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Perioperative Antibiotikaprophylaxe bei aseptischen Eingriffen in der Orthopädie

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Zusammenfassung

Indikation, Art, Dauer und Nutzen der perioperativen Antibiotikaprophylaxe bei aseptischen Eingriffen in der Orthopädie werden kontrovers diskutiert. Keine Evidenz für den Nutzen eines generellen Einsatzes von Antibiotika in der perioperativen Infektionspropylaxe besteht für unkomplizierte aseptische Operationen ohne Einlage von Fremdmaterial.

Bei aseptischen orthopädischen Eingriffen mit Einbringen von Fremdmaterial besteht momentan ebenfalls keine eindeutige Evidenz für eine generelle Antibiotikaprophylaxe. Dennoch ist wegen der potentiell bedrohlichen und schwerwiegenden Folgen für das Operationsergebnis und die Lebensqualität des Patienten nach Meinung der meisten Experten eine generelle antibiotische perioperative Prophylaxe mit einem Cephalosporin der 1. Generation trotz unklarer Datenlage bei primär aseptischen orthopädischen Operationen, die das Einbringen von Fremdmaterial beinhalten, indiziert. Hingegen besteht klare Evidenz für den Nutzen und die medizinische Sinnhaftigkeit einer perioperativen Antibiotikaprophylaxe mit Cephalosporinen der 1. oder 2. Generation in der Orthopädie bei primär aseptischer Versorgung der Schenkelhalsfraktur und bei totalendoprothetischem Gelenkersatz.

Die Anwendung von Glykopeptiden ist auf besondere Indikationen (β-Laktam-Allergie, hohes MRSA-/MRSE-Risiko) zu beschränken. Die perioperative Antibiotikaprophylaxe in der Orthopädie wird üblicherweise als „single shot“ 30 min vor dem Hautschnitt bzw. spätestens 10 min vor Anlegen der Blutsperre verabreicht. Bei Operationen von >3 h Dauer sollte eine erneute Applikation erfolgen. Ein prophylaktischer Einsatz von Lokalantibiotika im Knochenzement wird nicht empfohlen.

Abstract

Disagreement exists on the topic of antibiotic prophylaxis in aseptic orthopedic surgery. No evidence on the usefulness of prophylactic antibiotic administration exists with regard to noncomplex aseptic surgeries without placement of osteosynthetic material.

Likewise, no undisputed evidence exists on the usefulness of antibiotic prophylaxis with regard to aseptic orthopedic surgeries involving placement of osteosynthetic material. However, the majority of experts agree on antibiotic prophylaxis in the latter cases. In contrast clear evidence does exist regarding the usefulness of antibiotic prophylaxis with first- or second-generation cephalosporins for surgeries of the hip involving fracture treatment or prosthetic replacement.

The prophylactic use of glycopeptides should be confined to cases of high MRSA or MRSE risk. Administration of prophylactic antibiotics should precede incision time by around 30 min and tourniquet inflation by at least 10 min. Antibiotic administration may be repeated in the OR when surgery lasts longer than 3 h. The use of local antibiotics in bone cement has not proven useful as a prophylactic measure.

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Literatur

  1. American Society of Health-System Pharmacists (1999) ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. Am J Health Sys Pharm 56: 1839–1888

    Google Scholar 

  2. Boyd RJ, Burke JF, Colton T (1973) A double blinded clinical trial of prophylactic antibiotics in hip fractures. J Bone Joint Surg Am 55: 1251–1258

    Google Scholar 

  3. Buckley R, Huges G, Snodgrass T, Huchcroft SA (1990) Perioperative cefazolin prophylaxis in hip fracture surgery. Can J Surg 33: 122–127

    Google Scholar 

  4. Burnett JW, Gustilo RB, Williams DN, Kind AC (1980) Prophylactic antibiotics in hip fractures. J Bone Joint Surg Am 62: 457–462

    Google Scholar 

  5. Carlsson AS, Lindgren L, Lindberg L (1977) Prophylactic antibiotics against early and late deep infections after total hip replacement. Acta Orthop Scand 48: 405–410

    Google Scholar 

  6. Centers for Disease Control and Prevention (1994) Recommendations for preventing the spread of vancomycin resistance: Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 44: 1–13

