Pathogenesis of Prosthesis-Related Infection

Abstract

In spite of its incidence decreasing to 1% nowadays, prosthesis-related infection remains a research, diagnostic, therapeutic and cost-related problem. It can be defined as a presence of bacteria in the artificial joint space, which is significantly associated with evident laboratory and/or tissue markers, and clinical signs of running infection. We believe that the more precise understanding of pathogenesis, the more effective preventative and therapeutic measures, and the lower infection rate. The implants are colonized by airborne, skin-, and/ or surgeon-related bacteria during surgery despite being operated in closely respected operating regime. Some prosthetic characteristics are advantageous and may play important roles in the process of bacterial adherence. After successful attachment on the biomaterial surface bacteria multiply and physiologically transform into a "biofilm" community, making them much more resistant to antibiotic therapy and host immunity. Bacterial resistance is a complex phenomenon influenced by intrinsic and extrinsic factors, including the cell configuration in the biofilm community. So the cure of periprosthetic sepsis without removing of all foreign bodies and necrotic bone fragments is often ineffective. Acute hematogenous sepsis is suggestive of a distortion of a previously aseptic joint space by invasion of bacteria through the vessels.operative cultures in the group of 29 preoperatively "aseptic" cases. 57

Inflammatory response in 85 patients with loosened hip prostheses: A prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening

“…However, that level may be an underestimation, because it has been shown that detection of polymicrobial growth increases from up to 20% by conventional culture methods to 63% by extensive microbiological culture from an explanted prosthesis (Neut et al 2003, Lentino 2004. As proposed by Gallo et al (2003), a symbiotic relationship between several bacterial species may be advantageous for the development of biofilms. A surgical site infection after primary or revision hip replacement is a risk factor for development of a deep prosthesis infection (Wymenga et al 1992), which is supported by our data.…”

“…It is not known how long an occult bacterial infection on the surface of a prosthesis can last without provoking a host response, although a period of several years seems possible (Nguyen et al 2002, Tunney et al 1998, during which the process of periprosthetic osteolysis might maintain immunoincompetence-and also facilitate expansion of biofilm growth (Gallo et al 2003).…”

“…The complexity of diagnosing and treating these infections has made it difficult to achieve standardized management strategies (Zimmerli et al 2004). Microbial colonization of the joint space is affected by several factors such as characteristics of the prosthetic surface, occurrence of devitalized tissue, nonimmune and immune host factors, the bacterial inocula, and genetic characteristics of the species (Gallo et al 2003). Prosthetic joint infections are associated with biofilms (Gristina 1987(Gristina , 2004 in which bacteria are protected from both antimicrobial agents and the host response (Trampuz et al 2003, Patel 2005.…”

Skin and bone integrated prosthetic pylon: A pilot animal study

“…Implants may be colonized by airborne, skin, and/or surgeon-related bacteria during surgery despite use of closely monitored surgical techniques. After successful attachment on the biomaterial surface, bacteria multiply and form a "biofilm" community, which makes them much more resistant to antibiotic therapy and host immunity [5].…”

Universal Primers for Detection of Common Bacterial Pathogens Causing Prosthetic Joint Infection

“…On the other hand, the indolent and shifty nature of late occurring infections is more typical of less virulent bacteria such as coagulase-negative staphylococci. 3 Various algorithms have been proposed to improve joint sepsis diagnostics, including clinical, serological, microbiological, and imaging techniques. 4 It has been suggested that one useful method for lowgrade prosthetic sepsis bacteria identification should be sensitive and specific enough to allow early and adequate therapy.…”