Ricciardi Benjamin F, Muthukrishnan Gowrishankar, Masters Elysia, Ninomiya Mark, Lee Charles C, Schwarz Edward M
Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.
Curr Rev Musculoskelet Med. 2018 Sep;11(3):389-400. doi: 10.1007/s12178-018-9501-4.
The incidence of complications from prosthetic joint infection (PJI) is increasing, and treatment failure remains high. We review the current literature with a focus on Staphylococcus aureus pathogenesis and biofilm, as well as treatment challenges, and novel therapeutic strategies.
S. aureus biofilm creates a favorable environment that increases antibiotic resistance, impairs host immunity, and increases tolerance to nutritional deprivation. Secreted proteins from bacterial cells within the biofilm and the quorum-sensing agr system contribute to immune evasion. Additional immunoevasive properties of S. aureus include the formation of staphylococcal abscess communities (SACs) and canalicular invasion. Novel approaches to target biofilm and increase resistance to implant colonization include novel antibiotic therapy, immunotherapy, and local implant treatments. Challenges remain given the diverse mechanisms developed by S. aureus to alter the host immune responses. Further understanding of these processes should provide novel therapeutic mechanisms to enhance eradication after PJI.
人工关节感染（PJI）并发症的发生率正在上升，治疗失败率仍然很高。我们回顾当前文献，重点关注金黄色葡萄球菌的发病机制和生物膜，以及治疗挑战和新的治疗策略。
金黄色葡萄球菌生物膜创造了一个有利的环境，增加了抗生素耐药性，损害了宿主免疫力，并增加了对营养剥夺的耐受性。生物膜内细菌细胞分泌的蛋白质和群体感应agr系统有助于免疫逃避。金黄色葡萄球菌的其他免疫逃避特性包括形成葡萄球菌脓肿群落（SACs）和小管侵袭。针对生物膜并增加对植入物定植抵抗力的新方法包括新型抗生素治疗、免疫治疗和局部植入物治疗。鉴于金黄色葡萄球菌为改变宿主免疫反应而发展出的多种机制，挑战依然存在。对这些过程的进一步了解应能提供新的治疗机制，以提高PJI后的根除率。
