Year 2017 Vol. 25 No 6

TRAUMATOLOGY & ORTHOPEDICS

Z.S. NAUMENKO, M.V. CHEPELEVA, N.V. GODOVYKH

CYTOKINES AND MICROBIOCENOSIS IN PREDICTING THE POSTOPERATIVE PERIOD COURSE IN PATIENTS WITH PERIPROSTHETIC INFECTION OF THE HIP JOINT AFTER REMOVAL OF THE INFECTED IMPLANT

FSBE Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics of the RF, Ministry of Health, Kurgan,
The Russian Federation

Objective. To study microbiocenosis and the dynamics of the main cytokines in order to predict the postoperative period course after the hip joint implant removing in patients with the periprosthetic infection.
Methods. All the patients underwent debridement of the hip joint with the infected implant removal. The patients were retrospectively divided into two groups: group I included 29 patients with uncomplicated postoperative period course, group II 20 patients with the infection recurrence in the immediate postoperative period due to hematoma infection in the residual cavity of the femoral medullary canal after the removal of the implant stem. Study of the concentrations of IL-1β, IL-6, IL-10, IL-8, TNF&alfa;, IFNγ was carried out by the enzyme-linked immunosorbent method before the surgery, on the 3, 7, 21, 30 days after surgery. Microbiocenosis was analyzed before the surgery, intraoperatively and postoperatively.
Results. It was found out, that the pathogens represented by monocultures (mainly Staphylococcus aureus, S. epidermidis) prevailed in Group I patients, and mixed infections prevailed in Group II patients. Microbiocenosis of Group II patients was characterized by the increase in the proportion of Gram-negative bacterii (Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanii) postoperatively.
Dynamically, there was a tendency for Group I cytokines to decrease, and for those in Group II to increase. In Group I statistically significant differences were observed 30 days after surgery, comparing with the preoperative period, for IL-1β, IL-8, IL-10 the concentrations of which decreased. In Group II, IL-1β, IL-6, IL-10 significantly increased at this time. In Group I the complex dynamics of serum cytokines evidenced in favor of infection process stopping, in Group II in favor of pyoinflammatory complications.
Conclusions. The changes in microbiocenosis structure as well as the comprehensive investigation of cytokine concentrations can be used as additional predictive criteria of infection recurrences in patients with periprosthetic infection after the hip joint implant removal.

