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Septische Arthritis und Spondylodiszitis

Selten, aber gefürchtet

Septic arthritis and spondylodiscitis

Rare but feared diseases

  • Infektiologie
  • Published:
rheuma plus Aims and scope

Zusammenfassung

Die septische Arthritis und Spondylodiszitis sind eher seltene, aber gefährliche Infektionen mit zunehmender Inzidenz. Die septische Arthritis stellt eine Notfallerkrankung dar, die von einer hohen Morbidität (40 %) und einer nicht unerheblichen Letalität (11 %) gekennzeichnet ist. Die Infektion des Gelenkes entsteht entweder hämatogen, durch direkte Inokulation oder per continuitatem. Patienten mit vorbestehenden Gelenkdestruktionen oder Immunsuppression sind besonders gefährdet. Vor Einleiten der Antibiotikatherapie sollte über die Asservation der Synovialflüssigkeit eine Erregersicherung und Leukozytenquantifizierung erfolgen. Zum Gelenkerhalt ist eine frühzeitige Evakuation der infizierten Synovia aus dem Gelenk unerlässlich. Die Spondylodiszitis beschreibt eine Infektion der Bandscheibe und angrenzenden Wirbelkörper, die v. a. durch hämatogene Dissemination entsteht. Insbesondere immunsupprimierte und ältere Menschen sind gefährdet für diese Infektion. Die Diagnosestellung ist häufig verspätet, da das führende Symptom, der Rückenschmerz, sehr unspezifisch ist und Fieber in weniger als der Hälfte der Fälle auftritt. In Europa ist Staphylococcus aureus der häufigste Erreger, während weltweit die Tuberkulose führend ist. Bildgebend ist die Magnetresonanztomographie das Verfahren der Wahl. Bei stabilen Patienten sollte zuerst die Erregerisolierung (Blutkulturen oder Gewebeproben mittels Computertomographie-gesteuerter Punktion oder offener Biopsie) vor Beginn der antimikrobiellen Therapie erfolgen. Die empfohlene Dauer der erregerspezifischen antibiotischen Therapie beträgt bei nativer Spondylodiszitis in der Regel 6 Wochen.

Abstract

Septic arthritis and spondylodiscitis are relatively rare but severe diseases with increasing incidence. Septic arthritis is an emergency situation with high morbidity (40 %) and fatality rates (11 %). The infection occurs via a hematogenous route by direct inoculation or per continuitatem. Patients with pre-existing destructive joint diseases or under immunosuppressive treatment are particularly at risk. It is mandatory to sample synovial fluid for isolation of the relevant pathogen and quantification of leucocytes before starting antibiotic therapy. In order to preserve the joint, early evacuation of the infected synovial space is necessary. Spondylodiscitis is characterized by infection of the vertebra and neighboring discs mainly via a hematogenous route. Immunosuppressed and older patients are primarily at risk of infection. Back pain represents the main symptom but due to its unspecific character and the frequent absence of fever, diagnosis is often delayed. In Europe Staphylococcus aureus is the most prevalent pathogen, whereas tuberculosis is the most frequent causal agent worldwide. Magnetic resonance imaging (MRI) respresents the method of choice for the radiological diagnostics. In stable patients isolation of the pathogen should be achieved before starting antimicrobial therapy (e.g. blood cultures or tissue samples by computed tomography guided puncture or biopsy). The recommended duration of pathogen-specific antibiotic therapy for native spondylodiscitis is normally 6 weeks.

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Authors and Affiliations

  1. Klinik 1 für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50935, Köln, Deutschland

    N. Jung

  2. Plastische, Ästhetische und Handchirurgie, Franziskushospital Aachen, 52074, Aachen, Deutschland

    S. Vossen

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Correspondence to N. Jung.

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Interessenkonflikt

S. Vossen gibt an, dass kein Interessenkonflikt besteht. N. Jung gibt an, Vortragshonorare von Labor Stein, Novartis, Astellas Pharma, Alere GmbH, Basilea Pharmaceutica AG, Reiseunterstützung von Astellas, Novartis und Gilead sowie Honorare für eine Beobachtungsstudie von Infectofos erhalten zu haben.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Erstveröffentlichung in Zeitschrift für Rheumatologie (online am 15. September 2016). doi:10.1007/s00393-016-0200-5.

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Jung, N., Vossen, S. Septische Arthritis und Spondylodiszitis. rheuma plus 16, 24–30 (2017). https://doi.org/10.1007/s12688-016-0092-0

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