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Krankenhaushygiene up2date 2013; 08(02): 89-102
DOI: 10.1055/s-0033-1344206
Nosokomiale Infektionen
© Georg Thieme Verlag KG Stuttgart · New York

Gelenkendoprothesen-Infektionen

Johannes P. Borde
,
Peter Helwig
,
Oliver Hauschild
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Publication Date:
04 July 2013 (online)

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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.

 

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