Keywords: the hip joint, arthroplasty, periprosthetic infection, Staphylococcus aureus, cytokines, microbiocenosis, recurrence
p. 605-612 of the original issue
References
  1. Slobodskoi AB, Osintsev EI, Lezhnev AG, Voronin IV, Badak IS, Dunaev AG. Faktory riska razvitiia periproteznoi infektsii posle endoprotezirovaniia krupnykh sustavov [Risk factors for periprosthetic infection after endoprosthetics of large joints]. Vestn Travmatologii i Ortopedii im NN Priorova. 2015;(2):13-18.
  2. Darwiche H, Barsoum WK, Klika A, Krebs VE, Molloy R. Retrospective analysis of infection rate after early reoperation in total hip arthroplasty. Clin Orthop Relat Res. 2010 Sep;468(9):2392-96. doi: 10.1007/s11999-010-1325-5.
  3. Petrova NV. Diagnostika implant-assotsiirovannykh infektsii v ortopedii s pozitsii dokazatelnoi meditsiny [Diagnosis of implant-associated infections in orthopedics from the perspective of evidence-based medicine]. Khirurgiia Pozvonochnika. 2012;(1):74-83.
  4. Simbirtsev A.S., Gromova AI. Funktsionalnyi polimorfizm genov reguliatornykh molekul vospaleniia [Functional polymorphism of the genes of regulatory molecules of inflammation]. Tsitokiny i Vospalenie. 2005;4(1):3-10.
  5. Markelova EV, Kostiushko AV, Krasnikov VE. Patogeneticheskaia rol narushenii v sisteme tsitokinov pri infektsionno-vospalitelnykh zabolevaniiakh [Pathogenetic role of disorders in the cytokine system in infectious and inflammatory diseases]. Tikhookean Med Zhurn. 2008;(3):24-29.
  6. Romanova IM, Gintsburg AL. Tsitokiny vozmozhnye aktivatory rosta patogennykh bakterii [Cytokines are possible activators of growth of pathogenic bacteria]. Vestn RAMN. 2000;(1):13-17.
  7. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010 Sep 1;92(11):2102-9. doi: 10.2106/JBJS.I.01199.
  8. Buttaro MA, Tanoira I, Comba F, Piccaluga F. Combining C-reactive protein and interleukin-6 may be useful to detect periprosthetic hip infection. Clin Orthop Relat Res. 2010 Dec;468(12):3263-67. doi: 10.1007/s11999-010-1451-0.
  9. Elgeidi A, Elganainy AE, Abou Elkhier N, Rakha S. Interleukin-6 and other inflammatory markers in diagnosis of periprosthetic joint infection. Int Orthop. 2014 Dec;38(12):2591-95. doi: 10.1007/s00264-014-2475-y.
  10. Jacovides CL, Parvizi J, Adeli B, Jung KA. Molecular markers for diagnosis of periprosthetic joint infection. J Arthroplasty. 2011 Sep;26(6 Suppl):99-103.e1. doi: 10.1016/j.arth.2011.03.025.
  11. Chepeleva MV, Kliushin NM, Ermakov AM, Ababkov IV. Interleikin-6 v prognozirovanii techeniia posleoperatsionnogo perioda u patsientov s periproteznoi infektsiei tazobedrennogo sustava [Interleykin-6 in predicting the course of the postoperative period in patients with periprosthetic hip infection]. Sib Nauch Med Zhurn. 2015;35(4):45-48.
  12. Shipitsyna IV, Osipova EV, Naumenko ZS. Issledovanie faktorov persistentsii: bioplenkoobrazuiushchei sposobnosti i antilizotsimnoi aktivnosti etiologicheskikh agentov khronicheskogo osteomielita [Investigation of persistence factors: biofilm-forming ability and antilizimic activity of etiological agents of chronic osteomyelitis]. Infektsii v Khirurgii. 2014;12(2):40-42.
  13. Liu B, Tikhilov RM, Shubniakov II, Bozhkova SA, Artiukh VA, Denisov AO. Analiz effektivnosti saniruiushchikh operatsii pri paraendoproteznoi infektsii [Analysis of the effectiveness of sanitizing operations with paraendoprosthetic infection]. Travmatologiia i Ortopediia Rossii. 2014;(2):22-29.
  14. Frangiamore SJ, Siqueira MB, Saleh A, Daly T, Higuera CA, Barsoum WK. Erratum to: Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation. Clin Orthop Relat Res. 2016 Jul; 474(7):1740-41. doi: 10.1007/s11999-016-4824-1.
  15. Frangiamore SJ, Saleh A, Grosso MJ, Farias KM, Zhang X, Daly TM, et al. Neer Award 2015: Analysis of cytokine profiles in the diagnosis of periprosthetic joint infections of the shoulder. J Shoulder Elbow Surg. 2017 Feb;26(Is 2):186-96. doi: 10.1016/j.jse.2016.07.017.
Address for correspondence:
640014, Russian Federation,
Kurgan, M. Ulyanova str., 6,
FSBE Russian Ilizarov Scientific
Center Restorative Traumatology
and Orthopaedics,
Clinical Laboratory of Microbiology
and Immunology,
tel. office: +7 352 2 45-16-54,
e-mail: zinaida_n@inbox.ru,
Zinaida S. Naumenko
Information about the authors:
Naumenko Z.S., PhD, Head of the Scientific and Clinical Laboratory of Microbiology and Immunology of FSBE Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics.
Chepeleva M.V., PhD, Senior Researcherof the Scientific and Clinical Laboratory of Microbiology and Immunology of FSBE Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics.
Godovykh N.V., Junior Researcher of the Scientific and Clinical Laboratory of Microbiology and Immunology of FSBE Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics.
Contacts | ©Vitebsk State Medical University, 2007-2023