[Risk factors and prevention of infections of hip and knee prostheses].
Prevention of deep periprosthetic infection requires appreciation of the contributing factors to this phenomenon. The concept of an interdependent relationship between the bacteria, wound and host is most useful when considering the prevention of infections. Establishment of infection depends on the number and virulence of the bacteria, the host's ability to eliminate those bacteria and the status of the wound. Multiple variables contribute to the deposition and proliferation of bacteria into the wound environment which enhance the infectious process, such as the presence of a prosthetic implant or medical conditions and medications which impair the patient's defense. Prevention must address optimization of the wound environment, minimizing the number of bacteria into the wound and augmenting the host defenses. Administration of prophylactic antimicrobials prior to skin incision reduces the incidence of wound infections. The optimal antimicrobial agent should have excellent in vitro activity against staphylococci and streptococci, a long serum half-life, good tissue penetration, be non-toxic and inexpensive.
Aglietti
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Prima Clinica Ortopedica dell'Università di Firenze, Largo P. Palagi 1, 50139, Firenze, Italia.
Baldini
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D019072:Antibiotic Prophylaxis; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D006304:Health Status; D006801:Humans; D016867:Immunocompromised Host; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control*; D014774:Virulence