[Limits of clinical pathways. Implant-associated infections]

There are at present no valid guidelines for multimodal treatment of implant-associated infections; however, based on many years of experience gathered by specialized septic surgeons and likewise specialized treatment centers, established principles do exist. Treatment planning should always take into consideration the individual comorbidity of the patient, the underlying injury, the implant, the spectrum of germs, and the patient's compliance. The concept for managing implant-associated infections comprises five pillars and can be summarized as follows: first priority is given to rapid and radical surgical eradication of the infection by débridement of all infected and non-vital or underperfused tissue. We cannot propose clinical pathways as such for implant-related infections, i.e., by specifying interdisciplinary activities, control parameters, and responsibilities for a typical patient with clearly defined disease, but we can proffer strategic concepts for diagnostic work-up and treatment as we have already described.