Author/Editor		Dolinar, Drago; Koritnik, Branko; Meglič-Volkar, Jelka; Lotrič-Furlan, Stanka
Title		Preprečevanje in principi zdravljenja proteznih okužb v ortopediji
Translated title		Prevention and principles of treatment prosthetic joint infections
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 76, št. 2
Publication year		2007
Volume		str. 117-24
Language		slo
Abstract		The infections of joint endoprostheses are relatively rare but they represent a major complication after the insertion of the artificial joint. For this reason it is very important to take measures in order to prevent these infections. The measures consist of the following procedures: the preparation of the patient for the operation, the perioperative antibiotic protection and the postoperative prevention of possible later hematogenically occurring infections. The aims of the treatmentof prosthetic infections are to stop or alleviate the inflammation, to prevent or reduce the chance of reoccurrence and to prevent a permanent, chronic infection. Clinically we try to achieve a functionally good result. The treatment is normally a combination of a surgical and a long-term antibiotic treatment. The patients with a stable implant, short-lived endoprosthetic infection with a microorganism susceptible to an antimicrobial agent can be successfully treated with debridement and specific antibiotics. In all other patients with a long-lived endoprosthetic infection and loose implant a more invasive procedure such as one-stage or even two-stage exchange has to be chosen. The treatment of orthopaedic implants is demanding and complicated. Therefore we think that such patients can get proper medical care only in specialized medical ceyatres. When the right treatment procedure has been chosen the prospects of a successful treatment outcome are favourable.
Summary		Okužbe sklepnih endoprotez so sorazmerno redke, vendar pomenijo resen zaplet po vstavitvi umetnega sklepa. Prav zato so pomembni ukrepi za preprečevanje nastanka proteznih okužb, ki vključujejo predoperativno pripravo bolnika, perioperativno antibiotično zaščito in kasnejše pooperativno preprečevanje možnih hematogeno nastalih okužb. Glavni cilj zdravljenja proteznih okužb je odstraniti ali umiriti vnetje, preprečiti oziroma zmanj.šati možnost ponovitve ali nastanka stalne, kronične okužbe, klinično pa skušamo doseči funkcionalno dober rezultat. Možnosti zdravljenja so različne. Običajno,je potrebno kom binirano kirurško in dolgotrajno usmerjeno antibiotično zdravljenje. Bolnike z neomajano, kratkotrajno endoprotezno okužbo in dokazano občutljivostjo povzročitelja na antibiotike uspešno zdravimo le z izrezanjem odmrlega tkiva (debridment) in ustreznimi antibiotiki. Pri bolnikih z dolgotrajnejšo okužbo ter omajano endoprotezo se običajno odločamo za obsežnejše operativne posege z enostopenjsko ali dvostopenjsko zamenjavo endoproteze ob sočasnem ustreznem antibiotičnem zdravljenju. Zdravljenje okužb ortopedskih vsadkov je zahtevno in zapleteno, zato menimo, da je primerno zdraviti te bolnike le v za to usposobljenih medicinskih centrih. Možnosti uspešnega zdravljenja so pri pravilno izbranem protokolu zdravljenja ugodne.
Descriptors		ORTHOPEDICS JOINT PROSTHESIS PROSTHESIS-RELATED INFECTIONS ANTIBIOTICS