Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Himeji, Japan.
Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan.
J Orthop Surg (Hong Kong). 2021 Sep-Dec;29(3):23094990211051492. doi: 10.1177/23094990211051492.
In our hospital, cases of bone and soft tissue infections have been treated with continuous local antibiotics perfusion that allows for continuous circulation of antibiotics throughout the infected lesion. We termed this treatment "intramedullary antibiotics perfusion (iMAP)" for bone infection such as fracture-related infection (FRI) and "intrasoft tissue antibiotics perfusion" for soft tissue infection. Many cases are treated with both modalities. To introduce iMAP, this study focused on the patients with FRI treated with iMAP and reviewed their treatment outcomes.
We included 10 patients with FRI treated with iMAP between 2004 and 2017. The iMAP needles were inserted near the infected lesion, and an aminoglycoside antimicrobial was continuously administered. Patient characteristics, pathogenic bacteria, administered antibiotics, duration of administration, concentrations of antibiotics in blood and leachate fluid, fracture union rate, implant retention rate, and complications were studied.
The mean age of patients was 59.9 years, and the mean follow-up period was 2.5 years. Affected bones were the tibia ( = 8), humerus ( = 1), and fibula ( = 1). Deep infections developed on average 29.9 days after osteosynthesis. Pathogenic bacteria were methicillin-susceptible ( = 6), methicillin-resistant ( = 2), and unknown ( = 2). Average iMAP duration was 17.1 days. In all patients, infection was eradicated while preserving the implants, and fracture union was achieved without complications.
iMAP is a novel local drug delivery system allowing high concentrations of antibiotics to be administered without complications and is useful in the treatment of FRI.
在我院，采用局部持续抗生素灌注的方法治疗骨与软组织感染，使抗生素在感染病灶内持续循环。我们将这种治疗方法称为骨髓内抗生素灌注（iMAP）治疗骨折相关感染（FRI）等骨感染，以及用于治疗软组织感染的“软组织内抗生素灌注”。许多病例采用两种方式联合治疗。为了介绍 iMAP，本研究主要关注接受 iMAP 治疗的 FRI 患者，并回顾了他们的治疗效果。
我们纳入了 2004 年至 2017 年间接受 iMAP 治疗的 10 例 FRI 患者。将 iMAP 针插入感染病灶附近，并持续输注氨基糖苷类抗生素。研究患者的一般特征、病原菌、使用的抗生素、灌注时间、血样和渗出液中抗生素浓度、骨折愈合率、植入物保留率以及并发症。
患者的平均年龄为 59.9 岁，平均随访时间为 2.5 年。受累骨骼分别为胫骨（8 例）、肱骨（1 例）和腓骨（1 例）。深部感染平均在骨愈合术后 29.9 天发生。病原菌分别为耐甲氧西林敏感金黄色葡萄球菌（6 例）、耐甲氧西林金黄色葡萄球菌（2 例）和未知（2 例）。iMAP 的平均持续时间为 17.1 天。所有患者均在保留植入物的同时消除了感染，且骨折愈合良好，无并发症发生。
iMAP 是一种新型的局部药物输送系统，可在不产生并发症的情况下给予高浓度抗生素，在 FRI 的治疗中具有应用价值。
