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During the recent transition between acute diseases caused by
swarms of single planktonic bacteria, and chronic infections caused
by bacteria growing in slime-enclosed biofilms, a general clinical
consensus has emerged that pathologies with bacterial etiologies
are frequently culture negative. Because biofilm infections now
affect 17 million Americans per year (killing approximately
450,000), the suggestion that these common and lethal infections
regularly go unnoticed by the only FDA-approved method for their
detection and characterization is a matter of urgent concern.
Biologically, we would expect that planktonic bacterial cells would
colonize any new surface, including the surface of an agar plate,
while the specialized sessile cells of a biofilm community would
have no such proclivity. In the study of biofilm diseases ranging
from otitis media to prostatitis, it was found that direct
microscopy and DNA- and RNA-based molecular methods regularly
document the presence of living bacteria in tissues and samples
that are culture negative. The editors selected orthopedic biofilm
infections as the subject of this book because these infections
occur against a background of microbiological sterility in which
modern molecular methods would be expected to find bacterial DNA,
RNA-based microscopic methods would be expected to locate bacterial
cells, and cultures would be negative. Moreover, in Orthopedics we
find an already biofilm-adapted surgical group in which current
strategies are based on the meticulous removal of compromised
tissues, antibiotic options as based on high biofilm-killing local
doses, and there are practical bedside strategies for dealing with
biofilm infections. So here is where the new paradigm of biofilm
infection meets the equally new paradigm of the culture negativity
of biofilms, and this volume presents a conceptual synthesis that
may soon combine the most effective molecular methods for the
detection and identification of bacteria with a surgical discipline
that is ready to help patients.
This volume is the work product of an international group of
authors who are experienced in the field of musculoskeletal
allografts. The chapters are written by experts in many differing
areas of allografting and represents the current knowledge in this
rapidly changing dynamic field. The reconstructive community and
their patients owe a significant debt of gratitude to Doctors
Czitrom and Winkler for this volume. William F. Enneking, M. D.
Preface What follows is the result of a timely project bringing
together the newest ideas of top experts worldwide in a rapidly
growing technology: Orthopaedic Allograft Surgery. The title of the
book reflects a method rather than a speciality. It transgresses
well established subspecialities of orthopaedic surgery such as
joint replacement, oncology, spine, trauma and sports medicine. The
technology encompasses knowledge of tissue banking, biology and
biomechanics, both in a research and clinical sense. The common
denominator for those interested is the need and ability to provide
or use allogeneic tissues in orthopaedic applications. Inherent to
a multiauthored text based on chapters written by authors from many
parts of the world is a variety in format and style. While we tried
to some extent reducing large discrepancies, there was no attempt
made to eliminate dissimilar ities. We did not aim for a
homogeneous textbook. Rather, we asked for originality, novelty,
individuality in the presentation of data and concepts.
Consequently, chapters vary in format from that seen in a
scientific article to that of a descriptive essay."
During the recent transition between acute diseases caused by
swarms of single planktonic bacteria, and chronic infections caused
by bacteria growing in slime-enclosed biofilms, a general clinical
consensus has emerged that pathologies with bacterial etiologies
are frequently culture negative. Because biofilm infections now
affect 17 million Americans per year (killing approximately
450,000), the suggestion that these common and lethal infections
regularly go unnoticed by the only FDA-approved method for their
detection and characterization is a matter of urgent concern.
Biologically, we would expect that planktonic bacterial cells would
colonize any new surface, including the surface of an agar plate,
while the specialized sessile cells of a biofilm community would
have no such proclivity. In the study of biofilm diseases ranging
from otitis media to prostatitis, it was found that direct
microscopy and DNA- and RNA-based molecular methods regularly
document the presence of living bacteria in tissues and samples
that are culture negative. The editors selected orthopedic biofilm
infections as the subject of this book because these infections
occur against a background of microbiological sterility in which
modern molecular methods would be expected to find bacterial DNA,
RNA-based microscopic methods would be expected to locate bacterial
cells, and cultures would be negative. Moreover, in Orthopedics we
find an already biofilm-adapted surgical group in which current
strategies are based on the meticulous removal of compromised
tissues, antibiotic options as based on high biofilm-killing local
doses, and there are practical bedside strategies for dealing with
biofilm infections. So here is where the new paradigm of biofilm
infection meets the equally new paradigm of the culture negativity
of biofilms, and this volume presents a conceptual synthesis that
may soon combine the most effective molecular methods for the
detection and identification of bacteria with a surgical discipline
that is ready to help patients.
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