Prosthesis-related infection. Etiology, prophylaxis and diagnosis (a review).

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.

• Authors: A B Wymenga, B J Van Dijke, J R Van Horn, T J Slooff
• Journal: Acta orthopaedica Belgica (Acta Orthop Belg) Vol. 56 Issue 2 Pg. 463-75 ( 1990) ISSN: 0001-6462 [Print] Belgium
• PMID: 2122632 (Publication Type: Journal Article, Review)

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (administration & dosage)
• Environment, Controlled
• Humans
• Infection Control
• Infections (etiology, microbiology)
• Joint Prosthesis
• Operating Rooms
• Postoperative Complications (etiology)