Skip to main content
Log in

Bakterielle Osteitis

Besonderheiten beim immunkompromittierten Patienten

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

Zusammenfassung

Mit zunehmender Lebenserwartung der Bevölkerung und stetig steigender medizinischer Kompetenz steigt auch die Zahl älterer, häufig abwehrgeschwächter Patienten. Immunkompromittierte Patienten bedürfen sowohl bei der Diagnosestellung als auch der Therapie der bakteriellen Osteitis besonderer Beachtung.

Abstract

With increasing life expectancy and better medical competence, the number of older patients with multimorbidity is growing. Patients with a deficient immune system need more attention during diagnosis and treatment of osteomyelitis.

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

Access this article

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

Instant access to the full article PDF.

Literatur

  1. Aberg JA (2001) Reconstitution of immunity against opportunistic infections in the era of potent antiretroviral therapy. In: Volberding PA (ed) AIDS. Clin Rev 2001: 115–138

    Google Scholar 

  2. Aberg, JA, Chin-Hong PV, McCutchan A, Koletar SL, Currier JS (2002) Localized osteomyelitis due to mycobacterium avium complex in patients with human immunodeficiency virus receiving highly active antiretroviral therapy. Clin Infect Dis 35: 8–13

    Article  Google Scholar 

  3. Aguado JM, Herrero JA, Gavalda J et al. (1997) Clinical presentation and outcome of tuberculosis in kidney, liver, and heart transplant recipients in Spain. Transplantation 63: 1278–1286

    CAS  PubMed  Google Scholar 

  4. Alejandria MM, Lansang MA, Dans LF, Mantaring JBV (2003) Intravenous immunglobuline for treating sepsis and septic shock (Cochrane review). Update Software. The Cochrane Library, Issue 1, Oxford

  5. Baez-Escudero JL, Greene JN, Sandin RL (2000) Primary sternal aspergillus osteomyelitis. Infect Med 17: 505–516

    Google Scholar 

  6. Belzunegui J, Rodriguez-Arrondo F, Gonzalez C et al. (2000) Musculosceletal infections in intravenous drug addicts: report of 34 cases with analysis of microbiological aspects and pathogenic mechanisms. Clin Exp Rheumatol 18: 383–386

    CAS  PubMed  Google Scholar 

  7. Bistrian BR, Schwartz J, Istfan NW (1992) Cytokines, muscle proteolysis, and the catabolic response to infection and inflammation. Proc Soc Exp Biol Med 200: 220–223

    CAS  PubMed  Google Scholar 

  8. Bridges SL, Lopez-Mendez A, Han KH, Tracy IC, Alarcon GS (1991) Should methotrexate be discontinued before elective orthopedic surgery in patients with rheumatoid arthritis? J Rheumatol 18: 984–988

    PubMed  Google Scholar 

  9. Campisi J (1993) Mechanisms of aging that might contribute to musculosceletal impairment: deminished cell proliferative capacity. In: Buckwalter JA (ed) Musculosceletal soft tissue aging: impact on mobility. Am Acad Orthop Surg, Rosemont, Ill., pp 191–213

  10. Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW (1994) Assessment and management of foot disease in patients with diabetes. N Engl J Med 331: 854–860

    Article  CAS  PubMed  Google Scholar 

  11. Carpenter MT, West SG, Vogelsang SA, Casey Jones DE (1996) Postoperative joint infections in rheumatoid arthritis patients on methotrexate therapy. Orthopedics 19: 207–210

    CAS  PubMed  Google Scholar 

  12. Casado E, Olive A, Holgado S, Perez-Andrez R, Romeu J, Lorenzo JC, Clotet B, Tena X (2001) Musculosceletal manifestations in patients positive for human immunodeficiency virus: correlation with CD4 count. J Rheumatol 28: 802–804

    CAS  PubMed  Google Scholar 

  13. Castle SC (2000) Clinical relevance of age-related immune dysfunction. Clin Infect Dis 31: 578–585

    CAS  PubMed  Google Scholar 

  14. Chacko TK, Zhuang H, Stevenson K, Moussavian B, Alavi A (2002) The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses. Nucl Med Commun 23: 851–855

    Article  CAS  PubMed  Google Scholar 

  15. Chandrasekar PH, Narula AP (1986) Bone and joint infections in intravenous drug abusers. Rev Infect Dis 8: 904–911

    CAS  PubMed  Google Scholar 

  16. Cierny G, DiPasquale D (2002) Periprosthetic total joint infections: Staging, treatment and outcomes. Clin Orthop Relat Res 403: 23–28

