de Lalla F, Viola R, Pellizzer G, Lazzarini L, Tramarin A, Fabris P
Department of Infectious Diseases, San Bortolo Hospital, Vicenza, Italy.
Antimicrob Agents Chemother. 2000 Feb;44(2):316-9. doi: 10.1128/AAC.44.2.316-319.2000.
From January 1991 to June 1997, patients undergoing primary elective monolateral or bilateral total knee replacement (TKR) were consecutively enrolled in a prospective, open clinical study on the efficacy and safety of regional prophylaxis with teicoplanin (TEC). Those scheduled for monolateral TKR (115 patients) received 400 mg of TEC in 100 ml of saline as a 5-min infusion into a foot vein of the leg to be operated on immediately after the tourniquet was inflated to 400 mm Hg (ca. 50 kPa). For patients undergoing bilateral surgery (45 patients), regional administration of TEC was also repeated for the second knee operation. Follow-up ranged from a minimum of 2 years to 8 years. None of the patients experienced local or systemic adverse effects following regional administration of TEC. In the immediate postoperative and 2-year follow-up periods, only one superficial infection of the primary site attributable to intraoperative contamination (prophylaxis failure) out of the 205 prostheses implanted was observed. Deep infections involving the prosthesis did not occur. Infectious complications at distant sites were observed in nine cases (urinary tract infection due to Escherichia coli in eight cases, and Salmonella enteritidis gastroenteritis in one case) in the immediate postoperative period; they all were rapidly cured after antibiotic treatment. A delayed prosthetic infection, related to hematogenous spread of the etiological agent and therefore not considered a prophylactic failure, was observed in a patient who had undergone TKR 5 years before. Regional administration of TEC in monolateral and bilateral TKR appears to be a safe and valuable prophylactic technique.
1991年1月至1997年6月，接受初次择期单侧或双侧全膝关节置换术（TKR）的患者连续纳入一项关于替考拉宁（TEC）区域预防疗效和安全性的前瞻性、开放性临床研究。计划进行单侧TKR的患者（115例）在止血带充气至400 mmHg（约50 kPa）后，立即将400 mg TEC溶于100 ml生理盐水中，经足部静脉在5分钟内输注到即将手术的腿部。对于接受双侧手术的患者（45例），第二次膝关节手术时也重复进行TEC区域给药。随访时间最短为2年，最长为8年。TEC区域给药后，所有患者均未出现局部或全身不良反应。在术后即刻和2年随访期内，在植入的205个假体中，仅观察到1例因术中污染导致的原发部位浅表感染（预防失败）。未发生涉及假体的深部感染。术后即刻有9例出现远处部位的感染并发症（8例为大肠埃希菌引起的尿路感染，1例为肠炎沙门菌引起的肠胃炎）；经抗生素治疗后均迅速治愈。1例5年前接受TKR的患者出现了与病原体血行播散相关的延迟性假体感染，因此不认为是预防失败。TEC在单侧和双侧TKR中的区域给药似乎是一种安全且有价值的预防技术。
