Öz
Periprostetik eklem enfeksiyonu (PJI), sıklıkla uzun süreli antimikrobiyal tedavi gerektiren, artroplastinin ciddi bir komplikasyonudur. Enfeksiyon kontrolü için gerekli olmasına rağmen, uzun süreli antibiyotik maruziyeti hastaları, etkinliği ve hasta güvenliğini tehlikeye atabilecek advers ilaç olaylarına (ADE) yatkın hale getirir. Bu derleme, PJI’da antimikrobiyal ilaçlara bağlı ADE görülme sıklığı, yelpazesi ve risk faktörlerine ilişkin güncel kanıtları özetlemeyi amaçlamakta olup, ilaç sınıfına özgü toksik etkilere ve bunların terapötik sonuçlarına vurgu yapmaktadır. Ocak 2010 ile Eylül 2025 tarihleri arasında PubMed, Embase ve Cochrane Kütüphanesi’nde anlatısal bir literatür taraması yapılmıştır. PJI’ya yönelik antimikrobiyal tedaviyle ilişkili ADE’leri değerlendiren randomize çalışmalar, prospektif ve retrospektif kohortlar ve sistematik incelemeler çalışmaya dahil edilmiştir. İnsidans, şiddet, ilaç sınıfları, tedavi değişiklikleri ve belirlenen risk faktörlerine dair veriler çıkarılmıştır. Metodolojik heterojenlik nedeniyle anlatısal bir sentez yapılmıştır. Analiz edilen literatürde, bildirilen ADE’lerin insidansı %7,8 ile %46 arasında değişmekte olup, yaklaşık %7,8 ile %20,4’ü şiddetli olaylar olarak sınıflandırılmıştır. Vankomisin ve piperasilin-tazobaktam kombinasyonları en yüksek nefrotoksisite oranlarını gösterirken, rifampin ve linezolid sırasıyla hepatotoksisite ve hematolojik toksisite ile ilişkilendirilmiştir. Uzun süreli tedavi, intravenöz uygulama, ileri yaş, obezite ve eşlik eden hastalıklar ADE riskini önemli ölçüde artırmıştır. Ortaya çıkan kanıtlar, oral kademeli tedavi ve daha kısa antimikrobiyal rejimlerin, daha iyi güvenlik profilleri sunarken, karşılaştırılabilir etkinlik sağlayabileceğini göstermektedir. Antimikrobiyal ilişkili ADE’ler, PJI yönetiminde sık olarak ortaya çıkar ve klinik olarak önemlidir ve genellikle tedavi değişikliğine veya tedavinin sonlandırılmasına yol açar. Periprostetik eklem enfeksiyonu tedavisinde güvenliği ve terapötik sonuçları iyileştirmek için rejim seçiminin, süresinin ve takibinin optimize edilmesi ve standartlaştırılmış ADE raporlama çerçevelerinin benimsenmesi esastır.
Anahtar Kelimeler:
Periprostetik eklem enfeksiyonu, antimikrobiyal toksisite, advers ilaç reaksiyonları, antimikrobiyal güvenlik, risk faktörleri
Kaynaklar
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