Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Doškolování / In-service training

ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSL.,
84, 2017, p. 219 - 230

Infekce endoprotéz - doporučení antibiotické léčby Společné doporučení České společnosti pro ortopedii a traumatologii a Společnosti infekčního lékařství České lékařské společnosti J. E. Purkyně

Endoprosthesis Infections - Guidelines for Antibiotic Therapy Common Guidelines of the Czech Society for Orthopaedics and Traumatology and the Society for Infectious Diseases of the Czech Medical As

D. MUSIL1,2, M. BALEJOVÁ3, M. HORNÍKOVÁ3, A. CHRDLE4, N. MALLÁTOVÁ3, O. NYČ5, V. CHMELÍK4, J. GALLO6, D. JAHODA7, J. STEHLÍK1,2
1 Ortopedické oddělení, Nemocnice České Budějovice, a. s.
2 Ústav fyzioterapie a vybraných medicínských oborů, Zdravotně sociální fakulta, Jihočeská univerzita v Českých Budějovicích
3 Laboratoř klinické mikrobiologie, Nemocnice České Budějovice, a. s.
4 Infekční oddělení, Nemocnice České Budějovice, a. s.
5 Ústav lékařské mikrobiologie, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
6 Ortopedická klinika, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc
7 1. ortopedická klinika, 1. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole, Praha

ABSTRACT

PURPOSE OF THE STUDY

This study aims to articulate regional guidelines for curative and suppressive antibiotic therapy of total joint replacement infections.

MATERIAL AND METHODS

When developing the standard, used as source materials were the published foreign guidelines for antibiotic therapy of prosthetic joint infections, the analysis of resistance of bacterial strains conducted in the Hospital in České Budějovice, a.s. and the assessment of strain resistance for the Czech Republic published by the European Antimicrobial Resistance Surveillance Network (EARS-Net). Considered was also the availability of individual antibiotics in the Czech Republic and restricted prescription according to the Summary of Product Characteristics as specified in the State Institute for Drug Control marketing authorisation.

The expert group composed of orthopaedists, microbiologists and infectious disease specialists elaborated the basic antibiotic guideline for choosing an appropriate antibiotic/antifungal drug based on the usual susceptibility, its dose and dosage interval for initial and continuation therapy. The comments of individual specialists were gradually incorporated therein and in case of doubts majority rule was applied. The drafted document was sent for peer reviews to clinical orthopaedic, infectious disease and microbiological centres, whose comments were also incorporated and the finalised document was submitted for evaluation to specialised medical societies.

RESULTS

The outcome is the submitted guideline for antibiotic curative and suppressive therapy suitable for managing the prosthetic joint infections, which was approved by the committee of the Czech Society for Orthopaedics and Traumatology andthe Society for Infectious Diseases of the Czech Medical Association of J. E. Purkyně.

DISCUSION

Curative therapy of total joint replacement infections consists primarily in surgical treatment and has to be accompanied by adequate antibiotic therapy administered initially intravenously and later orally over a sufficient period of time. Bearing in mind the wide spectrum of pathogens that can cause infections of a joint replacement and their capacity to form a biofilm on foreign materials, the correct choice of an antibiotic, its dose and dosage interval are essential for successful treatment. Such standard should respect regional availability of antibiotics, regional pathogen resistance/susceptibility and ensure the achievement of sufficiently high concentrations at the requested location including anti-biofilm activity.

CONCLUSIONS

The submitted guideline is not the only treatment option for joint total replacement infections, but it makes the decision-making easier when treating these complications in the form of infections. The final choice of an antibiotic, its dose and duration of therapy shall be based on a critical assessment of results of microbiological (blood culture and molecular genetic) tests and reflect the patient s clinical condition. Since these are multidisciplinary issues, we consider useful for this guideline to be commented upon and approved by the committee of both the Society for Orthopaedics and Infectious Diseases so that it can become the starting point for treatment.

Key words: total joint replacement infection, TEP, ATB, antibiotic therapy, consensus meeting, guideline

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