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Prosthesis-related infection. Etiology, prophylaxis and diagnosis (a review)
A B Wymenga1, B J Van Dijke, J R Van Horn
1Department of Orthopedics, St. Radboud Hospital, University of Nijmegen, The Netherlands.
Abstract:
The recent literature concerning prosthesis-related infection is reviewed with respect to etiology, prophylaxis and diagnosis. Most prosthesis-related infections are initiated during operation by contamination with bacteria-carrying particles from the air as a result of dispersion of skin scales from individuals in the operating room. A small number of infections are caused by hematogenous seeding of bacteria. Glycocalyx, a slime layer produced by bacteria, plays an important role in the pathogenesis of infections, especially in the presence of biomaterial. Clean-air systems in combination with perioperative systemic antibiotics reduce prosthesis-related infections from 3 or 4 per cent to a few per thousand. The use of antibiotic-loaded bone cement is advised in high risk patients although further evaluation is needed. Physical examination of the patient, laboratory tests such as the E.S.R. and C-reactive protein, serial radiograms, isotope scanning techniques and joint aspiration can all help diagnose prosthesis-related infection. However definitive diagnosis is possible only by culturing several samples of material obtained from the interface during revision operation. A perioperative frozen section of interface tissue showing acute (more than 5 leucocytes per field) or severe chronic (more than 50 lymphocytes) inflammation is highly suggestive of sepsis.
Insights
Prosthesis-related infections, often caused by airborne bacteria during surgery, can be prevented with clean-air systems and antibiotics. Definitive diagnosis requires culturing samples during revision surgery.
Area of Science:
- Orthopedics
- Infectious Diseases
- Biomaterials Science
Background:
- Prosthesis-related infections are a significant complication following orthopedic surgery.
- Bacterial contamination during surgery is the primary cause, with airborne particles and skin scales playing a key role.
- Bacterial glycocalyx (slime layer) contributes to pathogenesis, particularly on biomaterials.
Purpose of the Study:
- To review current literature on the etiology, prophylaxis, and diagnosis of prosthesis-related infections.
- To highlight key factors in infection development and prevention strategies.
- To discuss diagnostic methods, from initial screening to definitive confirmation.
Main Methods:
- Literature review of studies on prosthesis-related infections.
- Analysis of etiological factors, including surgical contamination and bacterial virulence factors.
- Evaluation of prophylactic measures such as environmental controls and antibiotic use.
- Assessment of diagnostic techniques, including clinical, laboratory, imaging, and microbiological methods.
Main Results:
- Prosthesis-related infections are mainly initiated by intraoperative bacterial contamination.
- Clean-air systems and perioperative antibiotics significantly reduce infection rates.
- Antibiotic-loaded bone cement shows promise for high-risk patients.
- Diagnosis involves a combination of physical examination, lab tests (ESR, CRP), imaging, and joint aspiration.
- Definitive diagnosis relies on intraoperative cultures and perioperative frozen section analysis.
Conclusions:
- Effective prophylaxis involves stringent operating room protocols and judicious antibiotic use.
- Early and accurate diagnosis is crucial for successful treatment outcomes.
- Intraoperative culturing and tissue analysis remain the gold standard for diagnosing prosthesis-related infections.