Profilassi antibiotica perioperatoria nella chirurgia protesica

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profilassi antibiotica perioperatoria nella chirurgiaprotesica dell’anca e del ginocchio15linee guida siotimplementazione, aggiornamento, revisioneQuesto documento si intende efficace ed aggiornato almomento della sua presentazione attuale, ma prevedeun costante processo di revisione ed aggiornamento cheandrà basato sulle nuove informazioni eventualmenteprovenienti dalla letteratura. In particolare è importanteconsiderare quanto esposto a proposito dell’evoluzionedei fenomeni e delle caratteristiche di resistenza dei microrganismiche peraltro possono variare a seconda dellespecifiche realtà epidemiologiche locali. Con scadenzeprestabilite andrà valutato inoltre l’impatto dell’applicazionedelle attuali Linee Guida di profilassi antibioticaperioperatoria sulla fl ora microbica delle singole realtàospedaliere tenendo in debito conto la frequenza e latipologia degli isolamenti batterici. Sulla base di questiriscontri sarà possibile, se necessario, valutare modifichealle raccomandazioni attuali. Inoltre sono auspicabiliprocedure periodiche di audit che consentano, sullabase anche delle esigenze e dei rilievi effettuati da tuttoil personale sanitario coinvolto nell’applicazione deiprotocolli, di rivalutare nel tempo le eventuali problematicheconnesse alla sua applicazione.schema riassuntivo della profilassi antibiotica in chirurgia protesicaefficaciaantibiotico di sceltavia di somministrazioneprima dosetimingdimostratanon vi è un’indicazione assoluta: sono raccomandate cefalosporine di I-II generazione,in alternativa possono essere presi in considerazione i glicopeptidi in casodi elevate incidenze/maggiore rischio d’infezione da MRSAendovenosa30-60 min prima dell’incisionemantenere livelli sierici e tessutali adeguati per tutta la durata dell’intervento (considerarela farmacocinetica del farmaco scelto)durata Breve termine (24 h)bibliografia1Mangram AJ, Horan TC, Pearson ML, etal. Guideline for prevention of surgical siteinfection, 1999. Hospital Infection ControlPractices Advisory Committee. Infect ControlHosp Epidemiol 1999;20:250-278.2Kirkland KB, Briggs JP, Trivette SL, et al.The impact of surgical-site infections in the1990s: attributable mortality, excess lengthof hospitalization, and extra costs. InfectControl Hosp Epidemiol 1999;20:725-30.3Weinstein RA. Nosocomial infection update.Emerg Infect Dis 1998;4:416-20.4Silver A, Eichorn A, Kral J, et al. The antibioticprophylaxis study group. Timelinessand use of antibiotic prophylaxis in selectedinpatient surgical procedures. Am J Surg1996;171:548-52.5Ronveaux O, Mertens R, Jans B, et al.Methods in surgical antibacterial prophylaxisin Belgium, 1992-1995. Acta Clin Belg1996;51:386-94.6Evans RS, Pestotnik SL, Burke JP, et al. Reducingthe duration of prophylactic antibioticuse through computer monitoring of surgicalpatients. DICP (The Annals of Pharmacotherapy)1990;24:351-4.7Motola G, Russo F, Mangrella M, et al. Antibioticprophylaxis for surgical procedures:a survey from an Italian university hospital. JChemother 1998;10 375-80.8Gorecki P, Schein M, Rucinski JC, et al. Antibioticadministration in patients undergoingcommon surgical procedures in a communityteaching hospital: the chaos continues.World J Surg 1999;23:429-32.9Vaisbrud V, Raveh D, Schlesinger Y, et al.Surveillance of antimicrobial prophylaxis forsurgical procedures. Infect Control Hosp Epidemiol1999;20:610-3.10Codina C, Trilla A, Riera N, et al. Perioperativeantibiotic prophylaxis in spanishhospitals: results of a questionnairesurvey. Infect Control Hosp Epidemiol1999;20:436-9.11Zoutman D, Chau L, Watterson J, et al. A canadiansurvey of prophylactic antibiotic useamong hip-fracture patients. Infect ControlHosp Epidemiol 1999;20:752-5.12Bailly P, Lallemand M, Thouverez M, et al.Multicentre study on the appropriateness ofsurgical antibiotic prophylaxis. J Hosp Infect2001;49:135-8.13Dettenkofer M, Forster DH, Ebner W, etal. The practice of perioperative antibioticprophylaxis in eight German hospitals. Infection2002;30:164-7.14Burke JP. Maximizing appropriate antibioticprophylaxis for surgical patients: an updatefrom LDS Hospital, Salt Lake City. Clin InfectDis 2001;33(Suppl.2):S78-83.15Berry DJ, Bozic K. Current practice patternsin primary hip and knee arthroplasty amongmembers of the American Association ofHip and Knee Surgeons. J Arthroplasty2010;25(6 Suppl):2-4.16de Beer J, Petruccelli D, Rotstein C, et al.Antibiotic prophylaxis for total joint replacementsurgery: results of a survey ofCanadian orthopedic surgeons. Can J Surg2009;52:E229-34.17Carlsson AS, Lidgren L, Lindberg L. Prophylacticantibiotics against early and late deepinfections after total hip replacements. ActaOrthop Scand 1977;48:405-10.