    Article  Google Scholar 

  17. Cohen G, Schnall SB, Holtom P (2002) New onset diabetes mellitus in patients presenting with extremity infections. Clin Orthop Relat Res 403: 45–48

    Article  Google Scholar 

  18. Constans T, Bacq Y, Brechor JF, Guilmot JL, Choutet P, Lamisse F (1992) Protein-energy malnutrition in elderly medical patients. J Am Geriatr Soc 40: 263–268

    CAS  PubMed  Google Scholar 

  19. Delank KS, Hansen T, Eysel P, Eckardt A (2003) Infektionen des Bewegungsapparates bei der chronischen Polyarthritis während einer Kombinationstherapie mit Methotrexat und Leflunomid. Z Orthop 140: 555–560

    Article  Google Scholar 

  20. Doran MF, Crowson CS, Pond GR, O‘Fallon WM, Gabriel SE (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46: 2287–2293

    Article  PubMed  Google Scholar 

  21. Doran MF, Crowson CS, Pond GR, O‘Fallon WM, Gabriel SE (2002) Predictors of infection in rheumatoid arthritis. Arthritis Rheum 46: 2294–2300

    Article  PubMed  Google Scholar 

  22. Dubost JJ, Soubrier M, Sauvezie B (2000) Pyogenic arthritis in adults. Joint Bone Spine 67: 11–21

    CAS  PubMed  Google Scholar 

  23. Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP (1999) Nosocomial blodstream infections in US hospitals: a three-year analysis. Clin Infect Dis 29: 239–244

    CAS  PubMed  Google Scholar 

  24. Farizo KM, Buehler JW, Chamberland ME et al. (1992) Spectrum of disease in persons with human immunodeficiency virus infection in the United States. JAMA 267: 1798–1805

    Article  CAS  PubMed  Google Scholar 

  25. Farr M, Tunn EJ, Symmons DP (1989) Sulfasalazine in rheumatoid arthritis: haematological problems and changes in haematologicak indices associated with therapy. Br J Rheumatol 28: 134–138

    CAS  PubMed  Google Scholar 

  26. Finegold SM (1993) Host factors predisposing to anaerobic infections. FEMS Immunol Med Microbiol 6: 159–163

    Article  CAS  PubMed  Google Scholar 

  27. Fishman JA, Rubin RH (1998) Infection in organ-transplant recipients. N Engl J Med 338: 1741–1751

    CAS  PubMed  Google Scholar 

  28. Gavazzi G, Krause KH (2002) Ageing and infection. Lancet Infect Dis 2: 659–666

    Article  PubMed  Google Scholar 

  29. Glaser C, Matzko M, Reiser M (2000) Chronische Infektionen des Skelettsystems. Bildgebende Diagnostik. Radiologe 40: 547–556

    Article  CAS  PubMed  Google Scholar 

  30. Goldenberg DL (1989) Infectious arthritis complicating rheumatoid arthritis and other rheumatic disorders. Arthritis Rheum 32: 496–502

    CAS  PubMed  Google Scholar 

  31. Goodman SB (1996) Does the immune system play a role in loosening and osteolysis of total joint replacement? J Long Term Eff Med Implants 6: 91–101

    CAS  PubMed  Google Scholar 

  32. Gordon PM, Buxton PK, McLaren KM, Aldridge RD (1996) Sensitivity to sternotomy wires may cause post-operative pruritus. Ann Thorac Surg 61: 1514–1516

    Article  CAS  PubMed  Google Scholar 

  33. Gummert JF, Ikonen T, Morris RE (1999) Newer immunosuppressive drugs: a review. J Am Soc Nephrol 10: 1366–1380

    CAS  PubMed  Google Scholar 

  34. Hansen KA, Tho SPT (1998) Androgens and bone health. Semin Reprod Endocrinol 16: 129–134

    CAS  PubMed  Google Scholar 

  35. Hansis M (1995) Welche Größen beeinflussen das Zustandekommen eines Knocheninfektes? In: Kinzl (Hrsg) Diagnostik und Therapie der posttraumatischen Osteitis. Springer, Berlin Heidelberg New York Tokio, S 3–8

  36. Hatz HJ (1998) Glucocorticoide: Immunologische Grundlagen, Pharmakologie und Therapierichtlinien. Wiss. Verlagsgesellschaft, Stuttgart

