Skip to main content

Advertisement

SpringerLink
Log in

Antibiotische Infektionsprophylaxe in der Primär- und Revisionsendoprothetik der Hüfte

Was ist erwiesen?

Antibiotic prophylaxis in primary and revision hip arthroplasty

What is the evidence?

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Dank moderner Entwicklungen im peri- und postoperativen Umfeld von Endoprothesenimplantationen konnte die Infektrate kontinuierlich gesenkt werden und liegt im Falle der Hüftendoprothetik derzeit konstant zwischen 0,25 und 1%. Jedoch herrschen große Meinungsunterschiede nicht nur international, sondern auch national bzgl. Dauer, Zeitpunkt und Wahl der antibiotischen Prophylaxe. In der Primärendoprothetik gibt es eindeutige Empfehlungen zur antibiotischen Prophylaxe mit Evidenzlevel 1a. Im Fall der Revisionsendoprothetik ist die Situation aufgrund der vielen Variablen, der Komplexität und mangels großer randomisierter Studien deutlich diffiziler. Unter diesen Gesichtpunkten wurde die aktuelle Literatur gesichtet und vorliegende wissenschaftliche Daten zusammengefasst.

Abstract

Advances in the perioperative and postoperative management of total joint replacement have led to a steady decrease in the infection rate, which in the case of total hip replacement presently lies between 0.25 and 1%. Unfortunately there is disparity in current practice nationally and internationally, regarding duration, time of application and choice of antibiotics. Currently there are only Level 1a recommendations for primary hip arthroplasty, whereas, due to the heterogeneity and complexity of most revision cases as well as a lack of randomized controlled trials, antibiotic prophylaxis for hip revision arthroplasty is mostly based on the surgeon’s preference. In this article the current literature is reviewed and scientifically sound data and recommendations are summarized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Moynihan BGA (1920) The ritual of a surgical operation. Br J Surg 8:27–35

    Article  Google Scholar 

  2. Mahomed NN, Barret JA, Katz JN et al (2003) Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg [Am] 85:27–32

    Google Scholar 

  3. Ridgeway S, Wilson J, Charlet A et al (2005) Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg [Br] 87:844–850

    Google Scholar 

  4. Mahomed NN, Barret JA, Katz JN et al (2005) Epidemology of total knee replacement in the United States medicare population. J Bone Joint Surg [Am] 87:1222–1228

    Google Scholar 

  5. Wilson MG, Kelley K, Thornhill TS (1990) Infection as a complication of total knee replacement arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg [Am] 72:878–883

    Google Scholar 

  6. Windsor RE, Bono JV (1994) Infected total knee replacements. J Am Acad Orthop Surg 2:44–53

    PubMed  Google Scholar 

  7. Hanssen AD, Osmon DR, Nelson CL (1996) Instructional course lectures. The American Academy of Orthopaedic Surgeons – prevention of deep periprosthetic joint infection. J Bone Joint Surg 78:458–471

    Google Scholar 

  8. Ayers DC, Dennis DA, Johanson NA, Pellegrini VD Jr (1997) Common complications of total knee arthroplasty. J Bone Joint Surg [Am] 79:278–311

    Google Scholar 

  9. Rao N, Canella B, Crossett LS et al (2008) A preoperative decolonization protocol for staphylococcus aureus prevents orthopaedic infections. Clin Orthop Relat Res 466:1343–1348

    Article  PubMed  Google Scholar 

  10. Fulkerson E, Valle CJ, Wise B et al (2006) Antibiotic susceptibility of bacteria infecting total joint arthroplasty sites. J Bone Joint Surg [Am] 88:1231–1237

    Google Scholar 

  11. Fitzgerald RH Jr (1995) Infected total hip arthroplasty: diagnosis and treatment. J Am Acad Orthop Surg 3:249–262

    PubMed  Google Scholar 

  12. Hota B, Ellenbogen C, Hayden MK et al (2007) Community-associated methicillin-resistant staphylococcus aureus skin and soft tissue infection at a public hospital: do public housing and incarceration amplify transmission? Arch Intern Med 167:1026–1033. Erratum in Arch Intern Med 167:1455

    Article  Google Scholar 

  13. Al-Buhairan B, Hutchinson A, Hind D (2008) Antibiotic prophylaxis for wound infections in total joint arthroplasty. J Bone Joint Surg [Br] 90-B:915–919

    Google Scholar 

  14. Meehan J, Jamali AA, Nguyen H (2009) Prophylactic antibiotics in hip and knee arthroplasty J Bone Joint Surg [Am] 91:2480–2490

