Gallo Jirí, Kolár Milan, Florschütz Anthony V, Novotný Radek, Pantůcek Roman, Kesselová Michaela
Department of Orthopaedics, Palacký University, Teaching Hospital, Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2005 Jun;149(1):153-8. doi: 10.5507/bp.2005.019.
Sepsis is a greatly feared complication of total joint arthroplasty. One key question is how to prevent perioperative bacterial adherence, and therefore the potential for infectious complications. The objective of our study was to appraise the emerging capacity of staphylococcal survival on prosthetic materials and to analyze the in vitro effects of gentamicin and vancomycin loaded polymethylmethacrylate (PMMA) cement on bacterial adherence and growth. Hospital acquired staphylococcal strains were systematically inoculated on four orthopedic materials (ultrahigh molecular weight polyethylene, PMMA without antibiotic, commercially produced PMMA loaded with gentamicin, and manually mixed PMMA loaded with gentamicin and vancomycin). Staphylococci were identified using culture and biochemical tests. The inoculated material was allowed to incubate in a liquid broth growth media and subsequently prepared for scanning electron microscopy and bacterial growth quantification. Materials without antibiotics showed evidence of staphylococcal growth. PMMA loaded with only gentamicin grew methicillin-resistant Staphylococcus aureus. Gentamicin-vancomycin loaded PMMA completely inhibited any bacterial growth. Low-dose gentamicin-vancomycin loaded PMMA prevents staphylococcal colonization better than commercially manufactured PMMA loaded with gentamicin. We recommend this combination in high-risk procedures and revision surgeries requiring bone cement.
脓毒症是全关节置换术令人极为恐惧的一种并发症。一个关键问题是如何防止围手术期细菌黏附，进而预防感染性并发症的发生。我们研究的目的是评估葡萄球菌在假体材料上的生存能力，并分析载有庆大霉素和万古霉素的聚甲基丙烯酸甲酯（PMMA）骨水泥对细菌黏附和生长的体外作用。将医院获得性葡萄球菌菌株系统接种于四种骨科材料上（超高分子量聚乙烯、不含抗生素的PMMA、市售载有庆大霉素的PMMA以及手工混合载有庆大霉素和万古霉素的PMMA）。通过培养和生化试验鉴定葡萄球菌。将接种后的材料置于液体肉汤生长培养基中孵育，随后制备用于扫描电子显微镜检查和细菌生长定量分析。不含抗生素的材料显示有葡萄球菌生长迹象。仅载有庆大霉素的PMMA培养出耐甲氧西林金黄色葡萄球菌。载有庆大霉素 - 万古霉素的PMMA完全抑制了任何细菌生长。低剂量载有庆大霉素 - 万古霉素的PMMA比市售载有庆大霉素的PMMA能更好地防止葡萄球菌定植。我们建议在高危手术和需要骨水泥的翻修手术中使用这种组合。
