Stern P J, Staneck J L, McDonough J J, Neale H W, Tyler G
J Hand Surg Am. 1983 Sep;8(5 Pt 1):553-9. doi: 10.1016/s0363-5023(83)80124-5.
A randomized, prospective study of 200 consecutive established hand infections was designed to compare the efficacy of two antibiotics, cefamandole and nafcillin. Bacteriologic data revealed 63.5% of the patients grew multiple organisms (2.3 organisms per culture) and 26% of the patients had anaerobic infections. Complications were noted in 13% of all patients--26% in patients who grew aerobes and anaerobes and 9.8% in patients who grew aerobes alone (p less than 0.05). Despite the fact that 95% of all organisms were sensitive in vitro to cefamandole whereas only 67% of organisms were sensitive to nafcillin (p less than 0.01), complications occurred more frequently in patients treated with cefamandole. We conclude that the empirical selection of a broad-spectrum antibiotic is reasonable based on in vitro sensitivity studies; however, other factors such as treatment delay, initial extent of infection, anatomic location of infection, cause of infection, and extent of surgical debridement are important in the development of complications.
一项针对200例连续性确诊手部感染患者的随机前瞻性研究，旨在比较两种抗生素头孢孟多和萘夫西林的疗效。细菌学数据显示，63.5%的患者培养出多种微生物（每次培养2.3种微生物），26%的患者存在厌氧菌感染。所有患者中有13%出现并发症——培养出需氧菌和厌氧菌的患者中26%出现并发症，仅培养出需氧菌的患者中9.8%出现并发症（p<0.05）。尽管所有微生物中有95%在体外对头孢孟多敏感，而只有67%的微生物对萘夫西林敏感（p<0.01），但接受头孢孟多治疗的患者并发症发生率更高。我们得出结论，基于体外敏感性研究经验性选择广谱抗生素是合理的；然而，其他因素如治疗延迟、初始感染范围、感染的解剖位置、感染原因以及手术清创范围在并发症的发生中很重要。
