Kühn Klaus-Dieter, Renz Nora, Trampuz Andrej
Universitätsklinik für Orthopädie und Orthopädische Chirurgie, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich.
Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland.
Unfallchirurg. 2017 Jul;120(7):561-572. doi: 10.1007/s00113-017-0372-8.
The treatment of superficial wound infections with local antibiotics is considered to be problematic as it is accompanied by an increased risk of resistance development and ineffectiveness in deeper regions. On the contrary, the local application of antibiotics is useful in arthroplasty and necessary if implants are utilized. The reason for this is the prevention of a rapid biofilm formation on foreign implants and a resulting infection may remain undiscovered until it becomes chronic. Apart from exogenous material, necrotic tissue (e. g. bone sequestra) provides suitable retreat areas for pathogens in the body. Because of the characteristics of bone and joint infections and an exceptional infection recurrence rate, a combined approach is required. Systemic antibiotic prophylaxis is able to reduce the number of pathogens acquired by perioperative contamination or hematogenic spread from another focus of infection; however, systemically applied antibiotics often fail to form an effective colonization barrier around the implant because their ability to penetrate the bone is relatively low. On the other hand, the high concentration of locally released antibiotics leads to an effective protection of the implant from bacteria in situ. Thus, for the treatment of implant-associated infections, systemic and local application of anti-infective agents is a reliable adjuvant measure that improves the therapeutic success. Polymethylmethacrylate (PMMA) bone cement is the most commonly used local drug carrier. Based on clinical and microbiological results, microbiologists and infectious disease experts together with the surgeon and pharmacist determine which anti-infective agents are indicated for systemic and local, PMMA cement-related application. Because there is no evident concept for the local application, unlike the recommendation for systemic use of anti-infective agents, this review article describes which aspects should be taken into account.
用局部抗生素治疗浅表伤口感染被认为存在问题，因为这会增加耐药性发展的风险，且在较深部位效果不佳。相反，抗生素的局部应用在关节置换术中很有用，如果使用植入物则是必要的。其原因在于可防止异物植入物上快速形成生物膜，否则由此引发的感染可能直到变为慢性才被发现。除了外源性物质，坏死组织（如骨死骨）为体内病原体提供了合适的隐匿场所。由于骨和关节感染的特点以及极高的感染复发率，需要采取联合治疗方法。全身性抗生素预防能够减少围手术期污染或血源性传播从另一个感染灶获取的病原体数量；然而，全身应用的抗生素往往无法在植入物周围形成有效的定植屏障，因为它们穿透骨骼的能力相对较低。另一方面，局部释放的高浓度抗生素能有效保护植入物免受原位细菌侵害。因此，对于治疗与植入物相关的感染，全身和局部应用抗感染药物是一种可靠的辅助措施，可提高治疗成功率。聚甲基丙烯酸甲酯（PMMA）骨水泥是最常用的局部药物载体。根据临床和微生物学结果，微生物学家、传染病专家与外科医生和药剂师共同确定哪些抗感染药物适用于全身及与PMMA骨水泥相关的局部应用。由于局部应用没有明确的概念，与抗感染药物全身性应用的推荐不同，这篇综述文章描述了应考虑哪些方面。
