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SOP Gelenkinfektion
1.
SOP Gelenkinfektion Dauer
der Beschwerden ? Verletzungen ? Operationen ? Intraartikuläre Punktionen? Nebenerkrankungen ? Anamnese Risikofaktoren ja nein Diabetes mellitus Cortisontherapie Alter > 75 Jahre Arthrose Alkohol-/Drogenabusus Rheumatoide Arthritis Klinische Untersuchung ja nein ja nein Gelenkschmerzen Überwärmung Gelenkerguss Verminderte Mobilität Rötung Fieber > 38°C Röntgen ja nein Keine Fraktur Osteolyse Ultraschall ja nein Gelenkerguss Synovialitis Labor ja nein Leuk > 10/nl CRP > 100 mg/l PCT > 0,25 ng/ml V. a. GELENKINFEKTION ? Gelenkpunktion Durchführung: s.Leitlinie awmf.org Zellzahlbestimmung ja nein >25000 Leuk/µl Mikrobiologische Untersuchung (aerobe und anaerobe Blutkulturflaschen) V. a. GELENKINFEKTION ? Gächter I-III Gächter IV oder Sepsis ASK Spülung >5l NaCl Synovektomie (Gächter III) Arthrotomie Spülung >5l NaCl Synovektomie Stadiumbestimmung Beginn der antibiotischen Therapie intraoperativ Laborkontrolle (Blutbild und CRP am 2. postop. Tag) Abfrage des Ergebnisses der mikrobiologischen Untersuchung am 2. postop. Tag Physiotherapie und Motorschiene Revision in 2-3 Tagen (ASK bei Stadium I-III / Arthrotomie bei Stadium IV) Laborkontrolle, klinische Untersuchung Arthrotomie Umstellung der antibiotischen Therapie Bei anhaltenden Infektzeichen
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