Doub James B, Heil Emily L, Manson Theodore
Division of Infectious Diseases, University of Maryland School of Medicine, 725 West Lombard Street, BaltimoreMaryland, MD, 21201, USA.
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, 21201, USA.
Eur J Orthop Surg Traumatol. 2024 Feb;34(2):1031-1036. doi: 10.1007/s00590-023-03764-y. Epub 2023 Oct 21.
Chronic prosthetic joint infection patients who fail conventional two-stage revision surgery are an especially difficult to treat patient population. Consequently, the objective of this study was to investigate the safety and long-term effectiveness of adjuvant intra-articular vancomycin therapy in conjunction with two-stage revision knee arthroplasties for recalcitrant Staphylococcal prosthetic joint infections.
This was an observational cohort study of twelve patients with recalcitrant Staphylococcal prosthetic joint infections of the knee which had failed previous revision surgeries. Each patient subsequently underwent two-stage revision with placement of Hickman catheters to deliver intra-articular vancomycin therapy. In addition, systemic antibiotic therapy was administered for 6 weeks, and long-term follow-up was evaluated then for 5 years.
Seventy-five percent of the cohort have had no recurrence of their infections at 5 years. Two patients formed fistulas requiring above the knee amputations, and three patients had acute kidney injury. All patients had maximum measurable serum vancomycin trough levels that ranged from 6.1 to 93.6 mcg/mL.
The aggressive protocol used in this cohort with repeat two-stage revision surgery, intra-articular vancomycin and systemic antibiotics was able to prevent recurrence of infection in most patients, but higher than expected rates of acute kidney injury were observed in this study. Therefore, while intra-articular vancomycin therapy may have some effectiveness in treating recalcitrant prosthetic joint infections, its ability to eradicate all bacterial niduses is unproven, and clinicians should be cognizant of potential adverse events that can occur with this therapy.
传统两阶段翻修手术失败的慢性人工关节感染患者是特别难以治疗的患者群体。因此，本研究的目的是调查辅助关节内注射万古霉素联合两阶段翻修膝关节置换术治疗顽固性葡萄球菌人工关节感染的安全性和长期有效性。
这是一项对12例膝关节顽固性葡萄球菌人工关节感染患者的观察性队列研究，这些患者之前的翻修手术均失败。随后，每位患者都接受了两阶段翻修手术，并放置希克曼导管以进行关节内万古霉素治疗。此外，给予全身抗生素治疗6周，然后进行5年的长期随访评估。
该队列中有75%的患者在5年时感染未复发。2例患者形成瘘管，需要进行膝上截肢，3例患者发生急性肾损伤。所有患者可测量的血清万古霉素谷浓度最高范围为6.1至93.6 mcg/mL。
本队列中采用的积极方案，即重复两阶段翻修手术、关节内注射万古霉素和全身使用抗生素，能够在大多数患者中预防感染复发，但在本研究中观察到急性肾损伤发生率高于预期。因此，虽然关节内注射万古霉素治疗在治疗顽固性人工关节感染方面可能有一定效果，但其根除所有细菌病灶的能力尚未得到证实，临床医生应认识到这种治疗可能发生潜在不良事件。
