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.
Literatur
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
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
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
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
Baez-Escudero JL, Greene JN, Sandin RL (2000) Primary sternal aspergillus osteomyelitis. Infect Med 17: 505–516
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
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
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
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
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
Carpenter MT, West SG, Vogelsang SA, Casey Jones DE (1996) Postoperative joint infections in rheumatoid arthritis patients on methotrexate therapy. Orthopedics 19: 207–210
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
Castle SC (2000) Clinical relevance of age-related immune dysfunction. Clin Infect Dis 31: 578–585
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
Chandrasekar PH, Narula AP (1986) Bone and joint infections in intravenous drug abusers. Rev Infect Dis 8: 904–911
Cierny G, DiPasquale D (2002) Periprosthetic total joint infections: Staging, treatment and outcomes. Clin Orthop Relat Res 403: 23–28
Cohen G, Schnall SB, Holtom P (2002) New onset diabetes mellitus in patients presenting with extremity infections. Clin Orthop Relat Res 403: 45–48
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
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
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
Doran MF, Crowson CS, Pond GR, O‘Fallon WM, Gabriel SE (2002) Predictors of infection in rheumatoid arthritis. Arthritis Rheum 46: 2294–2300
Dubost JJ, Soubrier M, Sauvezie B (2000) Pyogenic arthritis in adults. Joint Bone Spine 67: 11–21
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
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
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
Finegold SM (1993) Host factors predisposing to anaerobic infections. FEMS Immunol Med Microbiol 6: 159–163
Fishman JA, Rubin RH (1998) Infection in organ-transplant recipients. N Engl J Med 338: 1741–1751
Gavazzi G, Krause KH (2002) Ageing and infection. Lancet Infect Dis 2: 659–666
Glaser C, Matzko M, Reiser M (2000) Chronische Infektionen des Skelettsystems. Bildgebende Diagnostik. Radiologe 40: 547–556
Goldenberg DL (1989) Infectious arthritis complicating rheumatoid arthritis and other rheumatic disorders. Arthritis Rheum 32: 496–502
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
Gordon PM, Buxton PK, McLaren KM, Aldridge RD (1996) Sensitivity to sternotomy wires may cause post-operative pruritus. Ann Thorac Surg 61: 1514–1516
Gummert JF, Ikonen T, Morris RE (1999) Newer immunosuppressive drugs: a review. J Am Soc Nephrol 10: 1366–1380
Hansen KA, Tho SPT (1998) Androgens and bone health. Semin Reprod Endocrinol 16: 129–134
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
Hatz HJ (1998) Glucocorticoide: Immunologische Grundlagen, Pharmakologie und Therapierichtlinien. Wiss. Verlagsgesellschaft, Stuttgart
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
Heimlich F, Dietz A, Daniel V, Maier H (1999) Einfluss tumorchirurgischer Eingriffe im Kopf-Hals-Bereich auf das Immunsystem. HNO 47: 885–892
Hoeger PH, Ganschow R, Finger G (2000) Staphylococcal septicemia in children with atopic dermatits. Pediatr Dermatol 17: 111–114
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
Jensen JE, Jensen TG, Smith TK, Johnston DA, Dudrick SJ (1982) Nutrition in orthopedic surgery. J Bone Joint Surg Am 64: 1263–1272
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
Josten C, Muhr G, Griga T (1990) Quantitative immunhistologische Analyse der zellmediierten Immunität im osteomyelitischen Knochengewebe. Unfallchirurg 93: 426–430
Kak V, Chandrasekar PH (2002) Bone and joint infections in injection drug users. Infect Dis Clin North Am 16: 681–695
Keusch GT, Farthing MJG (1986) Nutrition and infection. Ann Rev Nutr 6: 131–154
Kim JH, Perfect JR (1989) Infection and cyclosporine. Rev Infect Dis 11: 677–690
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
Koberg K (1993) Untersuchungen zur zellulären Immunität bei der posttraumatischen Osteomyelitis. Inauguraldissertation, Universität Aachen
Leibovici L (1995) Bacteriaemia in the very old. Features and treatment. Drugs Aging 4: 456–464
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
Lesourd BM, Mazari L, Ferry M (1998) The role of nutrition in immunity in the aged. Nutr Rev 56: 113–125
