Gelenkendoprothesen-Infektionen

Kernaussagen

• Die PJI-Inzidenz wird in der Literatur mit 0,3 – 1,7 % Infektionen für Hüft-TEP und mit 0,8 – 1,9 % für Knie-TEP angegeben.

• Staphylococcus spp. (S. aureus und koagulase-negative Staphylokokken) sind in mehr als der Hälfte aller Hüft- und Knie-TEP Infektionen die relevanten Erreger.

• Blutkulturen sollten als einfache und preisgünstige Methode zum Ausschluss eines bakteriämischen Geschehens in der diagnostischen Routine abgenommen werden.

• Der intraoperativen Diagnostik kommt ein entscheidender Stellenwert in der definitiven Diagnostik von PJI zu. Mindestens 3, besser aber 5 – 6 periprothetische Gewebeproben sollten zur kulturellen Diagnostik intraoperativ asserviert werden.

• Grundsätzlich existieren mehrere therapeutische und potenziell kurative Strategien, dazu gehören „Debridement, Antibiotics and Implant Retention (DAIR)“, einzeitiger und zweizeitiger Wechsel der infizierten Gelenkendoprothese.

• Die klinische Entscheidungsfindung wird sowohl durch aktuelle Leitlinien als auch durch die unverzichtbare interdisziplinäre Zusammenarbeit von Orthopäden und Infektiologen erheblich erleichtert.

• Literatur

• 1 Schnabel P, Borelli S. Endoprothesenregister. Höchsten Anforderungen genügen. Dtsch. Ärzteblatt 2011; 108 A-2598, B-2170, C-2142
• 2 Del Pozo JL, Patel R. Infection associated with prosthetic joints. N Engl J Med 2009; 361: 787-794
• 3 Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004; 351: 1645-1654
• 4 Osmon DR, Berbari EF, Berendt R et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Inf Dis 2012; 56: e1-e25
• 5 Giulieri SG, Graber P, Ochsner PE et al. Management of infection associated with total hip arthroplasty according to a treatment algorithm. Infection 2004; 32: 222-228
• 6 Sendi P, Banderet F, Graber P et al. Clinical comparison between exogenous and haematogenous periprosthetic joint infections caused by Staphylococcus aureus. Clin Microbiol Inf 2011; 17: 1098-1100
• 7 Peersman G, Laskin R, Davis J et al. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Rel Res 2001; 392: 15-23
• 8 Murdoch DR, Roberts S, Fowler Jr VG et al. Infection of orthopedic prostheses after Staphylococcus aureus bacteremia. Clin Inf Dis  2001; 32: 647-649
• 9 Pulido L, Ghanem E, Joshi A et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Rel Res 2008; 466: 1710-1715
• 10 Marculescu CE, Cantey JR. Polymicrobial prosthetic joint infections: risk factors and outcome. Clin Orthop Rel Res 2008; 466: 1397-1404
• 11 Berbari EF, Osmon DR, Duffy MCT et al. Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Inf Dis 2006; 42: 216-223
• 12 Rieg S, Kern W. Die nosokomiale Staphylococcus aureus-Bakteriämie. Krankenh hyg up2date 2011; 6: 261-274
• 13 Berbari EF, Marculescu C, Sia I et al. Culture-negative prosthetic joint infection. Clin Inf Dis 2007; 45: 1113-1119
• 14 Sperling JW, Kozak TK, Hanssen AD et al. Infection after shoulder arthroplasty. Clin Orthop Rel Res 2001; 382: 206-216
• 15 Marculescu CE, Berbari EF, Cockerill FR et al. Fungi, mycobacteria, zoonotic and other organisms in prosthetic joint infection. Clin Orthop Rel Res 2006; 451: 64-72
• 16 Bouvet C, Tchernin D, Seirafi M et al. No need to search for the source of haematogenous arthroplasty infections. Swiss Medical Weekly 2011; 141: w13306
• 17 Borde JP, Kern WV. [Treatment of MRSA infections]. Dtsch Med Wochenschrift 2012; 137: 2553-2557
• 18 Li Y-H, Tian X. Quorum sensing and bacterial social interactions in biofilms. Sensors 2012; 12: 2519-2538
• 19 Darouiche RO. Device-associated infections: a macroproblem that starts with microadherence. Clin Inf Dis 2001; 33: 1567-1572
• 20 Heilmann C. Adhesion mechanisms of staphylococci. Advances Experiment Med Biol 2011; 715: 105-123
• 21 Spangehl MJ, Masri BA, O’Connell JX et al. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg 1999; 81: 672-683
• 22 Berbari E, Mabry T, Tsaras G et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg (Am) 2010; 92: 2102-2109
• 23 Bottner F, Wegner A, Winkelmann W et al. Interleukin-6, procalcitonin and TNF-alpha: markers of peri-prosthetic infection following total joint replacement. J Bone Joint Surg (Br) 2007; 89: 94-99
• 24 Cuckler JM, Star AM, Alavi A et al. Diagnosis and management of the infected total joint arthroplasty. Orthop Clin N Am 1991; 22: 523-530
• 25 Glaudemans AW, Galli F, Pacilio M et al. Leukocyte and bacteria imaging in prosthetic joint infection. Eur Cells & Materials 2013; 25: 61-77
• 26 Bedair H, Ting N, Jacovides C et al. The Mark Coventry Award: diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Rel Res 2011; 469: 34-40
• 27 Trampuz A, Hanssen AD, Osmon DR et al. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med 2004; 117: 556-562
• 28 Schinsky MF, Della Valle CJ, Sporer SM et al. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg (Am) 2008; 90: 1869-1875
• 29 Trampuz A, Piper KE, Jacobson MJ et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 2007; 357: 654-663
• 30 Portillo ME, Salvadó M, Trampuz A et al. Sonication versus vortexing of implants for diagnosis of prosthetic joint infection. J Clin Microbiol 2013; 51: 591-594
• 31 Marín M, Garcia-Lechuz JM, Alonso P et al. Role of universal 16S rRNA gene PCR and sequencing in diagnosis of prosthetic joint infection. J Clin Microbiol 2012; 50: 583-9
• 32 Senthi S, Munro JT, Pitto RP. Infection in total hip replacement: meta-analysis. Int Orthop 2011; 35: 253-260
• 33 Waldman BJ, Hostin E, Mont MA et al. Infected total knee arthroplasty treated by arthroscopic irrigation and débridement. J Arthoplasty 2000; 15: 430-436
• 34 Zimmerli W, Widmer AF, Blatter M et al. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. J Am Med Assoc 1998; 279: 1537-1541
• 35 Arciola CR, Montanaro L, Costerton JW. New trends in diagnosis and control strategies for implant infections. Int J Artific Organs 2011; 34: 727-736