到令人满意的程度。在美国，每年有超过50万人接受初次关节成形术。假体接受者中不到10%的人在其一生中会出现并发症，常见原因是无菌性生物力学失败，其次是人工关节感染。人工关节感染的发病机制与生物膜中的细菌有关，在生物膜中，细菌受到保护，免受抗菌杀灭和宿主反应的影响，使得这些感染难以根除。目前用于诊断人工关节感染的微生物学实验室方法依赖于通过培养分离病原体。然而，这些方法既没有理想的敏感性，也没有理想的特异性。因此，不依赖培养的分子方法已被用于改善人工关节感染的诊断。在研究环境中，通过聚合酶链反应检测16S核糖体脱氧核糖核酸已被用于人工关节感染的分子诊断。针对破坏黏附细菌的各种抗生物膜策略是提高生物膜微生物检测及其根除的深入研究重点。本文对人工关节感染的分子和抗生物膜方法进行了综述。