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
McNaghten AD, Adams MR, Dworkin MS (2001) Case 23–2000: Osteomyelitis in HIV-infected patients. New Engl J Med 344: 66–67
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
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
Miller DJ, Mejicano GC (2001) Vertebral osteomyelitis due to candida species: Case report and literature review. Clin Infect Dis 33: 523–530
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
Moon MS (1997) Tuberculosis of the spine. Controversies and a new challenge. Spine 22: 1791–1797
Moon MS, Ha KY, Sun DH, Moon JL, Moon YW, Chung JW (1996) Pott‘s paraplegia—67 cases. Clin Orthop 323: 122–128
MSD (1993) Manual der Diagnostik und Therapie. Urban & Schwarzenberg, München, S 1204–1223
Nelson CL (1990) Prevention of infection. In: Evarts CM (ed) Surgery of the musculoskeletal system, 2nd edn. Churchill Livingstone, New York, pp 4313–4321
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
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
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
Pinzer MS (2000) The diabetic foot, 1999. Curr Opin Orthop 11: 87–91
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
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
Rau R (2000) Basistherapie der rheumatoide Arthritis. Unimed, Bremen, S 274–293
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
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
Sander O (2000) Zytokininhibitoren. In: Rau R (Hrsg) Basistherapie der rheumatoide Arthritis. Unimed, Bremen, S 274–293
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
Schlüter B, Köller M, König W (1991) Mikrobielle Pathogenitätsfaktoren und körpereigene Abwehrmechanismen—Parameter posttraumatischer Infektionen. Imun Infekt 19: 50–54
Sistermann R, Möllenhoff G, Walz M, Josten C, Muhr G (1992) Eine zellulär quantitative Immundefizienz bei der chronisch posttraumatischen Osteomyelitis. Unfallchirurg 95: 254–258
Smale BF, Mullen JL, Buzby GP, Rosato EF (1981) The efficiacy of nutritional assessment and support in cancer surgery. Cancer 47: 2375–2381
Sorensen RU, Boehm KD, Kaplan D, Berger M (1992) Cryptococcal osteomyelitis and cellular immunodeficiency associated with interleukin-2 deficiency. J Pediatr 121: 873–879
Statistisches Bundesamt 2001: www.statistik-bund.de/basis/d/gesu/gesutab5.htm
Stocks G, Janssen HF (2000) Infection in patients after implantation of an orthopedic device. ASAIO J 46: 41–46
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
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
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
Talpada M, Rauf SJ, Walling DM (2002) Primary nocardia osteomyelitis as a presentation of AIDS. AIDS Read 12: 75–78
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
Thomas P (2000) Allergologische Aspekte der Verträglichkeit von Biomaterialien. Biomaterialien 1: 37–42
Trautner C, Haastert B, Giani G, Burger M (1996) Incidence of lower limb amputations and diabetes. Diabetes Care 19: 1006–1009
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
Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Agudelo CA (1997) Musculoskeletal infections in patients with human immunodeficiency virus infection. Medicine 76: 284–294
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
Victor G, Fretwell M (1990) Infectious disease in the elderly. In Katlic MR et al.: Geriatric Surgery, Urban & Schwarzenberg, München, S 183–192
Vierter Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland: Risiken, Lebensqualität und Versorgung Hochaltriger. www.bundesregierung.de/Anlage260745/Vierter+Altenbericht.pdf
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
Watts HG, Lifeso RM (1996) Current concepts review: Tuberculosis of bones and joints. J Bone Joint Surg Am 78: 288–298
Whisnant JK, Pelkey J (1982) Rheumatoid arthritis: Treatment with azathioprin (IMURAN. Clinical side-efects and laboratory abnormalities. Ann Rheum Dis 41 (Suppl): 44–47
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
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
Yeh SS, Schuster MW (1999) Geriatric cachexia: the role of cytokines. Am J Clin Nutr 70: 183–197
Yoshikawa TT (2000) Epidemilogy and unique aspects of aging and infectious diseases. Clin Infect Dis 30: 931–933
Author information
Authors and Affiliations
Corresponding author
Rights 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
Issue Date:
DOI: https://doi.org/10.1007/s00132-003-0594-z