  37. Hayashi K, Kaneko H, Kawachi S, Saida T (1999) Allergic contact dermatits and osteomyelitis due to sternal stainless steel wire. Contact Dermatitis 41: 115–116

    CAS  PubMed  Google Scholar 

  38. Heimlich F, Dietz A, Daniel V, Maier H (1999) Einfluss tumorchirurgischer Eingriffe im Kopf-Hals-Bereich auf das Immunsystem. HNO 47: 885–892

    Article  CAS  PubMed  Google Scholar 

  39. Hoeger PH, Ganschow R, Finger G (2000) Staphylococcal septicemia in children with atopic dermatits. Pediatr Dermatol 17: 111–114

    Article  CAS  PubMed  Google Scholar 

  40. Howard-Lock HE, Lock CJC, Mewz A, Kean WF (1986) D-penicillamine: chemistry and clinical use in rgheumatic disease. Sem Arthritis Rheum 15: 261–281

    CAS  Google Scholar 

  41. Jensen JE, Jensen TG, Smith TK, Johnston DA, Dudrick SJ (1982) Nutrition in orthopedic surgery. J Bone Joint Surg Am 64: 1263–1272

    CAS  PubMed  Google Scholar 

  42. Johnson JE, Kenndy EJ, Shereff MJ, Patel NC, Collier BD (1996) Prospective study of bone, indium-111-labelled white blood cell, and gallium-67 scanning for the evaluation of osteomyelitis in the diabetic foot. Foot Ankle Int 17: 10–16

    CAS  PubMed  Google Scholar 

  43. Josten C, Muhr G, Griga T (1990) Quantitative immunhistologische Analyse der zellmediierten Immunität im osteomyelitischen Knochengewebe. Unfallchirurg 93: 426–430

    CAS  PubMed  Google Scholar 

  44. Kak V, Chandrasekar PH (2002) Bone and joint infections in injection drug users. Infect Dis Clin North Am 16: 681–695

    PubMed  Google Scholar 

  45. Keusch GT, Farthing MJG (1986) Nutrition and infection. Ann Rev Nutr 6: 131–154

    Article  CAS  Google Scholar 

  46. Kim JH, Perfect JR (1989) Infection and cyclosporine. Rev Infect Dis 11: 677–690

    CAS  PubMed  Google Scholar 

  47. Klein JD, Hey LA, Yu CS, Klein BB, Coufal FJ, Young EP, Marshall LF, Garfin SR (1996) Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine 21: 2676–2682

    Article  CAS  PubMed  Google Scholar 

  48. Koberg K (1993) Untersuchungen zur zellulären Immunität bei der posttraumatischen Osteomyelitis. Inauguraldissertation, Universität Aachen

  49. Leibovici L (1995) Bacteriaemia in the very old. Features and treatment. Drugs Aging 4: 456–464

    Google Scholar 

  50. Lennard TW, Shenton BK, Borzotta A et al. (1985) The influence of surgical operations on components of the human immune system. Br J Surg 72: 771–776

    CAS  PubMed  Google Scholar 

  51. Lesourd BM, Mazari L, Ferry M (1998) The role of nutrition in immunity in the aged. Nutr Rev 56: 113–125

    Google Scholar 

  52. Ludolph E (1986) Kausalität bei der Begutachtung der exogenen Osteomyelitis. In: Hierholzer G, Ludolph E (Hrsg) Gutachtenkolloquium 1. Die Begutachtung der posttraumatischen/postoperativen Osteomyelitis. Springer, Berlin Heidelberg New York, S 89–93

  53. McNaghten AD, Adams MR, Dworkin MS (2001) Case 23–2000: Osteomyelitis in HIV-infected patients. New Engl J Med 344: 66–67

    Article  CAS  PubMed  Google Scholar 

  54. McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection: Outcomes using a staging system. Clin Orthop Relat Res 403: 8–15

    Article  Google Scholar 

  55. Mels AK, Statius Muller MG, van Leeuwen PAM et al. (2001) Immune-stimulating effects of low-dose perioperative recombinant granulocyte-macrophage colony-stimulating factor in patients operated on for primary colorectal carcinoma. Br J Surg 88: 539–544

    Article  CAS  PubMed  Google Scholar 

  56. Miller DJ, Mejicano GC (2001) Vertebral osteomyelitis due to candida species: Case report and literature review. Clin Infect Dis 33: 523–530