    Google Scholar 

  7. Coventry MB (1975) Treatment of infections occurring in total hip surgery. Orthop Clin North Am 6: 991–1003

    Google Scholar 

  8. Cruse P, Foord JER (1980) The epidemiology of wound infection. Surg Clin North Am 60: 27–30

    Google Scholar 

  9. Cunha BA, Gossling HR, Pasternak HS, Nightingale CH, Quintiliani R (1977) The penetration characteristics of cefazolin, cefalotin, and cephradine into bone in patients undergoing total hip replacement J Bone Joint Surg Am 59: 856–859

    Google Scholar 

  10. DIN 1946-4 (1998) Raumlufttechnische Anlagen in Krankenhäusern. Beuth, Berlin

  11. Dotson LR, Witmer DR (1995) Development of ASHP therapeutic guidelines. Am J Health Syst Pharm 52: 254–255

    Google Scholar 

  12. Dreghorn CR, Roughneen P, Graham J, Hamblen DC (1986) The real cost of joint replacement. Br Med J 292: 1636–1637

    Google Scholar 

  13. Ericson C, Lindgren L, Lindberg L (1977) Cloxacillin in the prophylaxis of postoperative infections of the hip. J Bone Joint Surg Am 55: 808–813

    Google Scholar 

  14. Fitzgerald RH (1989) Infections of hip prosthesis and artificial joints. Infect Dis Clin North Am 3: 329–338

    Google Scholar 

  15. Gillespie WJ (1997) Prevention and management of infection after total joint replacement. Clin Infect Dis 25: 1310–1317

    Google Scholar 

  16. Gorbach SL, Condon RE, Conte JE Jr., Kaiser AB, Ledger WJ, Nichols RL (1992) Evaluation of new anti-infective drugs for surgical prophylaxis. Infectuous Disease Society of America and Food and Drug Administration. Clin Infect Dis 15 (Suppl 1): 313–338

    Google Scholar 

  17. Hannis M, Ahrens M (1999) Prophylaktische und therapeutische Anwendung von Antibiotika in der Unfallchirurgie. Unfallchirurg 99: 316–322

    Google Scholar 

  18. Harris WH, Sledge CV (1990) Total hip and total knee replacement. New Engl J Med 323: 725

    Google Scholar 

  19. Hedström SA, Lindgren L, Sernbo I, Torholm C, Onnerfalt R. (1987) Cefuroxime prophylaxis in trochanteric hip fracture operations. Acta Orthop Scand 58: 361–364

    Google Scholar 

  20. Henley MB, Jones RE, Wyatt RWB, Hofmann A, Cohen RL (1986) Prophylaxis with cefamandole naftate in elective orthopaedic surgery. Clin Orthop 209: 249–254

    Google Scholar 

  21. Hill C, Mazas F, Flamant R, Evrard J (1981) Prophylactic cefazolin versus placebo in total hip replacement. Lancet 1: 795–796

    Google Scholar 

  22. Lidwell OM, Lowbury EJL, White W, Blowers R, Stanley SJ, Lowe D (1982) Effect of ultra clean air in operating room on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J 285: 10–14

    Google Scholar 

  23. Liebergall M, Mosheiff R, Smith D et al. (1995) A double-blinded, randomised, controlled clinical trial to compare cefazolin and cefonizid for antimicrobial prophylaxis in clean orthopedic surgery. Israel J Med Sci 31: 62–64

    Google Scholar 

  24. Madsen MS, Neumann L, Andersen JA (1996) Penicillin prophylaxis in complicated wounds of hands and feet: a randomised double-blind trial. Injury 27: 275–278

    Google Scholar 

  25. Mauerhan DR, Nelson CL, Smith DL, Fitzgerald RH, Slama RW, Jones RE, Evans RP (1994) Prophylaxis against infection in total joint arthroplasty. J. Bone Joint Surg Am 76: 39–45

    Google Scholar 

  26. Mini E, Nobili S, Periti P (1997) Methicillin-resistent staphylococci in clean orthopaedic surgery. Drugs 54 (Suppl 6): 39–52

    Google Scholar 

  27. Mini E, Nobili St, Periti P (2000) Does surgical prophylaxis with teicoplanin constitute a therapeutic advance? J Chemother 12 (Suppl 5): 40–55

  28. Nafzinger DA, Saravolatz LD (1997) Infection in implantable prosthetic devices. In Wenzel RP (ed) Prevention and control of nosocomial infections. 3rd edn. Willams & Wilkins, Baltimore, S 889–923

