Kargupta Roli, Bok Sangho, Darr Charles M, Crist Brett D, Gangopadhyay Keshab, Gangopadhyay Shubhra, Sengupta Shramik
Department of Bioengineering, University of Missouri, Columbia, MO, USA.
Wiley Interdiscip Rev Nanomed Nanobiotechnol. 2014 Sep-Oct;6(5):475-95. doi: 10.1002/wnan.1273. Epub 2014 May 28.
Bacterial colonization and biofilm formation on an orthopedic implant surface is one of the worst possible outcomes of orthopedic intervention in terms of both patient prognosis and healthcare costs. Making the problem even more vexing is the fact that infections are often caused by events beyond the control of the operating surgeon and may manifest weeks to months after the initial surgery. Herein, we review the costs and consequences of implant infection as well as the methods of prevention and management. In particular, we focus on coatings and other forms of implant surface modification in a manner that imparts some antimicrobial benefit to the implant device. Such coatings can be classified generally based on their mode of action: surface adhesion prevention, bactericidal, antimicrobial-eluting, osseointegration promotion, and combinations of the above. Despite several advances in the efficacy of these antimicrobial methods, a remaining major challenge is ensuring retention of the antimicrobial activity over a period of months to years postoperation, an issue that has so far been inadequately addressed. Finally, we provide an overview of additional figures of merit that will determine whether a given antimicrobial surface modification warrants adoption for clinical use.
就患者预后和医疗成本而言，骨科植入物表面的细菌定植和生物膜形成是骨科干预最糟糕的结果之一。更令人烦恼的是，感染往往由手术医生无法控制的因素引起，且可能在初次手术后数周甚至数月才显现出来。在此，我们综述了植入物感染的成本和后果以及预防和管理方法。特别地，我们重点关注涂层和其他形式的植入物表面改性，这些改性方式能赋予植入器械一定的抗菌益处。此类涂层通常可根据其作用方式分类：防止表面粘附、杀菌、抗菌洗脱、促进骨整合以及上述方式的组合。尽管这些抗菌方法的功效取得了若干进展，但一个仍然存在的主要挑战是确保术后数月至数年期间抗菌活性的持续存在，这一问题迄今尚未得到充分解决。最后，我们概述了其他一些品质因数，这些因数将决定特定的抗菌表面改性是否值得在临床中采用。