16gruppo di lavoro linee guida siotlinee guida siot18Pollard JP, Hughes SP, Scott JE, et al. Antibioticprophylaxis in total hip replacement.BMJ 1979;1:707-9.19Schulitz KP, Winkelman W, Schoening B. Theprophylactic use of antibiotics on alloarthroplastyof the hip joint for coxarthrosis. ArchOrthop Trauma Surg 1980;96:79-82.20Hill C, Flamant R, Mazas F, et al. Prophylacticcefazolin versus placebo in total hip replacement.Report of a multicentre double-blindrandomised trial. Lancet 1981;1:795-6.21Fitzgerald RH Jr, Thompson RL. Cephalosporinantibiotics in the prevention andtreatment of musculoskeletal sepsis. J BoneJoint Surg Am 1983:65:1201-5.22Gunst JP, Deletang S, Rogez MJ, et al. Prophylacticantibiotic therapy by cefamandolein total hip surgery replacement usingCharnley’s tent: a randomized study. PatholBiol (Paris) 1984;32:567-9.23Doyon F, Evrard J, Mazas F, et al. Longtermresults of prophylactic cefaxolin versusplacebo in total hip replacement. Lancet1987;1:860.24Heath AF. Antimicrobial prophylaxis for arthroplastyand total joint replacement: discussionand review of published clinical trials.Pharmacotherapy 1991;11:157-63.25Norden CW. Antibiotic prophylaxis in orthopaedicsurgery. Rev Infect Dis 1991;13(Suppl 10):842-6.26Gillespie WJ, Walenkamp GH. Antibioticprophylaxis for surgery for proximalfemoral and other closed long bonefractures. Cochrane Database Syst Rev2010;3:CD000244.27AlBuhairan B, Hind D, Hutchinson A. Antibioticprophylaxis for wound infections intotal joint arthroplasty: a systematic review. JBone Joint Surg Br 2008;90:915-9.28Charnley J. The long-term results of lowfrictionarthroplasty of the hip performed asa primary intervention. J Bone Joint Surg Br197;54:61-76.29Charnley J. Postoperative infection after totalhip replacement with special reference to aircontamination in the operating room. ClinOrthop Relat Res 1972;87:167-87.30Fitzgerald RH Jr, Nolan DR, Ilstrup DM,et al. Deep wound sepsis following totalhip arthroplasty. J Bone Joint Surg Am1977;59:847-55.31Salvati EA, Robinson RP, Zeno SM, et al. Infectionrates after 3175 total hip and total kneereplacements performed with and without ahorizontal unidirectional filtered air-flow system.J Bone Joint Surg Am 1982;64:525-35.32Lidwell OM, Elson RA, Lowbury EJ, et al. Ultracleanair and antibiotics for prevention ofpostoperative infection. A multicenter studyof 8,052 joint replacement operations. ActaOrthop Scand 1987;58:4-13.33Eftekhar NS, Tzitzikalakis GI. Failuresand reoperations following low-friction arthroplastyof the hip. A five-to fifteen-yearfollow-up study. Clin Orthop Relat Res1986;211:65-78.34Brady LP, McCutchen JW. A ten-yearfollow-up study of 170 Charnley totalhip arthroplasties. Clin Orthop Relat Res1986;211:51-4.35Schutzer SF, Harris WH. Deep-wound infectionafter total hip replacement under contemporaryaseptic conditions. J Bone JointSurg Am 1988;70:724-7.36Wilson MG, Kelley K, Thornhill TS. Infectionas a complication of total knee replacementarthroplasty. Risk factors and treatmentin sixty-seven cases. J Bone Joint Surg Am1990;72:878-83.37Bengtson S, Knutson K. The infected knee arthroplasty.A 6-year follow-up of 357 cases.Acta Orthop Scand 1991;62:301-11.38Fitzgerald RH Jr. Total hip arthroplasty sepsis.Prevention and diagnosis. Orthop ClinNorth Am 1992;23:259-64.39Schmalzried TP, Amstutz HC, Au MK, et al.Etiology of deep sepsis in total hip arthroplasty.The significance of hematogenousand recurrent infections. Clin Orthop RelatRes 1992;280:200-7.40Wymenga AB, van Horn JR, Theeuwes A,et al. Perioperative factors associated withseptic arthritis after arthroplasty. Prospectivemulticenter study of 362 knee and2,651 hip operations. Acta Orthop