title: [Extracorporeal high hydrostatic pressure as a new technology for the disinfection of infected bone specimens]].
abstract: BACKGROUND
  Allogeneic bone transplantation is at risk of infection, and established disinfection methods typically compromise bone quality. High hydrostatic pressure (HHP) is well established for disinfection in food technology, and also it does protect biomechanical and biological properties of bone. This study is the first investigation of HHP regarding disinfection of bone biopsies.
  
  
  METHODS
  Bone biopsies of 34 patients with chronic infections were subjected to HHP and assessed for persisting bacterial growth. In series 1, bone biopsies were proceeded directly to HHP (10 min; maximal pressure Pmax 600 MPa). In series 2, HHP was applied after 5-day incubation in growth media (10 min or 2x30 min; Pmax 600 MPa). Furthermore, HHP-induced changes of bacterial morphology on artificially infected bone samples were evaluated by scanning electron microscopy (SEM).
  
  
  RESULTS
  For series 1, 71% of the bone samples were sterilised by HHP (n=17), compared to 38% of the untreated control samples, which were obtained during the same surgery (n=8). For series 2, after prior incubation, HHP disinfected 7% of the bone specimens (n=55), all control samples showed bacterial growth (n=33). Destruction of cell wall integrity of Gram-negative strains was observed by SEM.
  
  
  CONCLUSIONS
  The effectiveness of HHP for bone disinfection should be improved by optimising treatment parameters. Infections with barosensitive Gram-negative bacteria or yeast might represent possible clinical indications.
authors.affiliation: Orthopädische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Grosshadern, München, Deutschland. Patrick.Weber@med.uni-muenchen.de
authors.forename: Patrick
authors.initials: P
authors.lastname: Weber
authors.forename: Peter
authors.initials: P
authors.lastname: Diehl
authors.forename: Gunther O
authors.initials: GO
authors.lastname: Hofmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Miethke
authors.forename: Marcus
authors.initials: M
authors.lastname: Schmitt-Sody
authors.forename: Wolfram
authors.initials: W
authors.lastname: Mittelmeier
authors.forename: Reiner
authors.initials: R
authors.lastname: Gradinger
authors.forename: Hans
authors.initials: H
authors.lastname: Gollwitzer
mesh_terms: D001424:Bacterial Infections / Q000382:microbiology / Q000473:pathology* / Q000517:prevention & control*; D001850:Bone Diseases, Infectious / Q000382:microbiology / Q000473:pathology* / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D006801:Humans; D006874:Hydrostatic Pressure