Stoodley Paul, Ehrlich Garth D, Sedghizadeh Parish P, Hall-Stoodley Luanne, Baratz Mark E, Altman Daniel T, Sotereanos Nicholas G, Costerton John William, Demeo Patrick
National Centre for Advanced Tribology, University of Southampton, Southampton, UK.
Curr Orthop Pract. 2011 Nov;22(6):558-563. doi: 10.1097/BCO.0b013e318230efcf.
A recent paradigm shift in microbiology affects orthopaedic surgery and most other medical and dental disciplines because more than 65% of bacterial infections treated by clinicians in the developed world are now known to be caused by organisms growing in biofilms. These slime-enclosed communities of bacteria are inherently resistant to host defenses and to conventional antibacterial therapy, and these device-related and other chronic bacterial infections are unaffected by the vaccines and antibiotics that have virtually eliminated acute infections caused by planktonic (floating) bacteria. We examine the lessons that can be learned, within this biofilm paradigm, by the study of problems (e.g. non-culturability) shared by all biofilm infections and by the study of new therapeutic options aimed specifically at sessile bacteria in biofilms. Orthopaedic surgery has deduced some of the therapeutic strategies based on assiduous attention to patient outcomes, but much can still be learned by attention to modern research in related disciplines in medicine and dentistry. These perceptions will lead to practical improvements in the detection, management, and treatment of infections in orthopaedic surgery.
微生物学领域最近的范式转变影响着骨科手术以及大多数其他医学和牙科学科，因为目前已知在发达国家，临床医生治疗的超过65%的细菌感染是由生物膜中生长的微生物引起的。这些被黏液包裹的细菌群落对宿主防御和传统抗菌疗法具有内在抗性，而且这些与器械相关的以及其他慢性细菌感染不受那些实际上已消除了由浮游（漂浮）细菌引起的急性感染的疫苗和抗生素的影响。我们探讨在这种生物膜范式下，通过研究所有生物膜感染共有的问题（如不可培养性）以及专门针对生物膜中固着细菌的新治疗选择能够学到的经验教训。骨科手术已基于对患者预后的密切关注推导出了一些治疗策略，但通过关注医学和牙科学相关学科的现代研究仍能学到很多东西。这些认识将切实改善骨科手术中感染的检测、管理和治疗。
