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Zabieg operacyjny wszczepienia endoprotezy uwalnia pacjenta od bólu przywracając możliwość normalnego lub prawie normalnego funkcjonowania stawu biodrowego. Istotnym ograniczeniem jest żywotność protezy, która zależy nie tylko od rodzaju materiału i typu implantu, ale także od zabiegu operacyjnego w tym techniki operacyjnej oraz stanu zdrowia pacjenta. Konsekwencją naturalnego zużycia materiałów protezy lub infekcji w jej obrębie może być całkowite obluzowanie, które przebiega na drodze aseptycznej lub septycznej co wymaga przeprowadzenia operacji rewizyjnej. Na podstawie wiedzy o procesach toczących się w obrębie sztucznego stawu biodrowego, w tym znajomości markerów zapalnych mikrobiolodzy we współpracy z klinicystami mają możliwość zróżnicowania typu obluzowania i wdrożenia działań leczniczych, tak aby uchronić pacjenta przed wszelkimi niedogodnościami utrudniającymi normalne funkcjonowanie.
Loosening of the hip joint prosthesis is considered as one of the most significant postoperative complications in recent years. The laboratory diagnostic procedure used to differentiate periprosthetic infection from aseptic loosening is very difficult because of the biofilm which microorganisms form on the implant surface. The purpose of this research was to evaluate the level of concordance between clinical classification of implant loosening among 50 patients subjected to reimplantation procedure and laboratory investigation of PJI including microbiological culture results and the levels of inflammatory markers assessed in the patients’ synovial fluid samples, serum, and full blood. The synovial fluid was collected for leukocyte count, differential cell count, and culture on standard media. The levels of systemic inflammation markers such as the ESR and CRP concentration were determined in serum and full blood. Tissue samples were collected for microbiological studies. Components from endoprostheses were exposed to ultrasound in a process called sonication. Among the parameters measured in serum and full blood the levels of ESR and CRP were higher in the septic group of patients. Cytologic analysis of synovial fluid was in correlation with microbiologic identification. The most frequent isolated bacteria was Staphylococcus epidermidis. Culture results from materials such as synovial fluid, sonicate and tissues are crucial to establish the infectious aetiology of the loosening. Microscopic analysis of synovial fluid represents a simple, rapid and accurate method for differentiating PJI from aseptic failure. Sonication increases detection of the infectious process, and culture results are in correlation with the cytologic analysis of synovial fluid.
Background. Coagulase negative staphylococci are at the forefront of etiologic agents of periprosthetic joint infections (PJIs). The purpose of the study was to characterise causative isolates (n=19) of Staphylococcus epidermidis (SE) – with emphasis on their phenotypic and genotypic heterogeneity. Material and methods. The isolates were cultured from multiple samples obtained perioperatively during revision surgery from 14 patients with clinically and/or microbiologically proven PJI. Phenotypic heterogeneity included variations of colony morphologies, drug resistance patterns and/or the capability of the biofilm formation and was verified by the DNA fingerprinting assay. Results. Phenotypic discrepancies were observed between isolates cultured from 5 patients (35.7%). The genotyping assay identified 3 pairs of isolates as unrelated; single pairs were genetically related and indistinguishable. The biofilm production was detected in 17 isolates, among which 5 (29.4%) were proficient biofilm formers harbouring the icaADBC genes. Additionally, one ica-positive isolate produced a moderate, protease-sensitive biofilm. The remaining isolates were moderate biofilm producers among which four developed protease-sensitive biofilms. Conclusions. The majority of PJIs are monoclonal; nevertheless, phenotypic diversity of SE is a frequent phenomenon which can complicate the diagnostic proceeding. Adherence ability is an important pathogenic trait of SE although the chemical composition of the resultant biofilm, its intensity and regulation of development can vary.
The purpose of the study was to evaluate the usefulness of sonication for the diagnosis of prosthetic joint infections (PJIs) by its comparison with periprosthetic tissues (PTs) and synovial fluid (SV-F) cultures. The study groups included 54 patients undergoing exchange of total hip prostheses for so called “aseptic” loosening occurring without clinical manifestations of an accompanying PJI and 22 patients who developed a sinus tract communicating with the prosthesis which was indicative of an ongoing infectious process. Significant positive culture results were obtained among 10 (18.5%) patients with “aseptic” implant failure and in 18 (81.8%) patients who developed a sinus tract. Sonicate-fluid (S-F) yielded bacterial growth in all culture-positive patients with “aseptic” loosening vs. 15 patients with presumed PJIs. There was a concordance in terms of bacterial species isolated from S-F and conventional cultures from individual patients. Coagulase-negative staphylococci were isolated most frequently. Sensitivity of sonication (75%) exceeded that estimated for PTs (69%) and SV-F (45%) cultures. We conclude that identification of causative agents of PJIs which is critical to further therapeutic decisions is aided by the combination of sonication and conventional culture.
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