PubMed · 7478376
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F G Emmings. 1995. Resisting the routine.. https://pubmed.ncbi.nlm.nih.gov/7478376/
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Postoperative infection is a significant cause of surgical morbidity and mortality. The risk of infection after surgery depends on a number of factors, including the type and length of the surgical procedure; the age, underlying conditions, and previous history of the patient; the skill of the surgeon; the diligence with which infection control procedures are applied; and the type and timing of preoperative antibiotic prophylaxis. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci, now implicated in many postoperative infections, have been joined most recently by strains of S. aureus that show intermediate levels of resistance to vancomycin. Postoperative infections caused by drug-resistant pathogens are more difficult to treat and are associated with a higher morbidity and mortality. New antibiotics that are effective against drug-resistant pathogens are urgently needed, as is renewed dedication to the prevention of postoperative infection and to the use of the principles of infection control.
Chronic osteomyelitis is characterized by cicatrization of the focus of infection with deteriorating vascularization, which makes the disease increasingly difficult to treat. The treatment in chronic osteomyelitis consists primarily in surgical debridement of the scarified focus of infection; stabilization with external fixation allows better treatment. Following debridement, local antibiotic treatment is possible with gentamicin containing cement beads, if necessary combined with systemic antibiotic treatment. If the infection heals well, a reconstruction may, if necessary, be carried out: bone defects frequently necessitate bone transplantation, bone segment shifting (Ilizarov method) or free muscle flap grafts. In the future, resistant bacteria will make healing harder. There will be more possibility to use resorbable antibiotic vehicles and bone-replacing biomaterials.