Veit R, Melliere D, Etienne G, Becquemin J P, Brunbuisson C, Otterbein G
J Chir (Paris). 1986 Nov;123(11):621-5.
Although the principle and duration of prophylactic antibiotic therapy in prosthetic vascular surgery are fairly widely accepted, the choice of antibiotic is still open to discussion. During two successive periods, identical groups of patients received peri-operative prophylaxis with, during period I (455 cases) oxacillin alone and during period II (537 cases) combined treatment with oxacillin and amikacin. The aim of the study was to evaluate efficacy of the association and to draw general conclusions on choice of antibiotic. The addition of amikacin reduced frequency of infection in elective operations, particularly aorto-ilio-femoral prostheses (0.5% as against 1.24%), but not in operations conducted as emergencies. In addition, frequency of infection due to BGN fell only slightly. Finally, combined therapy with oxacillin-amikacin had 2 disadvantages: impossibility of using these antibiotics for prophylaxis alone as provided for in the protocol, and its high cost. Factors of choice of antibiotic should be: efficacy against germs encountered, which can vary from year to year, rarity of toxic or side effects, good tissue diffusion, the rare need for therapeutic use and a low cost.
尽管人工血管手术中预防性抗生素治疗的原则和疗程已得到相当广泛的认可，但抗生素的选择仍有待探讨。在两个连续的时间段内，相同组别的患者接受围手术期预防治疗，在第一阶段（455例）仅使用苯唑西林，在第二阶段（537例）使用苯唑西林和阿米卡星联合治疗。本研究的目的是评估联合用药的疗效，并就抗生素的选择得出一般性结论。添加阿米卡星降低了择期手术的感染发生率，尤其是主动脉-髂股人工血管手术（分别为0.5%和1.24%），但在急诊手术中并未降低。此外，由革兰阴性菌引起的感染发生率仅略有下降。最后，苯唑西林-阿米卡星联合治疗有两个缺点：无法按照方案规定单独使用这些抗生素进行预防，且成本高昂。选择抗生素的因素应包括：对每年可能不同的常见病菌有效、毒性或副作用罕见、良好的组织扩散性、极少需要用于治疗用途以及低成本。
