Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy.
Future Microbiol. 2011 Nov;6(11):1329-49. doi: 10.2217/fmb.11.117.
Infection is still the major complication of orthopedic implants and projections based on the actual trend indicate that total hip and knee arthroplasties and their consequent infection burden are destined to greatly increase. Staphylococcus aureus and Staphylococcus epidermidis are the leading etiologic agents of orthopedic implant infection. Here we report on epidemiology of implant-related Staphylococcus infections in orthopedics, also referring to our experience, and focus on the crucial role of bacterial adhesins and on their ability to direct the pathogenesis process. Bacteria initiate implant infection by adhering to biomaterials. In the early steps of infection, adhesins mediate the specific interaction between microbial cells and the extracellular matrix proteins filming biomaterial surface. Then adhesin-mediated anchorage allows bacteria to cling to the biomaterial surface and to produce a biofilm that favors their ability to resist antibiotics. With the aim to prevent implant-related infections, anti-infective and infection-resistant biomaterials are being developed. The research for novel therapeutic strategies is incited by the emergence of antibiotic-resistant bacteria. Vaccines against the adhesins or antisense molecules against virulence genes can open a future in combating implant infections.
感染仍然是骨科植入物和突出物的主要并发症，根据实际趋势表明，全髋关节和膝关节置换术及其随之而来的感染负担注定会大大增加。金黄色葡萄球菌和表皮葡萄球菌是骨科植入物感染的主要病原体。我们在此报告骨科植入物相关金黄色葡萄球菌感染的流行病学情况，同时也提到我们的经验，并重点介绍细菌黏附素的关键作用及其指导发病机制的能力。细菌通过黏附生物材料引发植入物感染。在感染的早期阶段，黏附素介导微生物细胞与覆盖生物材料表面的细胞外基质蛋白之间的特定相互作用。然后，黏附素介导的固定使细菌能够黏附在生物材料表面，并形成有利于其抵抗抗生素能力的生物膜。为了预防与植入物相关的感染，正在开发抗感染和抗感染的生物材料。抗生素耐药菌的出现激发了对新型治疗策略的研究。针对黏附素的疫苗或针对毒力基因的反义分子可以为对抗植入物感染开辟未来。
