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低骨量和抗吸收治疗对骨科器械相关感染大鼠模型中抗生素疗效的影响。

Impact of low bone mass and antiresorptive therapy on antibiotic efficacy in a rat model of orthopedic device-related infection.

机构信息

AO Research Institute Davos, Davos, Switzerland.

Department of Teaching, Research and Development, Schulthess Clinic, Zürich, Switzerland.

出版信息

J Orthop Res. 2021 Feb;39(2):415-425. doi: 10.1002/jor.24951. Epub 2020 Dec 23.

Abstract

A significant proportion of orthopedic devices are implanted in osteoporotic patients, but it is currently unclear how estrogen deficiency and/or exposure to antiresorptive bisphosphonates (BPs) influence orthopedic device-related infection (ODRI), or response to therapy. The aim of this study is to characterize the bone changes resulting from Staphylococcus epidermidis infection in a rodent ODRI model and to determine if ovariectomy (OVX) or BP treatment influences the infection or the success of antibiotic therapy. A sterile or S. epidermidis-contaminated screw was implanted into the proximal tibia of skeletally mature female Wistar rats (n = 6-9 per group). Bone changes were monitored over 28 days using in vivo micro-computed tomography scanning. OVX was performed 12 weeks before screw implantation. The BP zoledronic acid (ZOL) was administered 4 days before screw insertion. A combination antibiotic regimen (rifampin plus cefazolin) was administered from Days 7-21. In skeletally healthy animals, S. epidermidis induced marked changes in bone, with peak osteolysis occurring at Day 9 and woven bone deposition and periosteal mineralization from Day 14 onwards. Antibiotic therapy cleared the infection in the majority of animals (2/9 infected) but did not affect bone responses. OVX did not affect the pattern of infection-induced changes in bone, nor bacterial load, but reduced antibiotic efficacy (5/9 infected). ZOL treatment did not protect from osteolysis in OVX animals, or further affect antibiotic efficacy (5/9 infected) but did significantly increase the bacterial load. This study suggests that both BPs and OVX can influence host responses to bone infections involving S. epidermidis.

摘要

相当比例的骨科植入物是为骨质疏松症患者植入的,但目前尚不清楚雌激素缺乏和/或使用抗吸收双膦酸盐 (BPs) 如何影响骨科植入物相关感染 (ODRI) 或对治疗的反应。本研究的目的是描述表皮葡萄球菌感染在啮齿动物 ODRI 模型中引起的骨变化,并确定卵巢切除术 (OVX) 或 BP 治疗是否会影响感染或抗生素治疗的成功率。将无菌或表皮葡萄球菌污染的螺钉植入成熟雌性 Wistar 大鼠的胫骨近端(每组 6-9 只)。使用体内微计算机断层扫描在 28 天内监测骨变化。在螺钉植入前 12 周进行 OVX。在插入螺钉前 4 天给予 BP 唑来膦酸 (ZOL)。从第 7-21 天给予联合抗生素方案(利福平加头孢唑林)。在骨骼健康的动物中,表皮葡萄球菌引起了明显的骨变化,在第 9 天达到峰值溶骨,第 14 天开始出现编织骨沉积和骨膜矿化。抗生素治疗清除了大多数动物(2/9 感染)的感染,但并未影响骨反应。OVX 并未影响感染引起的骨变化模式或细菌负荷,但降低了抗生素的疗效(5/9 感染)。ZOL 治疗不能防止 OVX 动物的骨溶解,也不能进一步影响抗生素的疗效(5/9 感染),但显著增加了细菌负荷。这项研究表明,BPs 和 OVX 都可以影响宿主对涉及表皮葡萄球菌的骨感染的反应。

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