局部及全身使用抗生素预防手术部位感染效果更佳。一项体内研究。
Better prophylaxis against surgical site infection with local as well as systemic antibiotics. An in vivo study.
作者信息
Cavanaugh Daniel L, Berry John, Yarboro Seth R, Dahners Laurence E
出版信息
J Bone Joint Surg Am. 2009 Aug;91(8):1907-12. doi: 10.2106/JBJS.G.01237.
BACKGROUND
Prophylactic systemic antibiotics significantly lower the risk of postoperative infection, and injection of antibiotics directly into the wound cavity has been found to be even more effective. In this study, we investigated the efficacy of direct injection of antibiotics into a wound cavity after wound closure, both alone and in combination with systemic administration of antibiotics. We hypothesized that a combination of preoperative systemic administration and postoperative local injection would be the most effective treatment.
METHODS
Rats were divided into six treatment groups: no treatment, local gentamicin, systemic cefazolin, local cefazolin, systemic cefazolin plus local gentamicin, and systemic cefazolin plus local cefazolin. A wound cavity was opened along the femur, an implant was placed, and the wound was inoculated with 2.5 x 10(8) colony forming units of Staphylococcus aureus. Systemic antibiotics were injected subcutaneously thirty minutes before the initial incision. Local antibiotics were injected percutaneously into the wound cavity after closure. The rats were killed at forty-eight hours postoperatively, and quantitative cultures were performed.
RESULTS
All groups that received antibiotics showed significantly lower bacterial counts than the no-treatment control group (p < 0.0003). Local gentamicin treatment decreased the number of colony-forming-unit isolates by approximately two orders of magnitude as compared with the number in the group treated with systemic cefazolin (p = 0.00005) and five orders of magnitude as compared with the number in the control group (p = 0.00003). The combination of systemic cefazolin and local gentamicin decreased the bacterial count by approximately seven orders of magnitude as compared with the count in the no-treatment control group and significantly decreased the count as compared with that in the group treated with local gentamicin alone (p = 0.00006).
CONCLUSIONS
As we hypothesized, the combination of systemic cefazolin and local gentamicin proved to be the most effective regimen. Local injection of gentamicin proved more effective than systemic administration of cefazolin but was not as effective as the combination of both antibiotics. The initially high concentrations of locally applied antibiotic and the utilization of two different classes of antibiotics may have contributed to the observed efficacy.
背景
预防性全身使用抗生素可显著降低术后感染风险，且已发现将抗生素直接注入伤口腔更为有效。在本研究中，我们调查了伤口闭合后将抗生素直接注入伤口腔单独使用以及与全身使用抗生素联合使用的疗效。我们假设术前全身给药与术后局部注射相结合将是最有效的治疗方法。
方法
将大鼠分为六个治疗组：不治疗、局部使用庆大霉素、全身使用头孢唑林、局部使用头孢唑林、全身使用头孢唑林加局部使用庆大霉素以及全身使用头孢唑林加局部使用头孢唑林。沿股骨打开一个伤口腔，植入一个植入物，并用2.5×10⁸个金黄色葡萄球菌菌落形成单位接种伤口。在初次切口前30分钟皮下注射全身用抗生素。伤口闭合后经皮将局部用抗生素注入伤口腔。术后48小时处死大鼠并进行定量培养。
结果
所有接受抗生素治疗的组的细菌计数均显著低于未治疗的对照组（p<0.0003）。与全身使用头孢唑林治疗的组相比，局部使用庆大霉素治疗使菌落形成单位分离株数量减少了约两个数量级（p = 0.00005），与对照组相比减少了五个数量级（p = 0.00003）。与未治疗的对照组相比，全身使用头孢唑林和局部使用庆大霉素的联合使用使细菌计数减少了约七个数量级，与单独局部使用庆大霉素治疗的组相比显著降低了计数（p = 0.00006）。
结论
正如我们所假设的，全身使用头孢唑林和局部使用庆大霉素的联合使用被证明是最有效的治疗方案。局部注射庆大霉素被证明比全身使用头孢唑林更有效，但不如两种抗生素联合使用有效。局部应用抗生素最初的高浓度以及两种不同类别的抗生素的使用可能促成了观察到的疗效。
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