Periprosthetic joint infection (PJI) is a difficult complication requiring a comprehensive eradication protocol. Cure rates have essentially stalled in the last two decades, using methods of antimicrobial cement joint spacers and parenteral antimicrobial agents. Functional spacers with higher-dose antimicrobial-loaded cement and antimicrobial-loaded calcium sulphate beads have emphasized local antimicrobial delivery on the premise that high-dose local antimicrobial delivery will enhance eradication. However, with increasing antimicrobial pressures, microbiota have responded with adaptive mechanisms beyond traditional antimicrobial resistance genes. In this review we describe adaptive resistance mechanisms that are relevant to the treatment of PJI. Some mechanisms are well known, but others are new. The objective of this review is to inform clinicians of the known adaptive resistance mechanisms of microbes relevant to PJI. We also discuss the implications of these adaptive mechanisms in the future treatment of PJI. Cite this article: Bone Joint J 2022;104-B(5):575-580.

中文翻译：

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适应性抗菌药物耐药性、微生物变异的描述及其与假体周围感染的相关性。

假体周围关节感染（PJI）是一种困难的并发症，需要全面的根除方案。在过去的二十年里，使用抗菌水泥关节垫片和肠外抗菌剂的方法，治愈率基本上停滞不前。具有高剂量抗菌剂负载水泥和抗菌剂负载硫酸钙珠的功能性间隔物强调局部抗菌剂递送，前提是高剂量局部抗菌剂递送将增强根除。然而，随着抗菌压力的增加，微生物群已经以传统抗菌素耐药基因之外的适应机制做出反应。在这篇综述中，我们描述了与 PJI 治疗相关的适应性抵抗机制。有些机制是众所周知的，但其他机制则是新的。本综述的目的是让临床医生了解与 PJI 相关的已知微生物的适应性耐药机制。我们还讨论了这些适应性机制对 PJI 未来治疗的影响。引用这篇文章：骨关节杂志 2022;104-B(5):575-580。