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Implantatassoziierte Infektionen in der Traumatologie

Aktuelle Standards und neue Entwicklungen in der Diagnostik und Behandlung

Fracture-related infections in traumatology

Current standards and new developments in diagnostics and treatment

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Zusammenfassung

Hintergrund

Die hohen Anforderungen, die implantatassoziierte Infektionen an Patienten, Ärzte und Gesundheitssystem stellen, haben zur Gründung der internationalen Expertengruppe FRI („fracture-related infection“) Consensus Group geführt. Ihr Ziel ist die Formulierung evidenzbasierter Behandlungsempfehlungen.

Diagnostik

Implantatassoziierte Infektionen werden nach dem zeitlichen Auftreten, der Ausdehnung und der Therapiemöglichkeit klassifiziert. Der diagnostische Algorithmus unterscheidet dabei zwischen beweisenden und hinweisenden Diagnosekriterien. Bei Hinweisen auf eine Infektion wird die frühzeitige Gewebebiopsie mit mikrobiologischer und histologischer Aufarbeitung zur Diagnosesicherung empfohlen.

Therapie

Primäres Ziel der Behandlung einer implantatassoziierten Infektion ist die Konsolidierung der Fraktur unter Vermeidung einer Osteomyelitis. Therapieoptionen sind die Implantatentfernung, die Infekteradikation bei einliegendem Implantat oder die Infektsuppression bis zur knöchernen Konsolidierung. Ein multidisziplinäres Team ist notwendig, um die patientenadaptierte chirurgische und antimikrobielle Therapie optimal aufeinander abzustimmen.

Abstract

Background

The high demands that fracture-related infections put on patients, physicians and the healthcare system have led to the establishment of a international group of experts called the Fracture-Related Infection (FRI) Consensus Group, whose aim is to develop evidence-based treatment recommendations.

Diagnosis

Fracture-related infections are classified according to the time of occurrence, extent and treatment options. The diagnostic algorithm distinguishes between confirmatory and suggestive diagnostic criteria. If there are indications of an infection, tissue biopsy with microbiological and histological workup is recommended to confirm the diagnosis.

Therapy

The primary objective of FRI treatment is to achieve fracture consolidation, while avoiding osteomyelitis. Therapeutic options are removal of the implant, eradication of the infection with implant retention or suppression of FRI. A multidisciplinary team is recommended to develop a patient-specific, optimized surgical and antimicrobial therapy.

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Abbreviations

ABS:

Antibiotic Stewardship

AO :

Arbeitsgemeinschaft für Osteosynthesefragen

BSG :

Blutsenkungsgeschwindigkeit

CRP :

C‑reaktives Protein

DAIR :

„Debridement, antibiotics and implant retention“

DTT :

„Difficult-to-treat“

eGFR :

Eingeschränkte glomeruläre Filtrationsrate

FRI :

„Fracture-related infection“

HF :

„High-power field“

IDSA :

Infectious Disease Society of America

PCR :

Polymerasekettenreaktion

PJI :

Periprothetische Infektionen

PMMA :

Polymethylmethacrylat

PMN :

Polymorphnukleäre Zellen

SSI :

„Surgical site infections“

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Authors and Affiliations

  1. Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    H. Baecker, S. Frieler, T. A. Schildhauer, J. Gessmann & Y. Hanusrichter

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  1. H. Baecker
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  2. S. Frieler
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  3. T. A. Schildhauer
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  4. J. Gessmann
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Correspondence to H. Baecker.

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Interessenkonflikt

H. Baecker, S. Frieler, T.A. Schildhauer, J. Gessmann und Y. Hanusrichter geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Baecker, H., Frieler, S., Schildhauer, T.A. et al. Implantatassoziierte Infektionen in der Traumatologie. Orthopäde 49, 702–709 (2020). https://doi.org/10.1007/s00132-020-03948-y

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