Fiorenza Fabrice, Durox Hélène, El Balkhi Souleiman, Denes Eric
Orthopedic Department (Dr. Fiorenza), Limoges teaching Hospital; the Reference Center for Complex Bone and Joint Infections (Dr. Fiorenza, Dr. Durox, and Dr. Denes); the Infectious Diseases Department (Dr. Durox), Limoges teaching Hospital; the Pharmacology Laboratory (Dr. El Balkhi), Limoges teaching Hospital; the R&D Department (Dr. Denes), I.Ceram; and the Infectious Diseases Department (Dr. Denes), Clinique Chénieux, Limoges, France.
J Am Acad Orthop Surg Glob Res Rev. 2018 Nov 2;2(11):e079. doi: 10.5435/JAAOSGlobal-D-18-00079. eCollection 2018 Nov.
The classic treatment of chronic osteomyelitis is usually a two-stage surgery combined with systemic antibiotic therapy for several months. We report the case of a patient presenting a chronic osteomyelitis caused by methicillin-resistant who was treated with a one-stage surgery using an antibiotic-loaded ceramic. We used a porous alumina ceramic loaded with gentamicin to reconstruct the bone removed during débridement and to avoid its colonization. All bacteriological samples performed before and during the surgery revealed the presence of a methicillin-resistant . Because of the local release of the antibiotic, very high concentrations (more than 50 times the concentration needed) were administered in the surgical wound, thus helping to cure the infection. Owing to the strength of the ceramic, the patient was allowed to walk 10 days after the surgery. After a follow-up at 14 months, the patient is well-being, without any relapse of the infection. The CT-scan follow-up shows an osseointegration of the ceramic. Even, if it is too early to tell that infection is completely cured, these first results are encouraging for the use, in the future, of this antibiotic-loaded ceramic for complex bone infection.
慢性骨髓炎的经典治疗方法通常是两阶段手术，并结合数月的全身性抗生素治疗。我们报告了一例由耐甲氧西林菌引起的慢性骨髓炎患者，该患者接受了使用载有抗生素的陶瓷进行的一阶段手术治疗。我们使用载有庆大霉素的多孔氧化铝陶瓷来重建清创术中切除的骨组织，并防止其定植。手术前和手术期间进行的所有细菌学样本检测均显示存在耐甲氧西林菌。由于抗生素的局部释放，手术伤口处给予了非常高的浓度（超过所需浓度的50倍），从而有助于治愈感染。由于陶瓷的强度，患者在术后10天即可行走。在14个月的随访后，患者状况良好，感染未出现任何复发。CT扫描随访显示陶瓷与骨实现了骨整合。即使现在判断感染是否已完全治愈还为时过早，但这些初步结果对于未来将这种载有抗生素的陶瓷用于复杂骨感染的治疗是令人鼓舞的。
