PERİPROSTETİK EKLEM ENFEKSİYONUN ÖNLENMESİ

Dr. Sinan Yılmaz

Memorial Ankara Hastanesi, Ortopedi ve Travmatoloji Kliniği, Ankara, Türkiye

Yılmaz S. Periprostetik Eklem Enfeksiyonun Önlenmesi. Karaaslan F. editör. Periprostetik Eklem Enfeksiyonunda Tanı ve Tedavi. 1. Baskı. Ankara: Türkiye Klinikleri; 2024. p.23-32.

ÖZET

Periprostetik eklem enfeksiyonu (PEE), total eklem replasmanını takiben nispeten nadir görülen ancak yıkıcı bir komplikasyondur. Revizyonların %25’ten fazlasının bu enfeksiyonlara atfedildiği ve bu oranın artmasının beklendiği belirtiliyor. PEE, artroplasti cerrahisinden sonra herhangi bir zamanda ortaya çıkabilse de çoğunluğu prosedürünün ilk 2 yılı içinde teşhis edilir. PEE tanısı, enfeksiyon tedavisiyle ilişkili morbiditenin ötesinde önemli etkilere sahiptir. PEE, %2,7 ila %18 arasında bir mortalite oranıyla ilişkilendirilmiştir; bu, primer eklem replasmanı ve aseptik revizyon cerrahisiyle ilişkili mortalite oranlarının çok üzerindedir. Dahası, hem hasta hem de sağlık sistemi tarafından PEE tedavisinin ardından ortaya çıkan maliyet, birincil total eklem artroplastisinin (TJA) maliyetinin yaklaşık 4 katıdır. Nüfus demografisindeki değişiklikler göz önüne alındığında, bu zor en- feksiyonları tedavi etmenin yükü zamanla artacaktır. Kurtz ve ark. tarafından yapılan çalışmalarda, 2030 yılına kadar Amerika Birleşik Devletleri’nde her yıl gerçekleştirilen primer total diz artroplastilerinde %673 ve primer total kalça artroplastilerin de %174 artış olacağını göstermektedir. Her yıl gerçekleştirilen revizyon artroplasti- lerin sayısında da önemli artışlar beklenmektedir. Risk altındaki nüfusun büyümesi göz önüne alındığında, etkili enfeksiyon önleme stratejileri uygulamak için her türlü çaba gösterilmelidir. PEE gelişimiyle ilişkili birden fazla faktör vardır; bunlar arasında hasta ile ilgili faktörler, cerrahi faktörler, çevresel faktörler ve ilaca dirençli mikro- organizmaların ortaya çıkması bulunur. Etkili önleme stratejileri, bu faktörleri ameliyat öncesi, ameliyat sırasın- da ve ameliyat sonrası ortamlarda ele almalıdır. Bu bölümün amacı, özellikle Staphylococcus aureus taraması ve dekolonizasyonuna vurgu yapılarak bilinen PEE önleme stratejilerini gözden geçirmek olacaktır.

Anahtar Kelimeler: Artroplasti; Artroplasti, Replasman; Önleme ve kontrol

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