Manejo de la Infección Periprotésica. Revisión de la Literatura Actual y Algoritmo de Manejo

Resumen

Objetivo Este artículo revisa exhaustivamente el manejo de la infección periprotésica en ortopedia, basándose en consensos internacionales recientes para guiar un enfoque terapéutico que asegure la recuperación funcional del paciente.

Materiales y Métodos Se exploran diversas estrategias terapéuticas, como el desbridamiento con retención del implante (DAIR), recambios en uno y dos tiempos, y el uso de espaciadores de liberación antibiótica. Se presentan escalas de predicción como CRIME80 y KLIC para evaluar el riesgo de fracaso en cada intervención.

Resultados El DAIR tiene una tasa de éxito aproximada del 71% en infecciones agudas, siempre que se cumplan criterios específicos, como una duración corta de los síntomas y microorganismos sensibles a los antibióticos disponibles. Las escalas CRIME80 y KLIC permiten estimar el riesgo de fracaso en infecciones agudas y postquirúrgicas, respectivamente. El recambio en un solo tiempo es viable en pacientes seleccionados, aunque el recambio en dos tiempos sigue siendo el estándar para casos complejos.

Discusión Los resultados subrayan que un abordaje multidisciplinario, incluyendo microbiología y enfermedades infecciosas, y el uso de escalas predictivas son esenciales para mejorar los resultados terapéuticos y personalizar el tratamiento.

Conclusiones El éxito en el manejo de la infección periprotésica exige un enfoque que considere la biología del biofilm y permita una selección cuidadosa del tratamiento. Al integrar los últimos avances en diagnóstico y tratamiento quirúrgico, se pueden mejorar significativamente los resultados clínicos y la calidad de vida del paciente.

Nivel de evidencia: IV.

Palabras clave

infección periprotésica - DAIR - revisión quirúrgica en dos tiempos - revisión quirúrgica en un tiempo - infección en artroplastia de cadera

Publication History

Received: 19 March 2025

Accepted: 02 April 2025

Article published online:
20 May 2025

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