Department of Joint Surgery and Sports Medicine, Zhongnan Hospital of Wuhan Universitygrid.413247.7, Wuhan, China.
Department of Pharmacology, Wuhan University, Wuhan, China.
Antimicrob Agents Chemother. 2021 Aug 17;65(9):e0030321. doi: 10.1128/AAC.00303-21.
The rate of eradication of periprosthetic joint infection (PJI) caused by methicillin-resistant Staphylococcus aureus (MRSA) is still not satisfactory with systemic vancomycin administration after one-stage revision arthroplasty. This study aimed to explore the effectiveness and safety of intraarticular (IA) injection of vancomycin in the control of MRSA PJI after one-stage revision surgery in a rat model. Two weeks of intraperitoneal (IP) and/or IA injection of vancomycin was used to control the infection after one-stage revision surgery. The MRSA PJI rats treated with IA injection of vancomycin showed better outcomes in skin temperature, bacterial counts, biofilm on the prosthesis, serum α-acid glycoprotein levels, residual bone volume, and inflammatory reaction in the joint tissue, compared with those treated with IP vancomycin, while the rats treated with IP and IA administration showed the best outcomes. However, only the IP and IA administration of vancomycin could eradicate MRSA. Minimal changes in renal pathology were observed in the IP and IP plus IA groups but not in the IA group, while no obvious changes were observed in the liver or in levels of serum markers, including creatinine, alanine aminotransferase, and aspartate aminotransferase. Therefore, IA use of vancomycin is effective and safe in the MRSA PJI rat model and is better than systemic administration, while IA and systemic vancomycin treatment could eradicate the infection with a 2-week treatment course.
一期翻修术后，全身性万古霉素给药治疗耐甲氧西林金黄色葡萄球菌（MRSA）引起的人工关节周围感染（PJI）的清除率仍然不理想。本研究旨在探讨在大鼠模型中，一期翻修术后关节内（IA）注射万古霉素控制 MRSA PJI 的有效性和安全性。在一期翻修手术后，采用腹腔内（IP）和/或 IA 万古霉素注射 2 周来控制感染。与 IP 万古霉素治疗组相比，IA 注射万古霉素治疗的 MRSA PJI 大鼠在皮肤温度、假体上的细菌计数、生物膜、血清α-酸性糖蛋白水平、残余骨量和关节组织中的炎症反应方面的结果更好，而同时接受 IP 和 IA 万古霉素治疗的大鼠则表现出最佳结果。然而，只有 IP 和 IA 万古霉素给药才能根除 MRSA。IP 和 IP 加 IA 组的肾脏病理变化最小，但 IA 组没有明显变化，肝脏或血清标志物水平（包括肌酐、丙氨酸氨基转移酶和天冬氨酸氨基转移酶）也没有明显变化。因此，IA 应用万古霉素在 MRSA PJI 大鼠模型中是有效和安全的，优于全身给药，而 IA 和全身万古霉素治疗可以在 2 周疗程内根除感染。
