Sheftel T G, Mader J T, Pennick J J, Cierny G
Clin Orthop Relat Res. 1985 Sep(198):231-9.
In five patients, the diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis was made by clinical and roentgenographic methods and confirmed by bone biopsy cultures. The treatment was staged according to the anatomic setting of the infection and the systemic and local competence of the host. Seven episodes of osteomyelitis were encountered in the five patients. Two patients had persistence of their infection and were successfully treated by additional surgical debridement, antibiotics, and adjunctive hyperbaric oxygen. Vancomycin was administered to all patients. The daily dosage of vancomycin ranged between 100 mg and 2.0 gm. The length of vancomycin therapy ranged from 19 to 56 days. Five of seven biopsy specimens grew bacterial organisms in addition to MRSA. The MIC of vancomycin for MRSA ranged between 0.39 and 1.56 micrograms/ml. Osteomyelitis was arrested in five of seven episodes, and follow-up evaluations ranged from two to 35 months. Two of five (40%) patients receiving the combination of vancomycin and tobramycin developed signs of renal toxicity. Renal function returned to normal after discontinuation of the antibiotics. MRSA osteomyelitis is usually acquired by spread from a contiguous focus of infection and is often polymicrobic in nature. Treatment with vancomycin or vancomycin plus tobramycin when the infection was polymicrobic was effective. The combination of vancomycin plus tobramycin is potentially nephrotoxic.
5例患者通过临床和X线检查诊断为耐甲氧西林金黄色葡萄球菌（MRSA）骨髓炎，并经骨活检培养确诊。根据感染的解剖部位以及宿主的全身和局部状况分阶段进行治疗。这5例患者共发生7次骨髓炎发作。2例患者感染持续存在，通过再次手术清创、使用抗生素及辅助高压氧治疗获得成功。所有患者均使用万古霉素，万古霉素的每日剂量在100mg至2.0g之间，治疗时间为19至56天。7份活检标本中有5份除MRSA外还培养出其他细菌。万古霉素对MRSA的最低抑菌浓度在0.39至1.56μg/ml之间。7次发作中有5次骨髓炎得到控制，随访时间为2至35个月。接受万古霉素和妥布霉素联合治疗的5例患者中有2例（40%）出现肾毒性迹象，停用抗生素后肾功能恢复正常。MRSA骨髓炎通常由邻近感染灶播散而来，且往往具有多种微生物感染的性质。使用万古霉素或在感染为多种微生物感染时使用万古霉素加妥布霉素治疗有效。万古霉素加妥布霉素联合用药有潜在肾毒性。
