Williams Rhodri L, Ayre Wayne N, Khan Wasim S, Mehta Amisha, Morgan-Jones Rhidian
Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, United Kingdom.
J Arthroplasty. 2017 Mar;32(3):953-957. doi: 10.1016/j.arth.2016.09.010. Epub 2016 Sep 28.
Thorough debridement is mandatory in revision for infected total knee arthroplasties (TKA). We investigated a novel adjuvant chemical debridement strategy using acetic acid (AA) that seeks to create a hostile environment for microorganisms. We report the first orthopedic in vivo series using an AA soak in infected TKAs. We also investigated the in vitro efficacy of AA against bacteria isolated from these knees.
Twenty-three patients with infected TKA were treated with a standard debridement protocol and chemical debridement with a 20-minute AA soak. In parallel, bacteria from infected TKAs were cultured for in vitro susceptibility testing with AA solutions of different concentrations to understand its potential mechanism of action.
Intraoperatively, there were no physiological responses during the AA soak or on release of the tourniquet. Postoperatively, there was no increase in analgesic requirements or wound or soft-tissue complications. Clinical follow-up continued for 24 months to monitor recurrent infection. In vitro, zones of inhibition were formed on less than 40% of the organisms, demonstrating that AA was not directly bactericidal against the majority of the isolates. However, when cultured in a bacterial suspension, AA completely inhibited the growth of the isolates at concentrations as low as 0.19% vol/vol.
This study has shown that the use of 3% AA soak, as part of a debridement protocol is safe in patients. While the exact mechanism of action is yet to be determined, AA concentrations as low as 0.19% vol/vol in vitro are sufficient to completely inhibit bacterial growth.
对于感染性全膝关节置换术（TKA）的翻修手术，彻底清创是必不可少的。我们研究了一种使用乙酸（AA）的新型辅助化学清创策略，旨在为微生物创造一个不利的环境。我们报告了首个在感染性TKA中使用AA浸泡的骨科体内系列研究。我们还研究了AA对从这些膝关节分离出的细菌的体外疗效。
23例感染性TKA患者接受了标准清创方案和用AA浸泡20分钟的化学清创治疗。同时，对感染性TKA的细菌进行培养，用不同浓度的AA溶液进行体外药敏试验，以了解其潜在作用机制。
术中，在AA浸泡期间或松开止血带时没有生理反应。术后，镇痛需求、伤口或软组织并发症均未增加。临床随访持续24个月以监测复发性感染。在体外，不到40%的微生物形成了抑菌圈，表明AA对大多数分离株没有直接杀菌作用。然而，当在细菌悬液中培养时，AA在低至0.19%体积/体积的浓度下就能完全抑制分离株的生长。
本研究表明，作为清创方案的一部分，使用3%的AA浸泡对患者是安全的。虽然确切的作用机制尚待确定，但体外低至0.19%体积/体积的AA浓度足以完全抑制细菌生长。
