The diagnosis, treatment and management of prosthetic joint infections Protez enfeksiyonlarının tanı, tedavi ve yönetimi

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GÜL H. C., ARTUK C., YILDIZ C.

Journal of Clinical and Analytical Medicine, cilt.4, sa.4, 2013 (Scopus, TRDizin)

Özet

Implanting prostheses to the joints are frequent surgical procedures today. The improvements in medical technology and surgical techniques in recent years have decreased the risk of infection. Prosthesis infections (PIs) are classified into two categories according to their onset and clinical parameters. Classifying due to the onset is the most frequently used method. According to this approach the infections are labeled as early, delayed and late. Although numerous microorganisms cause PI, the most frequent causative agents are staphylococci. In early PIs the most common agents are gr (-) bacilli and Staphylococcus aureus, while coagulase negative staphylococci are more frequent in delayed PIs. In the diagnosis of PIs sonification of the prostheses is the new diagnostic methodology along with clinical, microbiological, pathological, and radiological methods. Today, combined medical and surgical approaches are preferred in the management of PIs. Debridement, DAIR (Debridement, Antibiotics, Implant retention) and replacement arthroplasties are applied as the surgical procedures. Replacement arthroplasties are performed in one or two steps. One of the most critical issues in the management of PIs is the duration of treatment. In general, antibiotics are given for three months in hip PIs, for six months in knee PIs. However, the duration of antibiotic therapy is interrelated to the surgical procedure applied. In debridement, DAIR, an one-step replacement arthroplasties the durations are three and six months in hip and knee PIs respectively. But, in two-steps replacement arthroplasties the duration of treatment was determined as six weeks unless a new infection ensues. Antimicrobial prohylaxis, laminar air flows in the operation rooms, special surgical clothing, the use antibiotic impregnated cement have key roles in the prevention of PIs. In this paper, we aimed to review current concepts in the diagnosis, management, and prevention of PIs.