Biofilm theory can guide the treatment of device-related orthopaedic infections
Biofilm theory can guide the treatment of device-related orthopaedic infections
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DOI：
10.1097/01.blo.0000175128.44966.d9
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发表时间：
2005-08-01
影响因子：
4.2
通讯作者：
Costerton, JW
中科院分区：
文献类型：
--
作者：
Costerton, JW
直接观察失败的骨科假体表面和受骨髓炎影响的骨（有或没有假体），表明引起这些感染的细菌生活在发育良好的生物膜中。这些基质封闭的表面相关群落中的细胞受到宿主防御和抗生素的保护，临床经验表明，在感染得到解决之前，必须将它们物理去除。这些疾病的生物膜病因学需要新的诊断方法，因为当通过刮擦或擦拭回收时，生物膜细胞通常不在琼脂平板上生长。我将推荐新的分子和免疫学诊断方法，这些方法在其他生物膜感染中很有用。这些疾病通过与急性加重交替的静止期进展，临床医生必须认识到抗生素治疗可以控制急性期，但不能解决感染的基本生物膜病灶。现在人们已经意识到这些骨科感染是由相对常见的生物膜形成细菌病原体引起的，需要检查局部和“按需”提供非常高浓度抗生素的新技术以及阻断控制生物膜形成的信号的新型分子“模拟物”。
Direct observations of the surfaces of orthopaedic prostheses that have failed and of bone affected by osteomyelitis with and without the presence of a prosthesis have shown that the bacteria that cause these infections live in well-developed biofilms. The cells within these matrix-enclosed surface-associated communities are protected from host defenses and antibiotics, and clinical experience has shown that they must be removed physically before the infection can be resolved. The biofilm etiology of these diseases demands new diagnostic methods because biofilm cells typically do not grow on agar plates when recovered by scraping or swabbing. I will recommend new molecular and immunologic diagnostic methods that have been useful in other biofilm infections. These diseases progress through quiescent periods that alternate with acute exacerbations, and clinicians must realize that antibiotic therapy can control the acute phases but cannot resolve the basic biofilm nidus of the infection. Now that it has been realized that these orthopaedic infections are caused by relatively common biofilm-forming bacterial pathogens, new technologies that deliver very high concentrations of antibiotics locally and "on demand" and novel molecular "mimics" that block the signals that control biofilm formation need to be examined.