Avtor/Urednik		Trampuž, Andrej; Kavčič, Martina; Grmek-Košnik, Irena; Trebše, Rihard
Naslov		Comparison of culture of synovial fluid, periprosthetic tissue and prosthesis sonicate for the diagnosis of knee prosthesis infection
Prevedeni naslov		Primerjava kulture sinovialne tekočine, obproteznega tkiva in sonikata proteze v diagnostiki okužb kolenskih protez
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 72, št. 3
Leto izdaje		2003
Obseg		str. 117-25
Jezik		eng
Abstrakt		Background. Synovial fluid and periprosthetic tissue specimens are the standard specimens cultured for the diagnosis of prosthetic joint infection (PJI). We hypothesize that ultrasonication of the explanted prosthesis may improve diagnosis of PJI by dislodging biofilm bacteria from the prosthesis surface and improve the sensitivity and specificity of diagnosis of PJl. Methods. Included were patients undergoing knee prosthesis exchange for septic or biomechanical failure and have not received antimicrobial therapy in the last 2 weeks prior specimen collection. Cultures of synovial jluid and periprosthetic tissue specimens were performed per the usual clinical practice. Additionally, explanted joint components were sonicated for 5 minutes at frequency 40 kHz in sterile Ringer solution; aliquots of 0.5 ml sonicate were plated onto five aerobic and five anaerobic blood agar plates, and incubated at 37degrees C and examined for the next seven days. The numberand identity of each colony morphology was recorded. Results. 35 patients undergoing knee replacement have been studied (24 for aseptic biomechanical failure and 11 for suspected PJI). In patients with PJl, coagulase-negative staphylococci (7 cases), Corynebacterium spp. (2 cases), Staphylococcus aureus (1 case), and viridans group streptococcus (1 case) were recovered. Culture sensitivity and specificity were for synovial fluid 88% and 100%, for periprosthetic tissue 83% and 81%, and for explant sonicate 91 % and 100% respectively. In sonicate cultures higher numbers of microorganisms than in periprosthetic tissue cultures were consistently detected. (Abstract truncated at 2000 characters).
Izvleček		Izhodišča. Uvedba ortopedskih protez je revolucionalizirala medicino in izdatno izboljšala kakovost življenja mnogim osebam z boleznimi kosti in sklepov. Manj kot 10% bolnikov z vstavljeno protezo razvije po artroplastiki zaplete, ki zahtevajo ponovno operacijo. Aseptična biomehanska disfunkcija je najpogostejši razlog zapletov sledijo jim okužbe sklepnih protez (OSP). Kljub temu da OSP predstavljajo relativno redek zaplet, sta ekonomska posledica za družbo in neprijetnost za bolnika ogromni. Diagnostika OSP je zapletena in zdrav jenje dolgotrajno. Najpomembnejši razlog za težavno diagnostiko in pogosto neuspešno zdravljenje je dejstvo, da mnogi mikroorganizmi na umetnem materialu tvorijo biofilm, s katerim se zaščitijo pred zunanjimi vplivi, kot so na primer antibiotiki ali imunski odziv. Zato so različni avtorji poskušali izboljšati diagnostiko in zdravljenje OSP s postopki, ki delujejo proti razvoju biofilma ali ga razgradijo. Sinovialna tekočina in obprotezno tkivo predstavljata običajni vrsti vzorca za mikrobiološko preiskavo v diagnostiki OSP. Obe vrsti vzorca nista optimalni za ugotavljanje bakterij v obliki biofilma. Zato smo z raziskavo želeli preveriti hipotezo, ali je z ultrasonikacijo ortopedske proteze mogoče odstraniti na površini pritrjene bakterije v obliki biofilma in s tem izboljšati občutljivost in specifičnost diagnostike OSP. Metode. Vključeni so bili hospitalizirani bolniki na kliniki Mayo (Rochester, Minnesota, USA), pri katerih je bila zaradi septičnega ali biomehaničnega vzroka med julijem 2001 in julijem 2002 zamenjana kolenska proteza. (Izvleček prekinjen pri 2000 znakih).
Deskriptorji		KNEE PROSTHESIS KNEE JOINT SYNOVIAL FLUID EQUIPMENT CONTAMINATION BIOFILMS PROSTHESIS FAILURE INFECTION