Drancourt M, Stein A, Argenson J N, Roiron R, Groulier P, Raoult D
Laboratoire de Microbiologie Clinique, Hôpital de la Timone, Marseille, France.
J Antimicrob Chemother. 1997 Feb;39(2):235-40. doi: 10.1093/jac/39.2.235.
Oral therapy of staphylococcal infection of orthopaedic implants with 900 mg/day rifampicin combined with either 1.5 g/day fusidic acid for 5 days followed by 1 g/day thereafter, or 600 mg/day ofloxacin was compared. Patients with an infected hip were treated for 6 months, with removal of any unstable prosthesis after 5 months' treatment and those with an infected knee prosthesis were treated for 9 months, with removal of the prosthesis after 6 months of treatment. Patients with infections of other type of bone implants were treated for 6 months with removal of the implant after 3 months of treatment, if necessary. Cure was defined as the absence of clinical, microbiological and radiological evidence of infection 12 months after completion of treatment. The treatment of 46 of the 52 included in the study was evaluated for safety and that of 42 was assessed for efficacy. Overall treatment was successful for 11 (55%) of 20 patients treated with rifampicin and fusidic acid group and for 11 (50%) of the 22 treated with rifampicin and ofloxacin. Treatment failed in four cases in each treatment group because of persistent infection. One patient given rifampicin and fusidic acid and three patients given rifampicin and ofloxacin failed treatment because of relapse. Superinfection led to failure in the remainder and was due to staphylococci in all but one case in which Acinetobacter calcoaceticus var. anitratus was isolated. There were no side effects related to study treatment. Oral treatment with rifampicin combined with fusidic acid may be a suitable alternative to the combination of rifampicin and ofloxacin for treating implant infections due to Staphylococcus spp. either when the patient is intolerant to quinolones or when the infecting organism is resistant to these drugs.
对900毫克/天利福平联合1.5克/天夫西地酸治疗5天，之后1克/天，或联合600毫克/天氧氟沙星治疗骨科植入物葡萄球菌感染的口服疗法进行了比较。感染髋关节的患者接受6个月治疗，治疗5个月后取出任何不稳定的假体；感染膝关节假体的患者接受9个月治疗，治疗6个月后取出假体。其他类型骨植入物感染的患者接受6个月治疗，必要时在治疗3个月后取出植入物。治愈定义为治疗完成后12个月无感染的临床、微生物学和放射学证据。对研究纳入的52例患者中的46例进行了安全性评估，对42例进行了疗效评估。利福平联合夫西地酸治疗组的20例患者中有11例（55%）总体治疗成功，利福平联合氧氟沙星治疗组的22例患者中有11例（50%）总体治疗成功。每个治疗组均有4例因持续感染治疗失败。1例接受利福平联合夫西地酸治疗的患者和3例接受利福平联合氧氟沙星治疗的患者因复发治疗失败。其余患者因二重感染导致治疗失败，除1例分离出醋酸钙不动杆菌反硝化亚种外，均由葡萄球菌引起。未发现与研究治疗相关的副作用。当患者不耐受喹诺酮类药物或感染病原体对这些药物耐药时，利福平联合夫西地酸口服治疗可能是治疗葡萄球菌属引起的植入物感染的利福平和氧氟沙星联合治疗的合适替代方案。
