Infections associated with percutaneous osseointegrated titanium implants for limb prostheses
Abstract
Femoral amputation is a devastating event. Percutaneous, bone anchored\nprosthetic systems reduce problems associated with socket suspended\nprostheses, but the design is inherently vulnerable to infection. The aims of\nthis thesis were to determine the risk of implant-associated infection, bacterial\nbiofilm properties and the functional impact using this implant treatment\nregime. Definition of implant related osteomyelitis was based on clinical\nsigns, radiography and positive tissue cultures. In 3-year prospective study 39\npatients were evaluated twice for infectious frequency, clinical presentation,\nand its relation to bacterial flora at the skin-implant interface (Paper 1). The\nfrequency of implant infection was 5% at inclusion and 18% at follow-up. The\nmost common bacteria in superficial, and deep cultures were Staphylococcus\naureus and coagulase-negative staphylococci. Despite frequent colonization\nby potentially virulent bacteria, limited disability, and only one implant\nremoval was found. Phenotypical and genotypical biofilm formation was\ndetermined in 13 (7 staphylococcal, 6 enterococcal) osteomyelitis strains\n(Paper II). Antimicrobial resistance was tested with a novel combination of\nthe Calgary biofilm MBEC device, and a custom-made susceptibility MIC\nplate. The majority of the strains produced biofilm with increased\nantimicrobial resistance, compared to their planktonic counterparts. Slime\nproducing strains tolerated higher antimicrobial…
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