周围假肢关节感染研究中的新兴概念:感染复发和微生物持久性
Nathanael D Heckmann1, McKenzie W Culler1, Liana M Atallah2
1Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
The Journal of arthroplasty
|October 17, 2025
概括
复发性周围假肢关节感染 (PJI) 可能源于微生物转化为休眠形式或从肠道转移. 这些机制解释了持久性感染,并建议专注于恒常控制而不是根除.
科学领域:
- 整形外科 整形外科 整形外科
- 传染性疾病 传染性疾病
- 微生物学 微生物学
背景情况:
- 周围假肢关节感染 (PJI) 是关节置换手术的严重并发症.
- 经常由同一个生物体引起的复发性PJI会带来重大治疗挑战.
- 传统的解释包括治疗耐药性,污染,血源性传播和生物膜.
研究的目的:
- 探索导致经常性PJI的新机制.
- 调查微生物表型变化和微生物群失生症在PJI复发中的作用.
- 挑战彻底消灭感染的模式,以支持恒温控制.
主要方法:
- 对微生物持久性的临床前和临床证据的审查.
- 对细菌细胞内生存和骨细胞透研究的分析.
- 检查将微生物组失调与细菌转移和关节感染联系在一起的研究.
主要成果:
- 葡萄球菌种类可以形成小殖民地变体 (SCVs),这些变体在细胞内持续存在,导致经常性PJI.
- 微生物可以入侵宿主细胞和骨细胞缺口-管网络,形成水库.
- 肠道微生物组失调可能会驱动细菌转移,导致PJI.
- 关节微生物群的特征与PJI的存在有关.
结论:
- 细胞内持久性,微生物储库和微生物组失调提供了对复发性PJI的令人信服的解释.
- 当复发不符合经典模型时,这些机制特别重要.
- 对PJI的治疗策略可能需要转向实现恒温控制,以防止复发.
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