Department of Orthopedic Surgery, University Medical Center Groningen, The Netherlands.
J Arthroplasty. 2013 Feb;28(2):374.e5-8. doi: 10.1016/j.arth.2012.04.034. Epub 2012 Jul 17.
We present a rare case of an immunocompetent host who developed a Candida albicans-infected total hip prosthesis. The infection could not be eradicated with debridement and extensive antifungal therapy. Our patient first underwent a resection of the proximal femur and local treatment with gentamicin-loaded cement beads. In a second procedure, a handmade cement spacer impregnated with voriconazole, amphotericin B, and vancomycin was placed. After 3 months of additional systemic antibiotic therapy, the patient remained afebrile, and a tumor prosthesis was placed. Six years postoperatively, she is doing well, walking with a small limp and no signs of recurrent infection. This is the first report on elution of voriconazole and amphotericin B from bone cement delivered at clinically significant concentrations for at least 72 hours.
我们报告了一例罕见的免疫功能正常宿主发生白色念珠菌感染的全髋关节假体。清创和广泛的抗真菌治疗未能根除感染。我们的患者首先接受了股骨近端切除术和局部使用庆大霉素载药水泥珠的治疗。在第二次手术中,使用伏立康唑、两性霉素 B 和万古霉素浸渍的手工制作的水泥间隔器被放置。在进行了 3 个月的全身性抗生素治疗后,患者体温正常,肿瘤假体被放置。术后 6 年,患者恢复良好,行走时有轻微跛行,无感染复发迹象。这是首例报告显示,至少 72 小时内以临床显著浓度从骨水泥中洗脱伏立康唑和两性霉素 B。