    Google Scholar 

  15. Prokuski L (2008) Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg 16:283–293

    PubMed  Google Scholar 

  16. Classen DC, Evans RS, Pestotnik SL et al (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326:281–286

    Article  PubMed  CAS  Google Scholar 

  17. Mandell GL, Bennet JE, Dolin R (eds) (2005) Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 6th edn, vol 2. Elsevier/Churchill Livingstone, New York

  18. Levine DP (2008) Vancomycin: understanding its past and preserving its future. South Med J 101:284–291

    Article  PubMed  Google Scholar 

  19. Eggimann P, Pittet D (2001) Infection control in the ICU. Chest 120:2059–2093

    Article  PubMed  CAS  Google Scholar 

  20. Harbarth S, Samore MH, Lichtenberg D, Carmeli Y (2000) Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 101:2916–2921

    PubMed  CAS  Google Scholar 

  21. Jiranek WA, Hanssen AD, Greenwald AS (2006) Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg [Am] 88:2487–2500

    Google Scholar 

  22. Parvizi J, Saleh KJ, Ragland PS et al (2008) Efficacy of antibiotic-impregnated cement in total hip replacement. Acta Orthop 79:335–341

    Article  PubMed  Google Scholar 

  23. Tsukayama DT, Estrada R, Gustillo RB (1996) Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg [Am] 78(4):512–523

    Google Scholar 

  24. Soriano A, Bori G, García-Ramiro S et al (2008) Timing of antibiotic prophylaxis for primary total knee arthroplasty performed during ischemia. Clin Infect Dis 46(7):1009–1014

    Article  PubMed  CAS  Google Scholar 

  25. Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for Prevention of Surgical Site Infection, Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132; quiz 133–134; discussion 96

    Article  PubMed  CAS  Google Scholar 

  26. Oishi CS, Carrion WV, Hoaglund FT (1993) Use of parenteral prophylactic antibiotics in clean orthopaedic surgery. A review of the literature. Clin Orthop Relat Res 296:249–255

    PubMed  Google Scholar 

  27. Elek SD, Conen PE (1957) The virulence of staphylococcus pyogenes for man; a study of the problems of wound infection. Br J Exp Pathol 38(6):573–586

    PubMed  CAS  Google Scholar 

  28. Von Eiff C, Kipp F, Peters G (2000) Pathogenesis, diagnosis and prevention of implant-associated infection. Internist (Berl) 41(11):1180–1182, 1184–1188

    Google Scholar 

  29. Ayliffe GA (1991) Role of the environment of the operating suite in surgical wound infection. Rev Infect Dis 13(suppl 10):S800–S804

    Article  PubMed  Google Scholar 

  30. Arbeitskreis „Krankenhaus- & Praxishygiene“ der AWMF (2004) Leitlinien zur Hygiene in Klinik und Praxis, Hygiene in Klinik und Praxis, 3. Aufl. mhp, Wiesbaden, S 139ff

  31. Wacha H, Hoyme U, Kujath P et al (2010) Perioperative Antibiotika-Prophylaxe. Chemother J 19:70–84

    Google Scholar 

  32. ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery (1999) American Society of Health-System Pharmacists. Am J Health Syst Pharm 56(18):1839–1888

    Google Scholar 

  33. Lidwell OM, Lowbury EJ, Whyte W et al (1984) Infection and sepsis after operations for total hip or knee-joint replacement: influence of ultraclean air, prophylactic antibiotics and other factors. J Hyg Lond 93:505–2934

    Article  PubMed  CAS  Google Scholar 

  34. Bratzler DW, Houck PM (2005) Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 189(4):395–404

    Article  PubMed  Google Scholar 

  35. Cunha BA, Gossling HR, Pasternak HS et al (1977) The penetration characteristics of cefazolin, cephalothin, and cephradine into bone in patients undergoing total hip replacement. J Bone Joint Surg [Am] 59(7):856–859

    Google Scholar 

  36. Cunha BA, Gossling HR, Pasternak HS et al (1984) Penetration of cephalosporins into bone. Infection 12(2):80–84

    Article  PubMed  CAS  Google Scholar 

  37. Johnson DP (1987) Antibiotic prophylaxis with cefuroxime in arthroplasty of the knee. J Bone Joint Surg [Br] 69(5):787–789

    Google Scholar 

  38. BQS Report 2008. http://www.bqs-qualitaetsreport.de/2008/ergebnisse/leistungsbereiche/hueft_endo_erst/hueft-erst.pdf/download

  39. Dellinger EP, Gross PA, Barrett TL et al (1994) Quality standard for antimicrobial prophylaxis in surgical procedures. The Infectious Diseases Society of America. Infect Control Hosp Epidemiol 15(3):182–188

    Article  PubMed  CAS  Google Scholar 

  40. Harbarth S, Samore MH, Lichtenberg D, Carmeli Y (2000) Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 101(25):2916–2921

