Cementni spejser sa antibiotskim sadržajem za lečenje bolesnika sa totalnom artroplastikom kuka i kolena inficiranih bakterijom Klebsiella

  • Radoslav Barjaktarović Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia
  • Dragan Radoičić Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia
  • Milorad Mitković Clinic for Orthopedic Surgery and Traumatology, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
DOI: https://doi.org/10.2298/4282
Ključne reči: arthroplasty, replacement, hip||, ||artroplastika kuka, knee||, ||artroplastika kolena, bacterial infections||, ||infekcija, bakterijska, klebsiella||, ||klebsiella, orthopedic procedures||, ||ortopedske procedure, anti-bacterial agents||, ||antibiotici, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod/Cilj. Infekcije totalnih artroplastika kuka (THA) i totalnih artroplastika kolena (TKA) mogu imati teške posledice. Neke baterije su češći uzročnici, druge se javljaju ređe, ali su ponekad te infekcije opterećene težim tokom i komplikacijama. Klebsiella bakterije su retki uzročnici ovih infekcija. Cilj rada bio je identifikacija efikasnog algoritma za lečenje infekcija THA i TKA koje izaziva Klebsiella. Metode. U 3-godišnjem periodu, od 1. januara 2009. do 31. decembra 2011, registrovali smo i lečili pet bolesnika sa THA ili TKA infekcijom uzrokovanom multirezistentnim sojem bakterije Klebsiella. Svi bolesnici su primarno operisani u drugim ustanovama, a u našu kliniku su bili primljeni posle pojave znakova infekcije. Kod tri bolesnika infekcija bakterijom Klebsiella bila je komplikovana dodatnom infekcijom (Staphyloccocus aureus, Pseudomonas aeruginosa i Serratia marscescens). Kod tri bolesnika izvedena je reviziona artroplastika nakon dvostruke izmene antibiotskog cementnog spejsera, a kod dva bolesnika reviziona artroplastika sa jednom izmenom spejsera. Rezultati. Srednja vrednost perioda praćenja bila je 17,1 mesec (od 2 do 31). Jedan bolesnik preminuo je dva meseca nakon druge reimplantacione procedure. Klebsiella infekcije izlečene su kod svih bolesnika. Na kraju perioda praćenja nakon definitivne reimplantacija, bolesnici nisu imali kliničkih, laboratorijskih, niti mikrobioloških parametara pozitivnih na prisustvo aktivne infekcije. Zaključak. Nakon našeg iskustva sa TKA/THA infekcijama prouzrokovanim multirezistentnim sojevima bakterije Klebsiella ustanovili smo da je pristup sa dvostrukom izmenom artikularnih cementnih spejsera pre definitivne reimplantacije najefikasnija opcija lečenja.

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Objavljeno
2015/04/24
Broj časopisa
Vol. 71 Br. 10 (2014)
Rubrika
Kratko saopštenje