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Periprothetische Infektionen nach Hüfttotalendoprothese mit ESBL-bildenden Bakterien

Bedeutung für die klinische Praxis

Periprosthetic infections following total hip replacement with ESBL-forming bacteria

Importance for clinical practice

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Zusammenfassung

Periprothetische Infektionen stellen eine gefürchtete Komplikation nach endoprothetischem Hüftgelenkersatz dar. Ein gesteigertes Infektionsrisiko besteht nach Wechseloperationen im Vergleich zur primären Implantation einer Hüftendoprothese. Weiterhin stellen die zunehmenden Resistenzen von Hospitalkeimen eine zusätzliche Bedrohung für den Patient und die endoprothetische Versorgung dar.

Extended-spectrum-β-Laktamase- (ESBL-)bildende Enterobakterien sind unter den multiresistenten Hospitalismuskeimen die am zweithäufigsten gefundenen Erreger. ESBL sind bakterielle Enzyme, welche die Fähigkeit besitzen, Cefalosporine der dritten und vierten Generation zu hydrolysieren und zur Ausbildung entsprechender Resistenzen beizutragen. Obwohl ESBL-bildende Bakterien bereits in den frühen 1980er Jahren erstmals beschrieben wurden, fanden sie bisher kaum spezifische Beachtung in der Orthopädie und Unfallchirurgie.

Im vorliegenden Artikel geben wir einen Überblick zur Epidemiologie und Diagnose von ESBL-Bildnern und zeigen die Schwierigkeiten bei der Behandlung periprothetischer Infektionen mit multiresistenten Bakterien auf. Weiterhin werden die im Zusammenhang mit ESBL-Bildnern besonderen hygienischen Maßnahmen und Therapieformen vorgestellt. Aufgrund eigener Erhebungen gehen wir davon aus, dass Infektionen mit ESBL-produzierenden Bakterien in der Orthopädischen Chirurgie keine Seltenheit mehr darstellen.

Abstract

Implant infections remain feared and severe complications after total hip replacement. An even higher rate of periprosthetic infections can be observed after revision surgery in comparison to primary total hip replacement. An additional threat for patients with artificial joints arises from the fact that bacteria resistant to a multitude of antibiotics are encountered with increasing frequency in the hospital setting.

Among these the enterobacteria producing extended spectrum β-lactamases (ESBL) are the second most frequent group of multiresistant pathogens. ESBLs are enzymes which possess the ability to hydrolyse third and fourth generation cephalosporins resulting in a distinctive resistance against these antibiotics. Even though ESBLs were first described in the early 1980’s and now represent pathogens of utmost importance in intensive care units, they have been hardly considered in orthopedic and trauma surgery.

In the present manuscript we provide an overview of the epidemiology and diagnostics of ESBL-expressing bacteria and demonstrate the difficulties in managing implant-associated infections with resistant bacteria. Furthermore, we emphasize the importance of recognizing ESBL-positive bacteria as increasingly important pathogens which require special precautions and treatment. Clinical evaluations suggest that ESBLs in orthopedic and trauma surgery are not a rare phenomenon any more.

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Authors and Affiliations

  1. Orthopädische Klinik und Poliklinik, Universität Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland

    M. Haenle, M. Ellenrieder, R. Skripitz, W. Mittelmeier & R. Bader

  2. Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universität Rostock, Rostock, Deutschland

    A. Podbielski & K. Arndt

  3. Sektion Endoprothetik und rekonstruktive Hüft- und Kniegelenkchirurgie, Klinik für Orthopädie und Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    H. Gollwitzer

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  1. M. Haenle
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Correspondence to M. Haenle.

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Haenle, M., Podbielski, A., Ellenrieder, M. et al. Periprothetische Infektionen nach Hüfttotalendoprothese mit ESBL-bildenden Bakterien. Orthopäde 40, 528–534 (2011). https://doi.org/10.1007/s00132-011-1762-1

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