Garazzino Silvia, De Rosa Francesco Giuseppe, Bargiacchi Olivia, Di Perri Giovanni
Clinica di Malattie Infettive, Università degli Studi di Torino, Italy.
Infez Med. 2008 Mar;16(1):43-6.
We describe the case of a young man who suffered from relapsing infections of a cranial prosthesis implanted in 1982 after a serious accident. The presence of a bacterial infection was diagnosed by microbiological assays performed on purulent drainage from the surgical wound, removed prosthetic material and bone biopsies obtained intraoperatively. The first prosthesis infection was sustained by two nosocomial pathogens, Enterobacter cloacae and methicillin-resistant Staphylococcus aureus (MRSA); it was treated for eight weeks with parenteral antibiotic therapy, including teicoplanin and piperacillin/tazobactam, in association with surgical debridement and prosthesis removal. The following relapse, sustained by Enterobacter cloacae, was treated with a prolonged course of parenteral antibiotic therapy and prosthesis substitution. A third infection was diagnosed two months after the last cranioplasty: cultures of purulent drainage grew MRSA and Staphylococcus gallinarum. In addition to radical debridement, oral antibiotic treatment including linezolid was introduced. Antibiotic therapy was stopped after 10 weeks; at a follow-up visit performed after three years no signs or symptoms of relapse were evident. This case shows the difficulty in eradicating prosthesis infections, and demonstrates the central role of radical surgical debridement and the need of appropriate antibiotic treatment in dosing and duration.
我们描述了一名年轻男子的病例，他在1982年一场严重事故后植入的颅骨假体反复发生感染。通过对手术伤口的脓性引流物、取出的假体材料以及术中获取的骨活检组织进行微生物检测，诊断出存在细菌感染。首次假体感染由两种医院病原体阴沟肠杆菌和耐甲氧西林金黄色葡萄球菌（MRSA）引起；采用包括替考拉宁和哌拉西林/他唑巴坦在内的肠外抗生素治疗八周，并结合手术清创和假体取出进行治疗。接下来由阴沟肠杆菌引起的复发，采用延长疗程的肠外抗生素治疗和假体置换进行处理。第三次感染在最后一次颅骨成形术后两个月被诊断出来：脓性引流物培养出MRSA和鸡葡萄球菌。除了彻底清创外，还采用了包括利奈唑胺在内的口服抗生素治疗。抗生素治疗10周后停止；在三年后的随访中，没有明显的复发迹象或症状。该病例显示了根除假体感染的困难，并证明了彻底手术清创的核心作用以及在给药剂量和疗程方面进行适当抗生素治疗的必要性。