    Article  CAS  PubMed  Google Scholar 

  57. Miller KL (1990) The immune system: An overview. In: Ram BP, Harris MC, Tyle P (eds) Immunology: Clinical, fundamental, and therapeutic aspects.VCH, New Nork Weinheim, pp 1–25

  58. Moon MS (1997) Tuberculosis of the spine. Controversies and a new challenge. Spine 22: 1791–1797

    CAS  PubMed  Google Scholar 

  59. Moon MS, Ha KY, Sun DH, Moon JL, Moon YW, Chung JW (1996) Pott‘s paraplegia—67 cases. Clin Orthop 323: 122–128

    Article  PubMed  Google Scholar 

  60. MSD (1993) Manual der Diagnostik und Therapie. Urban & Schwarzenberg, München, S 1204–1223

  61. Nelson CL (1990) Prevention of infection. In: Evarts CM (ed) Surgery of the musculoskeletal system, 2nd edn. Churchill Livingstone, New York, pp 4313–4321

  62. Newman LG, Waller J, Palestro CJ et al. (1991) Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline. JAMA 266: 1246–1251

    Article  CAS  PubMed  Google Scholar 

  63. Peersman G, Laskin R, Davis J, Peterson M (2001) Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 392: 15–23

    Article  Google Scholar 

  64. Perhala RS, Wilke WS, Clough JD, Segal AM (1991) Local infection complications following large joint replacement in rheumatoid arthritis patients treated with methotrexate versus those not treated with methotrexate. Arthritis Rheum 34: 146–152

    CAS  PubMed  Google Scholar 

  65. Pinzer MS (2000) The diabetic foot, 1999. Curr Opin Orthop 11: 87–91

    Article  Google Scholar 

  66. Poss R, Thornhill TS, Ewald FC, Thomas WH, Batte NJ, Sledge CB (1984) Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res 182: 117–126

    Google Scholar 

  67. Ragni MV, Crossett LS, Herndon JH (1995) Postoperative infection following orthopaedic surgery in human immunodeficiency virus-infected hemophiliacs with CD4 counts ≤200/mm3. J Arthroplasty 10: 716–721

    CAS  PubMed  Google Scholar 

  68. Rau R (2000) Basistherapie der rheumatoide Arthritis. Unimed, Bremen, S 274–293

  69. Roques F, Nashef SAM, Michel P (1999) Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15: 816–823

    CAS  PubMed  Google Scholar 

  70. Rudman D, Feller AG, Cohn I, Shetty KR, Rudman IW, Draper MW (1991) Effects of human growth hormone on body composition in elderly men. Horm Res 36: 73–81

    PubMed  Google Scholar 

  71. Sander O (2000) Zytokininhibitoren. In: Rau R (Hrsg) Basistherapie der rheumatoide Arthritis. Unimed, Bremen, S 274–293

  72. Sany J, Anaya JM, Canovas F et al. (1993) Influence of methotrexate on the frequency of postoperative infectious complications in patients with rheumatoid arthritis. J Rheumatol 20: 1129–1132

    CAS  PubMed  Google Scholar 

  73. Schlüter B, Köller M, König W (1991) Mikrobielle Pathogenitätsfaktoren und körpereigene Abwehrmechanismen—Parameter posttraumatischer Infektionen. Imun Infekt 19: 50–54

    Google Scholar 

  74. Sistermann R, Möllenhoff G, Walz M, Josten C, Muhr G (1992) Eine zellulär quantitative Immundefizienz bei der chronisch posttraumatischen Osteomyelitis. Unfallchirurg 95: 254–258

    CAS  PubMed  Google Scholar 

  75. Smale BF, Mullen JL, Buzby GP, Rosato EF (1981) The efficiacy of nutritional assessment and support in cancer surgery. Cancer 47: 2375–2381

    CAS  PubMed  Google Scholar 

  76. Sorensen RU, Boehm KD, Kaplan D, Berger M (1992) Cryptococcal osteomyelitis and cellular immunodeficiency associated with interleukin-2 deficiency. J Pediatr 121: 873–879

    CAS  PubMed  Google Scholar 

  77. Statistisches Bundesamt 2001: www.statistik-bund.de/basis/d/gesu/gesutab5.htm

  78. Stocks G, Janssen HF (2000) Infection in patients after implantation of an orthopedic device. ASAIO J 46: 41–46

    Article  Google Scholar 

  79. Straus S, Ostroff SM, Jernigan DB et al. (1994) Clinical and epidemiologic characteristics of Mycobacterium haemophilum, an emerging pathogen in immunocompromised patients. Ann Intern Med 120: 118–125

