PERİPROSTETİK EKLEM ENFEKSİYONU TEDAVİSİNDE ANTİBİYOTİK KULLANIMI

Mustafa Bulut

Aksaray Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, Aksaray, Türkiye

Bulut M. Periprostetik eklem enfeksiyonu tedavisinde antibiyotik kullanımı. Karaaslan F. editör. Periprostetik Eklem Enfeksiyonunda Tanı ve Tedavi. 1. Baskı. Ankara: Türkiye Klinikleri; 2024. p.75-83.

ÖZET

Artan nüfus ve yaş ile birlikte toplumda artroplasti sayısı artmaktadır. Artan sayı nedeniyle enfeksiyon sayısındada artış beklenmektedir. Periprostetik eklem enfeksiyonları(PEE) primer vakalarda %1 civarında gözükmekte iken, revizyon vakalarda bu oran %8-10’u bulabilmektedir. Primer vakaların revizyon sebeplerinin hala en büyük sebebi PEE’dir. Antibiyotik direnci ve yaş ortalamasının yükselmesi ile komorbiditelerin artmasıda tedavinin zor olma sebeplerindendir. PEE hastalarına birden fazla ameliyat, uzun süreli hastanede yatış ve uzun süreli antimikrobiyal tedavi gerekmesi nedeniyle ciddi bir sorundur. PEE?larında literatürde bir çok tedavi şekli tanımlanmıştır. Bunlar; Antibiyotik tedavisi, Debridman, Antibiyotik ve İmplantların Korunması olarak bilinen DAIR prosedürü, tek seans revizyon, iki seans revizyon, artrodez ve ampütasyondur. Antibiyotik tedavisi ise; ‘ampirik antibiyotik tedavisi, patojene spesifik antibiyotik tedavisi ve baskılayıcı antibiyotikler ile tedavi yönetimi’ olarak çeşitlendirilebilir. Ampirik antibiyotik tedavisi; kültür sonucu olmadan ameliyat sonrası ilk 24-72 saat içinde verilen geniş spektrumlu antibiyo- tiklerdir. Sıklıkla hastalarda ampirik olarak piperasilin-tazobaktam veya sefepime ek olarak vankomisin eklenir. Patojene spesifik antibiyoterapide ise; kültürde üremiş patojene antibiyogramlarda bakılan du- yarlı olduğu antibiyotikler verilir. Kültürde en sık S. aureus üremesi gözlenir. Patojen spesifik antibiyo- terapinin önemi ise gereksiz antibiyotik kullanımını azaltmak ve olası yan etkiyi minimalize etmektir. Son yıllarda artan antibiyotik dirençlerinden dolayı patojen spesifik antibiyoterapi önem kazanmaktadır. Baskılayıcı antibiyoterapide ise ilk intravenöz tedavi sonrası devam edilen oral antibiyotikler ile devam edilmesidir. Baskılayıcı antibiyoterapi özellikle yaşlı hastalarda etkili ve güvenli bir tedavi yöntemidir. PEE tedavisinde antibiyoterapinin enfeksiyon hastalıkları uzmanı ve ortopedi uzmanları tarafından tedavi protokollerine uyularak verilmesi tedavinin başarısı açısıdan önemlidir.

Anahtar Kelimeler: Artroplasti; Replasman; Protez kaynaklı enfeksiyonlar; Antibakteriyel ajanlar; Antibiyotik proflaksisi

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