Unit of Infectious Diseases, Basel University Medical Clinic, Liestal, Switzerland.
Clin Microbiol Infect. 2012 Dec;18(12):1176-84. doi: 10.1111/1469-0691.12003. Epub 2012 Oct 10.
Successful management of orthopaedic device-related infections requires combined surgical and antimicrobial therapy. Because of the heterogeneity of clinical situations, controlled trials are lacking. Although rational concepts for surgical treatment have been published, many aspects of antimicrobial therapy are still not well documented. In this review, some of these knowledge gaps are discussed, and rational arguments for initial parenteral treatment are presented. In addition, the interpretation of data regarding bone penetration is discussed. Whereas rifampin is now a standard combination partner in the treatment of staphylococcal infections, its role against other microorganisms is still unclear. Finally, in view of the increasing prevalence of methicillin-resistant staphylococci and their decreasing susceptibility to vancomycin, data are provided on linezolid and daptomycin, which can potentially be used in bone and joint infections.
成功管理骨科器械相关感染需要联合手术和抗菌治疗。由于临床情况的异质性，缺乏对照试验。尽管已经发表了关于手术治疗的合理概念，但抗菌治疗的许多方面仍未得到充分记录。在这篇综述中，讨论了其中一些知识空白，并提出了关于初始肠外治疗的合理论据。此外，还讨论了关于骨穿透数据的解释。虽然利福平现在是治疗葡萄球菌感染的标准联合治疗伙伴，但它对抗其他微生物的作用仍不清楚。最后，鉴于耐甲氧西林金黄色葡萄球菌的患病率不断增加，以及它们对万古霉素的敏感性降低，提供了关于利奈唑胺和达托霉素的数据，这两种药物可能可用于骨和关节感染。
