Ertan Mehmet Batu, Ayduğan Mehmet Yağız, Evren Ebru, İnanç İrem, Erdemli Esra, Erdemli Bülent
Department of Orthopedics and Traumatology, Atılım Unıversity School of Medicine, Ankara, Turkey.
Department of Orthopedics and Traumatology, Ministry of Health Haymana State Hospital, Ankara, Turkey.
Int Microbiol. 2025 Jan 16. doi: 10.1007/s10123-024-00629-0.
The most frequently used surgical procedures for periprosthetic joint infections (PJIs) are debridement, antibiotics, and implant retention (DAIR), as well as single- or two-stage revision arthroplasty. The choice of surgery is made depending on the full maturation of the biofilm layer. The purpose of this study was to evaluate the biofilm formation and microbial growth using common PJI-causing agents and compare its development on the implant surface.
The in vivo study was performed using 40 Sprague-Dawley rats divided into five groups (n = 8/group): Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Candida albicans, and control. Six standard titanium alloy discs were placed into the subcutaneous air pouches of the interscapular areas of the rats. After the inoculation of microorganisms, disc and soft tissue cultures were collected at 2-week intervals for 6 weeks, and the microbial load and the microscopic appearance of the biofilm were compared.
The disc samples from the S. aureus group had the highest infection load at all time points; however, in soft tissue samples, this was only observed at week 4 and 6. Electron microscopic images showed no distinctive differences in the biofilm structures between the groups.
S. aureus microbial burden was significantly higher in implant cultures at week 2 compared to other PJI-causing agents examined. These results may explain the higher failure rate seen if the DAIR procedure was performed at < 3-4 weeks after the PJI symptom onset and support the observation that DAIR may not be effective against PJIs caused by S. aureus.
用于治疗人工关节周围感染（PJI）最常用的外科手术方法是清创、使用抗生素和保留植入物（DAIR），以及一期或二期翻修关节成形术。手术方式的选择取决于生物膜层是否完全成熟。本研究的目的是使用常见的引起PJI的病原体评估生物膜的形成和微生物生长情况，并比较其在植入物表面的发展情况。
体内研究使用40只Sprague-Dawley大鼠，分为五组（每组n = 8）：金黄色葡萄球菌组、表皮葡萄球菌组、铜绿假单胞菌组、白色念珠菌组和对照组。将六个标准钛合金圆盘放入大鼠肩胛间区域的皮下气袋中。接种微生物后，每隔2周收集圆盘和软组织培养物，共收集6周，比较微生物负荷和生物膜的微观外观。
金黄色葡萄球菌组的圆盘样本在所有时间点的感染负荷最高；然而，在软组织样本中，仅在第4周和第6周观察到这种情况。电子显微镜图像显示各组之间生物膜结构没有明显差异。
与其他所检测的引起PJI的病原体相比，在第2周时，金黄色葡萄球菌在植入物培养物中的微生物负荷显著更高。这些结果可能解释了如果在PJI症状出现后<3 - 4周进行DAIR手术时观察到的较高失败率，并支持DAIR可能对由金黄色葡萄球菌引起的PJI无效的观点。
