Morgenstern Mario, Post Virginia, Erichsen Christoph, Hungerer Sven, Bühren Volker, Militz Matthias, Richards R Geoff, Moriarty T Fintan
Department of Trauma-Surgery, Trauma Centre Murnau, Prof. Kuentscher Strasse 8, 82418, Murnau, Germany.
AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland.
J Orthop Res. 2016 Nov;34(11):1905-1913. doi: 10.1002/jor.23218. Epub 2016 May 18.
The ability to form biofilm on the surface of implanted devices is often considered the most critical virulence factor possessed by Staphylococcus epidermidis in its role as an opportunistic pathogen in orthopaedic device-related infection (ODRI). Despite this recognition, there is a lack of clinical evidence linking outcome with biofilm forming ability for S. epidermidis ODRIs. We prospectively collected S. epidermidis isolates cultured from patients presenting with ODRI. Antibiotic resistance patterns and biofilm-forming ability was assessed. Patient information was collected and treatment outcome measures were determined after a mean follow-up period of 26 months. The primary outcome measure was cure at follow-up. Univariate logistic regression models were used to determine the influence of biofilm formation and antibiotic resistance on treatment outcome. A total of 124 patients were included in the study, a majority of whom (n = 90) involved infections of the lower extremity. A clear trend emerged in the lower extremity cohort whereby cure rates decreased as the biofilm-forming ability of the isolates increased (84% cure rate for infections caused by non-biofilm formers, 76% cure rate for weak biofilm-formers, and 60% cure rate for the most marked biofilm formers, p = 0.076). Antibiotic resistance did not influence treatment cure rate. Chronic immunosuppression was associated with a statistically significant decrease in cure rate (p = 0.044).
The trend of increasing biofilm-forming ability resulting in lower cure rates for S. epidermidis ODRI indicates biofilm-forming ability of infecting pathogens does influence treatment outcome of infections of the lower extremity. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1905-1913, 2016.
在植入装置表面形成生物膜的能力通常被认为是表皮葡萄球菌作为骨科装置相关感染（ODRI）中的机会致病菌所拥有的最关键的毒力因子。尽管有这种认识，但缺乏临床证据将表皮葡萄球菌ODRI的生物膜形成能力与治疗结果联系起来。我们前瞻性地收集了从患有ODRI的患者中培养出的表皮葡萄球菌分离株。评估了抗生素耐药模式和生物膜形成能力。收集了患者信息，并在平均随访26个月后确定了治疗结果指标。主要结果指标是随访时的治愈情况。使用单变量逻辑回归模型来确定生物膜形成和抗生素耐药性对治疗结果的影响。共有124名患者纳入研究，其中大多数（n = 90）涉及下肢感染。在下肢队列中出现了一个明显的趋势，即随着分离株生物膜形成能力的增加，治愈率下降（非生物膜形成菌引起的感染治愈率为84%，弱生物膜形成菌为76%，最显著生物膜形成菌为60%，p = 0.076）。抗生素耐药性不影响治疗治愈率。慢性免疫抑制与治愈率的统计学显著下降相关（p = 0.044）。
表皮葡萄球菌ODRI中生物膜形成能力增加导致治愈率降低的趋势表明，感染病原体的生物膜形成能力确实会影响下肢感染的治疗结果。© 2016骨科研究协会。由威利期刊公司出版。《矫形外科学研究》34:1905 - 1913，2016年。
