Gallo Jiri, Nieslanikova Eva
Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, I. P. Pavlova 6, 77900 Olomouc, Czech Republic.
J Clin Med. 2020 Jul 11;9(7):2190. doi: 10.3390/jcm9072190.
A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing "bacterial load" perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single "clinical pack", applied rigorously in all settings involving prosthetic joint implantation. In addition, "anti-infective" implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.
预计全关节置换术使用量的增加自然会导致假体关节感染（PJI）数量相应增加。抑制植入物周围局部免疫反应会阻碍根除细菌的努力，促使生物膜形成，并损害手术室采取的预防措施。基于这些原因，PJI的预防应同时关注以下目标：（i）识别高危患者；（ii）在围手术期减少“细菌负荷”；（iii）在手术部位营造抗菌/抗生物膜环境；（iv）刺激局部免疫反应。尽管近期在实验和临床研究方面取得了相当大的进展，但在提议的预防策略和临床实施的预防策略之间仍存在很大差异。最终的抗感染策略在于将所有预防方法优化组合成一个单一的“临床套餐”，并在所有涉及假体关节植入的情况下严格应用。此外，对于PJI风险增加的患者，“抗感染”植入物可能是一种选择。然而，如果不紧密结合使用质量改进工具与持续的数据挖掘，反映特定临床环境中预防策略的效果，就无法想象在预防PJI方面会取得进一步进展。
