Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
Orthopaedic and Plastic Surgery Research Laboratory, University of Utah, DVA SLC HCS, Research 151, 500 Foothill Drive, Salt Lake City, Utah, 84148.
J Orthop Res. 2019 Dec;37(12):2645-2654. doi: 10.1002/jor.24421. Epub 2019 Aug 2.
Percutaneous osseointegrated (OI) prostheses (POPs) are used to skeletally attach artificial limbs in amputees. While any permanent percutaneous interface is at risk of becoming infected by the resident microbiota colonizing the stoma, most of these patients remain infection-free. Avoidance of infection likely depends upon a mechanically and/or biologically stable skin-to-implant interface. The ultimate question remains, "why do some stomata become infected while others do not?" The answer might be found in the dynamic bacterial communities of the patient and within the stomal site itself. This study is an appendix to the first Food and Drug Administration approved prospective early feasibility study of OI prosthetic docking, in which, 10 transfemoral amputees were implanted with a unique POP device. In this analytical, longitudinal cohort study, each patient's skin and stomal microbiota were analyzed from the initial surgery to 1 year following the second-stage surgery. During each follow-up visit, three swab samples-stomal, device thigh skin and contralateral thigh skin-were obtained. DNA was extracted, and bacterial 16S ribosomal RNA (rRNA) genes were amplified and sequenced to profile microbial communities. The stomal microbiota were distinct from the microbiota on the adjacent thigh skin and the skin of the contralateral thigh, with a significantly increased abundance of Staphylococcus aureus within the stoma. Early on stomal microbiota were characterized by high diversity and high relative abundance of obligate anaerobes. Over time, the stomal microbiota shifted and stabilized in communities of lower diversity dominated by Streptococcus, Corynebacterium, and/or Staphylococcus spp. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2645-2654, 2019.
经皮骨整合（OI）假体（POP）用于将假肢与截肢者的骨骼连接。虽然任何永久性的经皮界面都有被定植于造口的常驻微生物菌群感染的风险，但大多数患者仍然没有感染。避免感染可能取决于机械和/或生物稳定的皮肤与植入物界面。目前仍存在一个终极问题：“为什么有些造口会感染，而有些则不会？”答案可能在于患者的动态细菌群落和造口部位本身。本研究是经美国食品和药物管理局批准的首个 OI 假体对接前瞻性早期可行性研究的附录，其中 10 名股骨截肢者植入了一种独特的 POP 装置。在这项分析性、纵向队列研究中，从初次手术到二期手术后 1 年，对每位患者的皮肤和造口微生物群进行了分析。在每次随访中，均从造口、器械大腿皮肤和对侧大腿皮肤获取三个拭子样本。提取 DNA，扩增和测序细菌 16S 核糖体 RNA（rRNA）基因，以分析微生物群落。造口微生物群与相邻大腿皮肤和对侧大腿皮肤的微生物群不同，造口中金黄色葡萄球菌的丰度明显增加。早期造口微生物群的特征是多样性高，兼性厌氧菌的相对丰度高。随着时间的推移，以链球菌、棒状杆菌和/或葡萄球菌属为主的低多样性群落的造口微生物群发生了转变并稳定下来。©2019 骨科研究协会。由 Wiley Periodicals, Inc. 出版。J Orthop Res 37:2645-2654, 2019.