    CAS  PubMed  Google Scholar 

  80. Sunday JM, Guille JT, Torg JS (2002) Complications of joint arthroplasty in patients with end-stage renal disease on hemodialysis. Clin Orthop Relat Res 397: 350–355

    Article  Google Scholar 

  81. Takala J, Ruokonen E, Webster NR, Nielsen MS, Zandstra DF, Vundelinckx G, Hinds CJ (1999) Increased mortality associated with growth hormone treatment in critically ill adults. N Engl J Med 341: 785–792

    Google Scholar 

  82. Talpada M, Rauf SJ, Walling DM (2002) Primary nocardia osteomyelitis as a presentation of AIDS. AIDS Read 12: 75–78

    PubMed  Google Scholar 

  83. Tang HJ, Lin HJ, Liu YC, Li CM (2002) Spinal epidural abscess—experience with 46 patietnts and evaluation of prognostic factors. J Infect 45: 76–81

    Article  PubMed  Google Scholar 

  84. Thomas P (2000) Allergologische Aspekte der Verträglichkeit von Biomaterialien. Biomaterialien 1: 37–42

    Google Scholar 

  85. Trautner C, Haastert B, Giani G, Burger M (1996) Incidence of lower limb amputations and diabetes. Diabetes Care 19: 1006–1009

    CAS  PubMed  Google Scholar 

  86. Van der Veen MJ, van der Heide A, Kruize AA, Bijlsma JWJ (1994) Infection rate and use of antibiotics in patients with rheumatoid arthritis treated with methotrexate. Ann Rheum Dis 53: 224–228

    PubMed  Google Scholar 

  87. Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Agudelo CA (1997) Musculoskeletal infections in patients with human immunodeficiency virus infection. Medicine 76: 284–294

    Article  CAS  PubMed  Google Scholar 

  88. Ventura G, Gasparini G, Lucia MB, Tumbarello M, Tacconelli E, Caldaro G, Cauda R (1997) Osteoarticular bacterial infections are rare in HIV-infected patients. 14 cases found among 4,023 HIV-infected patients. Acta Orthop Scand 68: 554–558

    CAS  PubMed  Google Scholar 

  89. Victor G, Fretwell M (1990) Infectious disease in the elderly. In Katlic MR et al.: Geriatric Surgery, Urban & Schwarzenberg, München, S 183–192

  90. Vierter Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland: Risiken, Lebensqualität und Versorgung Hochaltriger. www.bundesregierung.de/Anlage260745/Vierter+Altenbericht.pdf

  91. Walpert J, von Deimling U, Schmitt O, Fliedner M (1995) Skelettuberkulose—aktuelle Entwicklung und Ergebnisse einer Nachuntersuchung von 1970–1994. Orthop Prax 31: 266–270

    Google Scholar 

  92. Watts HG, Lifeso RM (1996) Current concepts review: Tuberculosis of bones and joints. J Bone Joint Surg Am 78: 288–298

    CAS  PubMed  Google Scholar 

  93. Whisnant JK, Pelkey J (1982) Rheumatoid arthritis: Treatment with azathioprin (IMURAN. Clinical side-efects and laboratory abnormalities. Ann Rheum Dis 41 (Suppl): 44–47

    PubMed  Google Scholar 

  94. Williams HJ, Reading JC, Ward JR, O‘Brien JM (1980) Comparison of high and low dose cyclophosphamide therapy in rheumatoid arthritis. Arthritis Rheum 23: 521–527

    CAS  PubMed  Google Scholar 

  95. Wolfe RA, Ashby VB, Milford EL et al. (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341: 1725–1730

    Google Scholar 

  96. Yeh SS, Schuster MW (1999) Geriatric cachexia: the role of cytokines. Am J Clin Nutr 70: 183–197

    CAS  PubMed  Google Scholar 

  97. Yoshikawa TT (2000) Epidemilogy and unique aspects of aging and infectious diseases. Clin Infect Dis 30: 931–933

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C. Niedhart.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Niedhart, C., Miltner, O., Zilkens, KW. et al. Bakterielle Osteitis. Orthopäde 33, 297–304 (2004). https://doi.org/10.1007/s00132-003-0594-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-003-0594-z

Schlüsselwörter

Keywords

Navigation