Lazzarini L, Pellizzer G, Stecca C, Viola R, de Lalla F
Department of Infectious Diseases, San Bortolo Hospital, Venezia, Italy.
J Chemother. 2001 Apr;13(2):182-7. doi: 10.1179/joc.2001.13.2.182.
From January 1991 to June 1997 217 patients undergoing monolateral or bilateral total knee replacement (TKR) were consecutively enrolled in a prospective study on the incidence of postoperative infections and related risk factors. Regional antimicrobial prophylaxis (teicoplanin 400 mg) was used in 263 (95%) prostheses implanted; in the remaining 14 implants (5%) perioperative antibiotic prophylaxis (teicoplanin 800 mg) was administered as usual by systemic route. None of the patients experienced local or systemic adverse effects. Over the 2-year follow-up period, 8 (2.9%) primary site infectious complications were recorded, i.e. 4 superficial infections, which were cured without involvement of the prostheses, and 4 deep infections, which required prosthesis removal. Six infections occurred in patients who had undergone previous surgery of the same knee joint, and 2 in patients undergoing primary TKR (p= 0.0005); diabetic patients had infections (13%) more frequently than non-diabetic patients (1.9%, p=0.01). Staphylococci were the leading organisms isolated from infections; however 3 strains of Escherichia coli were isolated from patients who had undergone a previous prosthesis implantation at the same knee joint. Regional administration of teicoplanin appears to be a safe and valuable prophylactic technique; however, in patients at risk of infection a prophylactic regimen which is also active against gram-negative bacteria should probably be considered.
1991年1月至1997年6月，217例接受单侧或双侧全膝关节置换术（TKR）的患者连续纳入一项关于术后感染发生率及相关危险因素的前瞻性研究。在植入的263个（95%）假体中采用了区域抗菌预防（替考拉宁400mg）；其余14个植入物（5%）按常规通过全身途径给予围手术期抗生素预防（替考拉宁800mg）。所有患者均未出现局部或全身不良反应。在2年的随访期内，记录到8例（2.9%）原发性部位感染并发症，即4例表浅感染，未累及假体而治愈，4例深部感染，需要取出假体。6例感染发生在同侧膝关节曾接受过手术的患者中，2例发生在初次接受全膝关节置换术的患者中（p = 0.0005）；糖尿病患者感染发生率（13%）高于非糖尿病患者（1.9%，p = 0.01）。葡萄球菌是从感染中分离出的主要病原体；然而，从同侧膝关节曾接受过假体植入术的患者中分离出3株大肠杆菌。替考拉宁的区域给药似乎是一种安全且有价值的预防技术；然而，对于有感染风险的患者，可能应考虑一种对革兰氏阴性菌也有效的预防方案。
