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生物膜理论可指导与植入物相关的骨科感染的治疗。

Biofilm theory can guide the treatment of device-related orthopaedic infections.

作者信息

Costerton J William

机构信息

University of Southern California, Center for Biofilms, School of Dentistry, Los Angeles, 90089, USA.

出版信息

Clin Orthop Relat Res. 2005 Aug(437):7-11. doi: 10.1097/00003086-200508000-00003.

Abstract

Direct observations of the surfaces of orthopaedic prostheses that have failed and of bone affected by osteomyelitis with and without the presence of a prosthesis have shown that the bacteria that cause these infections live in well-developed biofilms. The cells within these matrix-enclosed surface-associated communities are protected from host defenses and antibiotics, and clinical experience has shown that they must be removed physically before the infection can be resolved. The biofilm etiology of these diseases demands new diagnostic methods because biofilm cells typically do not grow on agar plates when recovered by scraping or swabbing. I will recommend new molecular and immunologic diagnostic methods that have been useful in other biofilm infections. These diseases progress through quiescent periods that alternate with acute exacerbations, and clinicians must realize that antibiotic therapy can control the acute phases but cannot resolve the basic biofilm nidus of the infection. Now that it has been realized that these orthopaedic infections are caused by relatively common biofilm-forming bacterial pathogens, new technologies that deliver very high concentrations of antibiotics locally and "on demand" and novel molecular "mimics" that block the signals that control biofilm formation need to be examined.

摘要

对已失效的骨科假体表面以及受骨髓炎影响的骨骼(有无假体存在)的直接观察表明,引发这些感染的细菌生活在发育良好的生物膜中。这些被基质包裹的表面相关群落中的细胞受到宿主防御和抗生素的保护,临床经验表明,在感染得以解决之前,必须将它们物理清除。这些疾病的生物膜病因需要新的诊断方法,因为当通过刮擦或擦拭回收时,生物膜细胞通常不会在琼脂平板上生长。我将推荐在其他生物膜感染中有用的新的分子和免疫诊断方法。这些疾病通过与急性加重期交替的静止期发展,临床医生必须认识到抗生素治疗可以控制急性期,但无法消除感染的基本生物膜病灶。既然已经认识到这些骨科感染是由相对常见的形成生物膜的细菌病原体引起的,那么就需要研究能够局部且“按需”递送非常高浓度抗生素的新技术,以及阻断控制生物膜形成信号的新型分子“模拟物”。

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