| Dokumentenart: | Artikel | ||||
|---|---|---|---|---|---|
| Titel eines Journals oder einer Zeitschrift: | Zeitschrift für Rheumatologie | ||||
| Verlag: | SPRINGER HEIDELBERG | ||||
| Ort der Veröffentlichung: | HEIDELBERG | ||||
| Band: | 82 | ||||
| Nummer des Zeitschriftenheftes oder des Kapitels: | 10 | ||||
| Seitenbereich: | S. 859-866 | ||||
| Datum: | 2023 | ||||
| Institutionen: | Medizin > Lehrstuhl für Orthopädie | ||||
| Identifikationsnummer: |
| ||||
| Stichwörter / Keywords: | PERIPROSTHETIC JOINT INFECTION; DEBRIDEMENT; FAILURE; HIP; IRRIGATION; RETENTION; DIAGNOSIS; Endoprosthesis infection; Biofilm formation; Surgical debridement; <middle dot> Antibiotic treatment; Spacers | ||||
| Dewey-Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin | ||||
| Status: | Veröffentlicht | ||||
| Begutachtet: | Ja, diese Version wurde begutachtet | ||||
| An der Universität Regensburg entstanden: | Ja | ||||
| Dokumenten-ID: | 75714 |
Web of ScienceZusammenfassung
Background: Endoprosthesis infections represent a major challenge for doctor sand patients. Due to the increase in endoprosthesis implantation because of the increasing life expectancy, an increase in endoprosthesis infections is to be expected. In addition to infection prophylaxis, methods of infection control become highly relevant,especially in the group of geriatric and multi morbid patients. ...
Zusammenfassung
Background: Endoprosthesis infections represent a major challenge for doctor sand patients. Due to the increase in endoprosthesis implantation because of the increasing life expectancy, an increase in endoprosthesis infections is to be expected. In addition to infection prophylaxis, methods of infection control become highly relevant,especially in the group of geriatric and multi morbid patients. The aim is to reduce the high 1-year mortality from prosthesis infections through a structured algorithm.Algorithm for prosthesis infections:Prosthesis infections can basically be divided into early and late infections. According to the criteria of the International Consensus Meeting, a late infection is defined as the occurrence more than 30 days after implantation. With respect to the planned approach, the (p)TNM classification offers an orientation. In the early postoperative interval the clinical appearance iscrucial as in this phase neither laboratory parameters nor an analysis of synovial fluid show a high sensitivity. It is fundamental that, apart from patients with sepsis,environment diagnostics should be initiated. If a late infection is suspected, inaddition to radiological diagnostics (X-ray, skeletal scintigraphy and if necessary,computed tomography, CT), laboratory (C-reactive protein, CRP, leukocytes, bloodsed imentation, and if necessary, interleukin-6, procalcitonin) and microbiologicaldiagnostics (arthrocentesis with synovial analysis and microbiology) are indicated;however, in addition to the arthrocentesis result, the clinical appearance is crucialin cases where an exclusion cannot be confirmed by laboratory parameters. If an infection is confirmed, the treatment depends on the spectrum of pathogens, the soft tissue situation and the comorbidities, including a multistage procedure with temporary explantation and, if necessary, implantation of an antibiotic-containing spacer is necessary. A prosthesis preservation using the debridement, antibiotics and implant retention (DAIR) regimen is only appropriate in an acute infection situation.Basically, radical surgical debridement should be carried out to reduce the pathogen load and treatment of a possible biofilm formation for both early and late infections.The subsequent antibiotic treatment (short or long interval) should be coordinated with the infectious disease specialists.Conclusion:A structured approach for prosthesis infections oriented to an evidence-based algorithm provides a sufficient possibility of healing. An interdisciplinary approach involving cooperation between orthopedic and infectious disease specialistshas proven to be beneficial. Surgical treatment with the aim of reducing the bacterialload by removing the biofilm with subsequent antibiotic treatment is of intrinsicimportance
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