Hayes G, Moens N, Gibson T
University of Guelph, Department of Clinical Studies, Guelph, Ontario, Canada.
Vet Comp Orthop Traumatol. 2013;26(4):251-9. doi: 10.3415/VCOT-12-05-0065. Epub 2013 Mar 22.
In the face of increasing incidence of multi-drug resistant implant infections, local antibiotic modalities are receiving increased attention for both infection prophylaxis and treatment. Local antibiotic therapy that achieves very high antibiotic drug concentrations at the site of the implant may represent an avenue for treatment of biofilm-forming bacterial pathogens. Randomized controlled trials in human patients have demonstrated an infection risk reduction when antibiotic-impregnated cement is used for infection prophylaxis in implanted joint prostheses, and when a gentamicin-impregnated collagen sponge is used for infection prophylaxis in midline sternotomy. The other modalities discussed have for the most part yet to be evaluated in randomized controlled trials in veterinary or human patients. In general, the in vivo pharmacokinetics and appropriate dosing profiles for local antibiotic modalities have yet to be elucidated. Toxicity is possible, and attention to the dose applied is warranted.
面对多药耐药植入物感染发病率的不断上升，局部抗生素治疗方式在感染预防和治疗方面正受到越来越多的关注。在植入部位实现非常高的抗生素药物浓度的局部抗生素治疗可能是治疗形成生物膜的细菌病原体的一条途径。在人类患者中进行的随机对照试验表明，当使用抗生素浸渍骨水泥预防植入关节假体感染时，以及当使用庆大霉素浸渍胶原海绵预防正中开胸术后感染时，感染风险会降低。所讨论的其他治疗方式在很大程度上尚未在兽医或人类患者的随机对照试验中进行评估。一般来说，局部抗生素治疗方式的体内药代动力学和合适的给药方案尚未阐明。存在毒性的可能性，因此有必要关注所使用的剂量。
