Berberich Christof, Kühn Klaus-Dieter, Alt Volker
Heraeus Medical GmbH, Philipp-Reis-Str. 8/11, 61273, Wehrheim, Deutschland.
Universitätsklinik für Orthopädie und Orthopädische Chirurgie, Medizinische Universität Graz, Graz, Österreich.
Orthopadie (Heidelb). 2023 Dec;52(12):981-991. doi: 10.1007/s00132-023-04447-6. Epub 2023 Oct 13.
There is widespread consensus that adjuvant local use of antimicrobial agents in combination with their systemic administration can better prevent and treat implant-associated musculoskeletal infections. The advantage of local antibiotics lies in their particular pharmacokinetics with initially high antibiotic concentrations at the implant site with only low systemic uptake.
The aim of local application is to protect the foreign bodies directly at the implantation site from bacterial colonization and biofilm formation (prophylaxis) and to support the eradication of an already established infection after surgical debridement (treatment). Since the observations of Prof. Buchholz, bone cement has been the most frequently used local carrier system.
In cases of infection, surgeons should ideally work together with microbiologists, infectiologists or clinical pharmacists to determine which anti-infective agents are indicated systemically for the patient and which ones are indicated locally with PMMA cement, based on the pathogen(s) and antibiograms. However, for the anti-infective agents administered with bone cement, there is still uncertainty about which agents can be added to this carrier material and at what concentrations. Accordingly, the authors of this review article not only summarize the rationale and evidence for local antibiotic use but also elaborate on the points that must be considered for admixing these agents to the cement.
广泛的共识是，抗菌剂局部使用与全身给药相结合能够更好地预防和治疗植入相关的肌肉骨骼感染。局部使用抗生素的优势在于其特殊的药代动力学，即植入部位最初的抗生素浓度高，而全身吸收低。
局部应用的目的是直接保护植入部位的异物免受细菌定植和生物膜形成（预防），并在手术清创后支持根除已形成的感染（治疗）。自布赫霍尔茨教授的观察以来，骨水泥一直是最常用的局部载体系统。
在感染病例中，理想情况下外科医生应与微生物学家、感染病学家或临床药剂师合作，根据病原体和抗菌谱确定哪些抗感染药物适合患者全身使用，哪些适合与聚甲基丙烯酸甲酯（PMMA）骨水泥局部使用。然而，对于与骨水泥一起使用的抗感染药物，仍不确定哪些药物可以添加到这种载体材料中以及添加的浓度。因此，这篇综述文章的作者不仅总结了局部使用抗生素的基本原理和证据，还详细阐述了将这些药物混入骨水泥时必须考虑的要点。
