Laboratory methods for diagnostic infections total prosthesis articulations

Prosthesis articulations and their infectious complications are currently a much discussed problem among orthopaedists and microbiologists. The most operations are performed especially at hip and knee joints. The main reason for their most frequent damage is secondly the fact that endoprostheses of these joints have a good possibility of fixing of plastic materials into the bone and a long lifetime. Endoprostheses are used also in joints of shoulders, elbows etc. Despite of all aseptic procedures infection development sometimes appears. This complication is the most common cause of endoprostheses damage and it is often the reason for re-operation. The development of infection depends on interactions between a micro-organism, prosthesis articulations and a host. Bacterial agents causing infections of prosthesis articulations include gram-positive cocci, especially Staphylococcus aureus and Staphylococcus epidermidis, sometimes even streptococci. Further they could be gram-negative bars, especially Escherichia coli, Proteus species, Pseudomonas aeruginosa, Enterobacter species a Serratia marcescens etc. In mixed infections there can also appear anaerobic bacteria, especially Propionibacterium acnes and anaerobic streptococci. Most of bacterial agents are a part of so called bio film, which is important for bacteria and their survival. Bacteria in bio film acquire matrix protection against the effect of antibodies and phagocytes and also against the effects of antibiotics. Implementation of new laboratory procedures and methods, when among others ultrasound is used to destroy bio film, and making further cultivation and identification of infectious agents easier proved as a contribution. It leads to significantly higher capture of etiological agents of infectious complications of prosthesis articulations and this way it contributes to better securing of re-implantations. Procedures and methods presented in this thesis can be used in other modifications at examination of other inorganic materials and implantations and at examination of tissues taken out of patient ´s body at various infectious complications. Presented thesis compares laboratory procedures and methods used so far at OLM (Department of Medical Microbiology) in Nemocnice Jindřichův Hradec, a.s. (Hospital in Jindřichův Hradec, Ltd.) with laboratory procedures newly implemented for this purpose to examine infections of prosthesis articulations in cooperation with the author of presented thesis in spring months of 2008