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Prinzipien der Antibiotikabehandlung bei periprothetischen Infektionen

Guidelines on antimicrobial therapy in situations of periprosthetic THR infection

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Zusammenfassung

Die periprothetische Infektion ist heute eine seltene Komplikation einer weit verbreiteten Operation, dem künstlichen Gelenkersatz. Diese fremdkörperassoziierte Infektion im Knochengewebe ist durch Antibiotikatherapie schwer zu erreichen und mit Ausnahme der frühen, nicht etablierten Infektion nur durch chirurgische Entfernung des Fremdmaterials zu behandeln. Vorzugsweise erfolgt dazu der ein- oder zweizeitige Austausch des Prothesensystems. In einigen Fällen ist die Entfernung der Prothese allein mit Belassung einer Pseudoarthroplastik oder einer Arthrodese ohne dauerhaft verbleibendes Fremdmaterial erforderlich. Ultima ratio ist die Amputation. Immer muss eine an das chirurgische Konzept angepasste Antibiotikatherapie erfolgen, systemisch und/oder lokal an Wirkstoffträger gebunden. Kontrollierte Studien für den Vergleich der Behandlungsverfahren liegen bislang nicht vor. Die periprothetische Infektion sollte nur in Kompetenzzentren und interdisziplinär von Chirurgen und erfahrenen Infektiologen behandelt werden.

Abstract

Periprosthetic infection is nowadays a rare complication in artificial joint replacement. The infection of joint prostheses is a foreign body associated infection at the site of bone tissue which is difficult to treat with antimicrobial agents. Apart from cases with early, non-established infections, the surgical removal of the foreign material and radical débridement of bone and soft tissue is necessary. The surgical revision is performed preferentially using a one or two stage exchange of the prosthesis. In some cases, only the removal of the prosthesis is necessary. In these cases, a pseudoarthroplasty or an arthrodesis without definitely implanted foreign material is performed. Amputation is carried out if all other forms of revision have failed. All of these surgical procedures are accomplished by antimicrobial therapy, whether systemically administered and/or topically by drug delivery systems. Controlled studies for the comparison of one and two stage exchange procedures are not currently available. For the therapy of periprosthetic infection, an infectious disease specialist who is experienced in this area is needed in addition to an experienced surgical team. Thus, the therapy of these infections should be performed exclusively in centres of competence.

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  1. ENDO-Klinik Hamburg GmbH

    L. Frommelt

  2. ENDO-Klinik Hamburg GmbH, Holstenstraße 2, 22767, Hamburg

    L. Frommelt

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Frommelt, L. Prinzipien der Antibiotikabehandlung bei periprothetischen Infektionen. Orthopäde 33, 822–828 (2004). https://doi.org/10.1007/s00132-004-0677-5

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