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Knochenzement als lokaler Antibiotikaträger

Bone cement as a local antibiotic carrier

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Zusammenfassung

Hintergrund

Es besteht weitgehend Konsens darüber, dass der adjuvante lokale Einsatz von antimikrobiellen Wirkstoffen in Kombination mit ihrer systemischen Verabreichung implantatassoziierte muskuloskelettale Infektionen besser bekämpfen kann. Der Vorteil der lokalen Antibiotika liegt in ihrer besonderen Pharmakokinetik mit initial hohen Antibiotikakonzentrationen am Implantationsort bei nur geringer systemischer Aufnahme.

Behandlungsziel

Ziel der lokalen Anwendung ist der Schutz des körperfremden Materials direkt am Implantationsort vor Keimbesiedelung und Biofilmbildung (Prophylaxe) sowie die Unterstützung der Sanierung einer Infektion nach chirurgischem Debridement (Behandlung). Knochenzement ist dabei seit den Beobachtungen von Prof. Buchholz der am häufigsten verwendete lokale Wirkstoffträger.

Anwendung

In Infektfällen bestimmen dabei im Idealfall Chirurgen gemeinsam mit Mikrobiologen, Infektiologen oder klinischen Pharmazeuten auf der Basis des Keimnachweises und Antibiogramms, welche antiinfektiven Wirkstoffe systemisch und welche mit PMMA-Zement lokal für den Patienten indiziert sind. Allerdings besteht für die mit dem Knochenzement verabreichten Antiinfektiva nach wie vor Unsicherheit darüber, welche Wirkstoffe in welchen Konzentrationen diesem Trägermaterial zugemischt werden können. Entsprechend fassen die Autoren dieses Übersichtsartikels nicht nur die Rationale und die Evidenz des lokalen Antibiotikaeinsatzes zusammen, sondern führen auch aus, welche Punkte für die Zumischung dieser Wirkstoffe zum Zement beachtet werden müssen.

Abstract

Background

There is widespread consensus that adjuvant local use of antimicrobial agents in combination with their systemic administration can better prevent and treat implant-associated musculoskeletal infections. The advantage of local antibiotics lies in their particular pharmacokinetics with initially high antibiotic concentrations at the implant site with only low systemic uptake.

Aim of treatment

The aim of local application is to protect the foreign bodies directly at the implantation site from bacterial colonization and biofilm formation (prophylaxis) and to support the eradication of an already established infection after surgical debridement (treatment). Since the observations of Prof. Buchholz, bone cement has been the most frequently used local carrier system.

Application

In cases of infection, surgeons should ideally work together with microbiologists, infectiologists or clinical pharmacists to determine which anti-infective agents are indicated systemically for the patient and which ones are indicated locally with PMMA cement, based on the pathogen(s) and antibiograms. However, for the anti-infective agents administered with bone cement, there is still uncertainty about which agents can be added to this carrier material and at what concentrations. Accordingly, the authors of this review article not only summarize the rationale and evidence for local antibiotic use but also elaborate on the points that must be considered for admixing these agents to the cement.

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Abbreviations

eGFR:

Geschätzte glomeruläre Filtrationsrate

IE :

Internationale Einheiten

ISO :

Internationale Organisation für Normung

MHK :

Minimale Hemmkonzentration

MRSA :

Methicillin-resistenter Staphylococcus aureus

MRSE :

Methicillin-resistenter Staphylococcus epidermidis

PMMA :

Polymethylmethacrylat

PPI :

Periprothetischer Infekt

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Authors and Affiliations

  1. Heraeus Medical GmbH, Philipp-Reis-Str. 8/11, 61273, Wehrheim, Deutschland

    Christof Berberich & Klaus-Dieter Kühn

  2. Universitätsklinik für Orthopädie und Orthopädische Chirurgie, Medizinische Universität Graz, Graz, Österreich

    Klaus-Dieter Kühn

  3. Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    Volker Alt

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Correspondence to Christof Berberich.

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Interessenkonflikt

V. Alt gibt an, dass kein Interessenkonflikt besteht. C. Berberich und K.-D. Kühn sind Mitarbeiter des Unternehmens Heraeus Medical.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Die Übersichtsarbeit basiert auf einer ausführlichen Literaturrecherche. Eigene klinische Studien der Autoren wurden an anderer Stelle schon veröffentlicht und sind im Literaturteil benannt.

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Berberich, C., Kühn, KD. & Alt, V. Knochenzement als lokaler Antibiotikaträger. Orthopädie 52, 981–991 (2023). https://doi.org/10.1007/s00132-023-04447-6

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