Department of Medicine (Irwin and Dr. Cornish), Department of Surgery (Dr. Wagner Mackenzie), and Department of Molecular Medicine and Pathology (Dr. Matthews and Dr. Swift), The University of Auckland, Auckland, New Zealand; (Dr. Williams); Department of Orthopaedics, University of Utah, Salt Lake City, UT (Dr. Williams), Department of Pathology (Dr. Williams), Department of Bioengineering (Dr. Williams), University of Utah, Salt Lake City, UT; and Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD (Dr. Williams).
J Am Acad Orthop Surg Glob Res Rev. 2021 Nov 4;5(11):e20.00217. doi: 10.5435/JAAOSGlobal-D-20-00217.
Prosthetics increase the risk of deep surgical site infections in procedures intended to restore function. In orthopaedics, prosthetic joint infections can lead to repetitive surgeries, amputation, or worse. Biofilm formation both in vitro and in vivo involves stages of attachment, accumulation, and maturation. The level of maturation affects susceptibility to antibiotics, the immune system, and the success of surgical interventions. A review of the literature indicates that orthopedic publications are less likely to mention biofilm. We have reviewed animal models of infection to assess in vivo models of prosthetic infection. Although most prosthetic infections seem to originate from local skin microbiota, clinically representative biofilm inocula are unusual. Biofilm-related end points are more widely adopted, but studies rarely include both quantification of adherent microbial burden and imaging of the in vivo biofilm. Failure to differentiate between planktonic and biofilm infections can skew research away from needed chronic disease models. In this review, we address prosthetic joint infections as an important model for chronic biofilm infection research, identify critical requirements for in vivo models of chronic infection, and propose that resistance to the terminology of biofilm research exists within both research and regulation, which could limit progress toward important orthopaedic targets.
义肢会增加旨在恢复功能的手术中深部手术部位感染的风险。在矫形外科，人工关节感染可导致反复手术、截肢或更糟的情况。生物膜的形成无论是在体外还是体内，都涉及附着、积累和成熟阶段。成熟度会影响对抗生素、免疫系统和手术干预的成功率的敏感性。对文献的回顾表明，矫形外科出版物不太可能提及生物膜。我们回顾了感染的动物模型，以评估人工感染的体内模型。尽管大多数人工感染似乎起源于局部皮肤微生物群，但临床上代表性的生物膜接种物并不常见。与生物膜相关的终点被更广泛地采用，但研究很少包括粘附微生物负荷的定量和体内生物膜的成像。未能区分浮游和生物膜感染会使研究偏离需要的慢性疾病模型。在这篇综述中，我们将人工关节感染作为慢性生物膜感染研究的重要模型，确定了慢性感染体内模型的关键要求，并提出了在研究和监管中都存在对生物膜研究术语的抵制，这可能会限制在重要的矫形学目标方面取得进展。
