Isiklar Z U, Darouiche R O, Landon G C, Beck T
Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
Clin Orthop Relat Res. 1996 Nov(332):184-9. doi: 10.1097/00003086-199611000-00025.
Treatment of orthopaedic device related infections with antibiotics alone generally has been thought to be inadequate. A rabbit model was used to compare the efficacy of 4 different antibiotic regimens for treating orthopaedic device related infection caused by slime producing Staphylococcus epidermidis. After bacterial inoculation of a hole drilled through the intercondylar notch, a stainless steel screw was placed into the femur. Two weeks later, rabbits were randomized to receive a 2-week course of antibiotics: (1) 9 rabbits received vancomycin alone; (2) 10 rabbits received minocycline alone; (3) 10 rabbits received vancomycin plus rifampin; and (4) 10 rabbits received minocycline plus rifampin. Quantitative bone cultures were performed, and antibiotic levels in serum, bone, and biofilm were determined. Despite high levels of vancomycin in biofilm, infection was never cured by vancomycin alone and was eradicated in only 20% of rabbits that received minocycline alone. The highest cure rate (90%) was achieved with the combination of vancomycin and rifampin, whereas the combination of minocycline and rifampin yielded a cure rate of 70%. These results encourage the clinical evaluation of the combination of vancomycin and rifampin in patients in whom infected orthopaedic device cannot be removed.
一般认为，仅用抗生素治疗骨科器械相关感染是不够的。使用兔模型比较4种不同抗生素方案治疗由产黏液表皮葡萄球菌引起的骨科器械相关感染的疗效。在通过髁间切迹钻孔并接种细菌后，将一枚不锈钢螺钉置入股骨。两周后，将兔子随机分组接受为期2周的抗生素治疗：（1）9只兔子仅接受万古霉素治疗；（2）10只兔子仅接受米诺环素治疗；（3）10只兔子接受万古霉素加利福平治疗；（4）10只兔子接受米诺环素加利福平治疗。进行定量骨培养，并测定血清、骨和生物膜中的抗生素水平。尽管生物膜中万古霉素水平较高，但仅用万古霉素从未治愈感染，仅接受米诺环素治疗的兔子中只有20%的感染得到根除。万古霉素和利福平联合使用的治愈率最高（90%），而米诺环素和利福平联合使用的治愈率为70%。这些结果促使对无法取出感染骨科器械的患者进行万古霉素和利福平联合治疗的临床评估。
