Prävention und Diagnostik von periprothetischen Infektionen

Die periprothetische Infektion ist eine schwerwiegende Komplikation im Bereich der Endoprothetik, die nur sehr aufwendig saniert werden kann. Neben der Prävention ist die Kenntnis über eine effiziente Diagnostik entscheidend für den Erfolg der Therapie. In diesem Beitrag wird die aktuelle Empfehlung zur Prävention vor elektiver endoprothetischer Versorgung und die Diagnostik einer periprothetischen Infektion unter Berücksichtigung der Empfehlungen des International Consensus Meeting 2018 zusammengefasst.

Kernaussagen

• Im Bereich der Endoprothetik ist die periprothetische Infektion (PPI) eine schwerwiegende Komplikation, die nur sehr aufwendig saniert werden kann.

• Es wurden bereits zahlreiche Faktoren identifiziert, die das Risiko für das Auftreten einer PPI verringern können.

• Unterschieden werden dabei patientenbezogene und perioperative Faktoren, die kritisch evaluiert bzw. während der perioperativen Phase optimiert werden sollten.

• Bei Verdacht auf eine Infektion sollte eine frühzeitige und effiziente Diagnostik durchgeführt werden.

• Für die weitere Therapie spielt die Unterteilung in akute und chronische PPI eine wichtige Rolle.

• Die aktuelle Strategie zur Diagnostik einer PPI nach den Empfehlungen des International Consensus Meetings 2018 (ICM) kann sowohl für Kniegelenks- als auch für Hüftgelenksendoprothesen verwendet werden (hohe Sensitivität und Spezifität). Sie beinhaltet eine Kombination aus prä- und postoperativen Kriterien, wobei der Punktion eine besondere Rolle zugesprochen wird. Des Weiteren ermöglicht sie eine frühere Diagnose einer PPI und schließt zudem Patienten ein, bei denen die Diagnose einer PPI unklar ist.

Schlüsselwörter

Endoprothetik - periprothetische Infektion - Erregernachweis - Hüftgelenksprothese - Kniegelenksprothese

Publication History

Article published online:
26 May 2021

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