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Logistische Voraussetzungen und Probenentnahme bei periprothetischen Infektionen

Was muss beachtet werden?

Logistic requirements and biopsy of periprosthetic infections

What should be taken into consideration?

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Zusammenfassung

Der Diagnostik periprothetischer Infekte kommt eine zentrale Bedeutung zu, da der Nachweis eines periprothetischen Infekts eine maßgebliche Änderung des therapeutischen Regimes hervorruft. Daher sollte sie vor jedem Prothesenwechsel durchgeführt werden und Verfahren beinhalten, die einen direkten Bakteriennachweis mit Austestung von Antibiotikasensibilitäten erlauben. Hierdurch kann im Fall eines periprothetischen Infekts eine gezielte systemische und gegebenenfalls lokale Antibiotikatherapie rechtzeitig mit der Operation eingeleitet und das Risiko von Resistenzentwicklungen reduziert werden. Aufgrund eigener Studien konnte nachgewiesen werden, dass die bioptische Probenentnahme von periprothetischem Gewebe die höchste diagnostische Genauigkeit erzielt, da sie mehrere Verfahren (Bebrütung und Histologie) kombinieren lässt. Sie sollte zumindest bei klinischem Verdacht und negativem Punktionsergebnis eingesetzt werden. Die Bebrütung muss in 14 Tagen erfolgen, wie eigenen Studien zeigen konnten.

Abstract

Preoperative diagnosis of periprosthetic infections is particularly important before revision of knee and hip arthroplasties because of the therapeutic consequences. Therefore, periprosthetic infections should be ruled out before any revision surgery is performed. Of the different diagnostic methods direct techniques which allow the direct detection of microorganisms with testing of antibiotic sensitivity are recommended. This allows microorganism-specific systemic and local antibiotic therapies and helps to reduce the risk of development of resistance. In our studies it could be shown that the time for incubation to detect microorganisms should be 14 days and that biopsy of periprosthetic tissues is superior to aspiration alone because it combines several diagnostic methods (microbiological and histological). It is preferable to repeating an aspiration when data are unclear, i.e. in cases of potentially false positives or negatives results of aspiration.

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Authors and Affiliations

  1. Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland

    B. Fink

  2. MVZ Labor, Ludwigsburg, Deutschland

    P. Schäfer

  3. Zentrum für Infektiologie und Mikrobiologie, ENDO-Klinik, Hamburg, Deutschland

    L. Frommelt

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  1. B. Fink
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  2. P. Schäfer
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  3. L. Frommelt
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Correspondence to B. Fink.

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Fink, B., Schäfer, P. & Frommelt, L. Logistische Voraussetzungen und Probenentnahme bei periprothetischen Infektionen. Orthopäde 41, 15–19 (2012). https://doi.org/10.1007/s00132-011-1836-0

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