真菌性假体关节感染最有利的灌洗液是什么

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-09 DOI:10.1016/j.jcot.2025.103013

Maggie Manchester , James B. Doub

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引用次数: 0

摘要

真菌假体关节感染（PJI）正在增加，但我们对这些复杂感染的正确治疗知之甚少，特别是在临床上使用最有利的灌洗液方面。因此，本研究的目的是确定哪种常用的灌洗液在分散真菌生物膜方面最有利。方法用临床分离的9株假体关节真菌感染菌在24个微孔板上形成生物膜。然后灌注不同的灌洗液，测定生物膜残留量，并与生理盐水灌洗液进行比较。用扫描电镜直接观察真菌生物膜。结果各灌洗方案评价均显著(p <；与生理盐水相比，0.05)减少了真菌生物膜。然而，葡萄糖酸氯己定和次氯酸钠对真菌生物膜的分散作用比其他灌洗液明显（p小于0.05）。此外，扫描电镜显示，大多数念珠菌的真菌生物膜通常由菌丝和酵母形式组成。结论所有灌洗液均能减少念珠菌生物膜，但葡萄糖酸氯己定和次氯酸钠对念珠菌生物膜的破坏作用最大。然而，考虑到次氯酸钠潜在的组织毒性，在真菌PJI的临床治疗中，应优先使用氯己定作为灌洗液，以帮助降解残留硬件和组织上的生物膜。然而，需要进一步的研究来确定真菌生物膜降解的相关机制，以及评估防止PJI中念珠菌菌丝形成的新方法。

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What is the most advantageous lavage solution to use for fungal prosthetic joint infections

Background

Fungal prosthetic joint infections (PJI) are increasing yet we have a poor understanding on the proper treatment of these complex infections especially with respect to most advantageous lavage solutions to use clinically. Consequently, the objective of this study was to determine which commonly used lavage solutions are most advantageous at dispersing fungal biofilms.

Methods

Nine clinical isolates from past fungal prosthetic joint infections were used to form biofilms in 24 microwell plates. Then different lavage solutions were instilled, and residual biofilm were measured and compared to normal saline lavage solutions. Moreover, fungal biofilms were directly observed with scanning electron microscopy.

Results

All lavage solutions evaluated significantly (p < 0.05) reduced fungal biofilms compared to normal saline. However, chlorhexidine gluconate and sodium hypochlorite were able to disperse fungal biofilms significantly (p˂0.05) more than the other lavage solutions. As well, scanning electron microscopy showed fungal biofilms are typically composed of hyphae and yeast forms for most Candidal species.

Conclusion

All lavage solutions can reduce Candidal biofilms, but chlorhexidine gluconate and sodium hypochlorite were the most advantageous agents in disrupting Candidal biofilms. Yet given the potential tissue toxicity associated with sodium hypochlorite should prioritize the use of chlorohexidine as lavage solutions in the clinical treatment of fungal PJI to help degrade biofilms on retained hardware and tissues. However, further studies are needed to determine the mechanism associated with degradation of fungal biofilms as well as evaluating novel ways to prevent Candidal hyphae formation in PJI.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.