[Methicillin-resistant Staphylococcus aureus (MRSA). Current status and significance of preventing infection in technical orthopedics]

Many patients of the Clinic for Technical Orthopedics and Rehabilitation of the Munster University are facing several risk factors at the same time, which have to be considered for infection registration and therapy accordingly. The interaction of the known late consequences of diabetes mellitus creates the prerequisites which give way for infections of the soft parts and bones. Very often, patients are only being transferred to special university clinics after long-lasting pre-treatments as day-patients or inpatients. The integrity of patients physiological barriers is often broken through by the already existing morphological damages, and the function of the immune systems defence possibly is affected by already existing basic diseases. Parallel to the increasing importance of Staphylococcus aureus (S. aureus) being the pathogen for nosocomial infections, the resistance situation towards a lot of antibiotics has significantly and increasingly deteriorated. The methicillin resistance of S. aureus, i.e. the resistance of the pathogen towards so-called staphylococcus-effective penicillinase-resistant penicillins (isoxazolylpenicillins), is presently creating the especially for the clinical practice problematic resistance mechanisms. The methicillin (oxacillin)-resistant S. aureus (MRSA, ORSA) stems usually present the phenomenon of multiresistance, i.e. the resistance towards substances of several classes of antibiotics, and, therefore, are not only resistant to all beta-lactamantibiotics (penicillins, cephalosporins, carbapenems). Thus, MRSA infections become a significant risk factor for the respective patients. In many cases there are only a very few options left for an antibiotic therapy. The increasing and often unquestioned use of "reserve substances" is leading to a selection of pathogens creating resistances to the corresponding substances. This results in a resistance spiral which makes an antibiotic therapy more and more difficult.