  29. Nationales Referenzzentrum für Krankenhaushygiene (1998) Definitionen nosokomialer Infektionen. Mercedes-Druck GmbH, Berlin

  30. Nelson CL, Green TG, Porter GA, Warren RD (1983) One day versus 7 days of preventive antibiotic therapy in orthopaedic surgery. Clin Orthop 176: 258–263

    Google Scholar 

  31. Oishi CS, Carrion WV, Hoaglund FT (1993) Use of prophylactic antibiotics in clean orthopedic surgery. Clin Orthop 296: 249–255

    Google Scholar 

  32. Olix ML, Klug TJ, Coleman CR (1960) Prophylactic penicillin and streptomycin in elective operations on bones, joints, and tendons. Surg Forum 10: 818–819

    Google Scholar 

  33. Paiement GD, Renaud E, Dagenais G, Gosselin RA (1994) Double-blind, randomised prospective study of the efficacy of antibiotic prophylaxis for open reduction and internal fixation of closed ankle fractures. J Orthop Trauma 8: 64–66

    Google Scholar 

  34. Pavel A, Smith RL, Ballard A, Larsen IJ (1974) Prophylactic antibiotics in clean orthopaedic surgery. J Bone Joint Surg Am 56: 777–782

    Google Scholar 

  35. Periti P, Mini E, Grassi F, Cherubino P (2000) Antibiotic prophylaxis of postoperative infection in orthopedics. Results of an epidemiologic survey in Italy conducted by the Journal of Chemotherapy. J Chemother 12 (Suppl 2): 28–38

    Google Scholar 

  36. Pollard JP, Hughes SP, Scott JE, Evans MJ, Benson MK (1979) Antibiotic prophylaxis in total hip replacement Br Med J 1: 707–709

  37. Schonholtz GJ, Borgia CA, Blair JD (1962) Wound sepsis in orthopaedic surgery. J Bone Joint Surg Am 44: 1548–1552

    Google Scholar 

  38. Simon C, Stille W (2000) Antibiotika-Therapie in Klinik und Praxis, 10. Aufl. Schattauer, Stuttgart New York

  39. Tengve B, Kjellander J (1978) Antibiotic prophylaxis in operations on trochanteric femoral fractures. J Bone Joint Surg Am 60: 97–99

    Google Scholar 

  40. Ullmann U (2003) Infektionsprophylaxe bei Gelenkersatz in der Orthopädie. Chemother J 12: 57–59

    Google Scholar 

  41. Van Eiff C, Kipp F, Peters G (2000) Pathogenese, Diagnostik und Prävention von Fremdkörper-assoziierten Infektionen. Internist 41: 1180–1188

    Google Scholar 

  42. Winninger DA, Fass RJ (1996) Antibiotic-impregnated cement and beads for orthopaedic infections. Antimicrob Chemother 40: 2675–2679

    Google Scholar 

  43. Leigh DA (1986) Serum and bone concentrations of cefuroxime in patients undergoing knee arthroplasty. J Antimicrob Chemother 18: 609–611

    Google Scholar 

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Authors and Affiliations

  1. Institut für Medizinische Mikrobiologie, Klinikum, Johann-Wolfgang-Goethe-Universität, Frankfurt/M.

    K.-P. Hunfeld, T. A. Wichelhaus & V. Schäfer

  2. Abteilung für Rheumaorthopädie, Klinikum, Johann-Wolfgang-Goethe-Universität, Frankfurt/M.

    M. Rittmeister

  3. Institut für Medizinische Mikrobiologie, Klinikum, Johann-Wolfgang-Goethe-Universität, Paul-Ehrlich-Straße 40, 60596, Frankfurt am Main

    K.-P. Hunfeld

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  1. K.-P. Hunfeld
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  2. T. A. Wichelhaus
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  3. V. Schäfer
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  4. M. Rittmeister
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Correspondence to K.-P. Hunfeld.

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Hunfeld, KP., Wichelhaus, T.A., Schäfer, V. et al. Perioperative Antibiotikaprophylaxe bei aseptischen Eingriffen in der Orthopädie. Orthopäde 32, 1070–1077 (2003). https://doi.org/10.1007/s00132-003-0558-3

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  • DOI: https://doi.org/10.1007/s00132-003-0558-3

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