Scand1992;63:665-71.41Espehaug B, Engesaeter LB, Vollset SE, etal. Antibiotic prophylaxis in total hip arthroplasty.Review of 10,905 primary cementedtotal hip replacements reported to the Norwegianarthroplasty register, 1987 to 1995.J Bone Joint Surg Br 1997;79:590-5.42Eveillard M, Mertl P, Canarelli B, et al. Riskof deep infection in first-intention total hipreplacement. Evaluation concerning a continuousseries of 790 cases. Presse Med2001;30:1868-75.43Engesaeter LB, Lie SA, Espehaug B, et al. Antibioticprophylaxis in total hip arthroplasty: effectsof antibiotic prophylaxis systemically andin bone cement on the revision rate of 22,170primary hip replacements followed 0-14 yearsin the Norwegian Arthroplasty Register. ActaOrthop Scand 2003;74:644-51.44Blom AW, Brown J, Taylor AH, et al. Infectionafter total knee arthroplasty. J Bone JointSurg Br 2004;86 B:688-91.45Hamilton H, Jamieson J. Deep infection in totalhip arthroplasty. Can J Surg 2008;51:111-7.46Willis-Owen CA, Konyves A, Martin DK.Factors affecting the incidence of infectionin hip and knee replacement. An analysis of5277 cases. J Bone Joint Surg Br 2010;92B:1128-33.47Johnson DP, Bannister. The outcome of infectedarthroplasty of the knee. GC J Bone JointSurg Br 1986;68:289-91.48Tsukayama, Dean T, Estrada R, et al. Infectionafter total hip arthroplasty. A Study of theTreatment of One Hundred and Six Infections.J Bone Joint Surg Am 1996;78:512-23.49Segawa H, Tsukayama DT, Kyle RF, etal. Infection after total knee arthroplasty.A retrospective study of the treatment ofeighty-one infections. J Bone Joint Surg Am1999;81:1434-45.50Pandey R, Berendt AR, Athanasou NA. Histologicaland microbiological findings in noninfectedand infected revision arthroplasty tissues.The OSIRIS Collaborative Study Group.Oxford Skeletal Infection Research and InterventionService. Arch Orthop Trauma Surg2000;120:570-4.51Peersman G, Laskin R, Davis J, et al. Infectionin total knee replacement: a retrospective reviewof 6489 total knee replacements. ClinOrthop Relat Res 2001;392:15-23.52Ridgeway S, Wilson J, Charlet A, et al. Infectionof the surgical site after arthroplasty of thehip. J Bone Joint Surg Br 2005;87:844-50.53Phillips JE, Crane TP, Noy M, et al. The incidenceof deep prosthetic infections in aspecialist orthopaedic hospital: a 15-yearprospective survey. J Bone Joint Surg Br2006;88:943-8.54Fulkerson E, Valle CJ, Wise B, et al. Antibioticsusceptibility of bacteria infecting totaljoint arthroplasty sites. J Bone Joint Surg Am2006;88:1231-7.55Joshy S, Gogi N, Thomas B, et al. Delayedonset of deep infection after total knee arthroplasty:comparison based on the infectingorganism. J Orthop Surg 2007;15:154-8.56Müller M, Morawietz L, Hasart O, et al.Diagnosis of periprosthetic infection followingtotal hip arthroplasty-evaluation of thediagnostic values of pre- and intraoperativeparameters and the associated strategy topreoperatively select patients with a highprobability of joint infection. J Orthop SurgRes 2008;21;3:31.57Chesney D, Sales J, Elton R, et al. Infectionafter knee arthroplasty a prospective study of1509 cases. J Arthroplasty 2008;23:355-9.58Pulido L, Ghanem E, Joshi A, et al. Periprostheticjoint infection: the incidence, timing,and predisposing factors. Clin Orthop RelatRes 2008;466:1710-5.59Rao N, Cannella B, Crossett LS, et al. Apreoperative decolonization protocol forstaphylococcus aureus prevents orthopaedicinfections. Clin Orthop Relat Res2008;466:1343-8.60Glenny A, Song F. Antimicrobial prophylaxisin total hip replacement: a systematic review.Health Technol Assess 1999;3:1-57.61Crabtree TD, Pelletier SJ, Gleason TG, etal. 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