Ahmad Riaz, Tham Ji, Naqvi Syed Ghufran Ali, Butt Umer, Dixon John
Department of Orthopaedics, Weston General Hospital, Weston Super Mare, UK.
Ann R Coll Surg Engl. 2011 Mar;93(2):130-2. doi: 10.1308/003588411X12851639107755. Epub 2010 Nov 18.
Infection after joint arthroplasty is a disastrous complication. Implants used in hip arthroplasty increase the risk of infection from organisms of low pathogenicity. Potential reservoirs, that have not been assessed as yet, are the supports used for patient positioning in hip arthroplasty. The purpose of this study was to assess these supports for presence of bacterial pathogens.
We studied 40 supports used in 20 hip arthroplasty procedures. Tryptone soya agar plates were used to sample these supports. All agar plates were incubated at 37 °C for 48 h.
Of the 20 anterior supports, 17 (85%) showed bacterial colonisation; of the 20 posterior supports, 10 (50%) had bacterial colonisation. Fourteen (52%) supports were contaminated with one organism, 9 (33%) with two organisms, three (11%) with three organisms and one (4%) with four organisms. Coagulase-negative staphylococci were the most common isolated organisms (61%) followed by coryneforms (10%) and bacilli (10%). Anterior supports had two times more colony forming units compared to the posterior supports.
This study showed contamination of supports used for positioning patients during hip arthroplasty. It reflects poor cleaning practice and certainly raises the possibility that a high bacterial load on these supports may contribute to higher infection rates in hip arthroplasties. The study raises concerns related to contamination of supports, as there is a potential for cross-infection, wound problems, and deep sepsis around implants which could be disastrous. While colonisation does not equate with infection, we suggest thorough cleaning of the supports before and after every surgical procedure.
关节置换术后感染是一种灾难性并发症。髋关节置换术中使用的植入物会增加低致病性微生物引发感染的风险。在髋关节置换术中用于患者体位摆放的支撑物，作为潜在的感染源尚未得到评估。本研究旨在评估这些支撑物上细菌病原体的存在情况。
我们研究了用于20例髋关节置换手术的40个支撑物。用胰蛋白胨大豆琼脂平板对这些支撑物进行采样。所有琼脂平板在37℃下孵育48小时。
20个前侧支撑物中，17个（85%）显示有细菌定植；20个后侧支撑物中，10个（50%）有细菌定植。14个（52%）支撑物被一种微生物污染，9个（33%）被两种微生物污染，3个（11%）被三种微生物污染，1个（4%）被四种微生物污染。凝固酶阴性葡萄球菌是最常见的分离出的微生物（61%），其次是棒状杆菌（10%）和芽孢杆菌（10%）。前侧支撑物的菌落形成单位数量是后侧支撑物的两倍。
本研究表明髋关节置换术中用于患者体位摆放的支撑物存在污染。这反映了清洁操作不佳，并且确实增加了这些支撑物上高细菌载量可能导致髋关节置换术感染率升高的可能性。该研究引发了对支撑物污染的担忧，因为存在交叉感染、伤口问题以及植入物周围深部脓毒症的潜在风险，而这些可能是灾难性的。虽然定植并不等同于感染，但我们建议在每次手术前后对支撑物进行彻底清洁。