    PubMed  CAS  Google Scholar 

  41. De Chiara S, Chiumello D, Nicolini R et al (2010) Prolongation of antibiotic prophylaxis after clean and clean-contaminated surgery and surgical site infection. Minerva Anestesiol 76(6):413–419

    Google Scholar 

  42. Nelson CL, Green TG, Porter RA, Warren RD (1983) One day versus seven days of preventive antibiotic therapy in orthopedic surgery. Clin Orthop Relat Res 176:258e–263e

    Google Scholar 

  43. Gatell JM, Garcia S, Lozano L et al (1987) Perioperative cefamandole prophylaxis against infections. J Bone Joint Surg [Am] 69(8):1189e–1193e

    Google Scholar 

  44. Wymenga A, van Horn J, Theeuwes A et al (1992) Cefuroxime for prevention of postoperative coxitis. One versus three doses tested in a randomized multicenter study of 2,651 arthroplasties. Acta Orthop Scand 63(1):19e–24e

    Google Scholar 

  45. Mauerhan DR, Nelson CL, Smith DL et al (1994) Prophylaxis against infection in total joint arthroplasty. One day of cefuroxime compared with three days of cefazolin. J Bone Joint Surg [Am] 76(1):39e–45e

    Google Scholar 

  46. Engesæter LB, Lie SA, Espehaug B et al (2003) Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0–14 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 74(6):644–651

    Article  PubMed  Google Scholar 

  47. Van Kasteren ME, Manniën J, Ott A et al (2007) Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Clin Infect Dis 44(7):921–927

    Article  Google Scholar 

  48. Burnett RS, Aggarwal A, Givens SA et al (2010) Prophylactic antibiotics do not affect cultures in the treatment of an infected TKA: a prospective trial. Clin Orthop Relat Res 468(1):127–134

    Article  PubMed  Google Scholar 

  49. Della Valle C, Parvizi J, Bauer TW et al (2010) Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 18(12):760–770

    Google Scholar 

  50. Geipel U, Herrmann M (2005) The infected implant: bacteriology. Unfallchirurg 108:961–978

    Article  PubMed  CAS  Google Scholar 

  51. Johnson AJ, Zywiel MG, McGrath MS et al (2010) Prophylactic oral antibiotics reduce re-infection rates following revision knee arthroplasty. Annual Meeting of the American Academy of Orthopaedic Surgeons. New Orleans, LA, podium abstract 157

  52. American Academy of Orthopaedic Surgeons Advisory Statement (2011) Recommendations for the Use of Intravenous Antibiotic Prophylaxis in Primary Total Joint Arthroplasty. Available at: http://www.aaos.org/about/papers/advistmt/1027.asp, accessed March 13.2011

  53. Salgado CD, Dash S, Cantey JR et al (2007) Higher risk of failure of methicillin-resistant staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res 461:48–53

    PubMed  Google Scholar 

  54. Ferry T, Uçkay I, Vaudaux P et al (2010) Risk factors for treatment failure in orthopedic device-related methicillin-resistant staphylococcus aureus infection. Eur J Clin Microbiol Infect Dis 29(2):171–180

    Article  PubMed  CAS  Google Scholar 

  55. Parvizi J, Saleh KJ, Ragland PS et al (2008) Efficacy of antibiotic-impregnated cement in total hip replacement. Acta Orthop 79(3):335–341

    Article  PubMed  Google Scholar 

  56. Gristina AG (1987) Biomaterial-centered infection: microbial adhesion versus tissue integration. Science 228:990, 1985 und 237:1588, 1987

    Google Scholar 

  57. Paterson DL, Bonomo RA (2005) Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 18(4):657–686

    Article  PubMed  CAS  Google Scholar 

  58. Fogelberg EV, Zitzmann EK, Stinchfield FE (1970) Prophylactic penicillin in orthopaedic surgery. J Bone Joint Surg [Am] 52(1):95–98

    Google Scholar 

  59. Burke JF (1961) The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 50:161–168

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Klinikum rechts der Isar, TU München, Ismaninger Straße 22, 81675, München, Deutschland

    G. Gradl, L.K.L. Postl  & H. Gollwitzer

  2. Klinik für Orthopädie, König-Ludwig-Haus, Universität Würzburg, Würzburg, Deutschland

    C. Horn

  3. Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, TU München, München, Deutschland

    T. Miethke

Authors
  1. G. Gradl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Horn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L.K.L. Postl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Miethke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Gollwitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Gradl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gradl, G., Horn, C., Postl , L. et al. Antibiotische Infektionsprophylaxe in der Primär- und Revisionsendoprothetik der Hüfte. Orthopäde 40, 520–527 (2011). https://doi.org/10.1007/s00132-011-1755-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-011-1755-0

Schlüsselwörter

Keywords

Search

Navigation