Nehrer S, Thalhammer F, Schwameis E, Breyer S, Kotz R
Universitätsklinik für Orthopädie, AKH-Wien, Universitätskliniken, Vienna, Austria.
Arch Orthop Trauma Surg. 1998;118(1-2):32-6. doi: 10.1007/s004020050306.
Perioperative antibiotic prophylaxis has been shown to be effective in reducing postoperative wound infections. The rising incidence of infections secondary to methicillin-resistant strains of Staphylococcus aureus. S. epidermidis and S. enterococcal prompted us to administer Teicoplanin to infection in elective total joint arthroplasty. In 111 patients Teicoplanin was given in a single intravenous dose of 10 mg/kg prior to surgery. In the postoperative period no deep infection of the prosthetic device was found in a 14-month follow-up. In two patients the following organisms were isolated from superficial infections of the wound: S. epidermidis (methicillin-sensitive), Pseudomonas aeruginosa, and Enterobacter sp. In no patient was revision surgery necessary. The serum concentration of Teicoplanin was within the therapeutic range during surgery, and tissue levels of Teicoplanin in cancellous (6.2 mg/kg, range 3.8-10.9 mg/kg) and cortical (7.1 mg/kg, range 2.6-12.1 mg/kg) bone during surgery in 16 patients exceeded the minimum inhibitory concentration of 90% (MIC90) of methicillin-resistant strains reported for methicillin-resistant strains. In our experience a single dose regimen of Teicoplanin is a safe and effective method of antibiotic prophylaxis in hip joint replacement, particularly when methicillin-resistant bacteria are present.
围手术期抗生素预防已被证明在减少术后伤口感染方面有效。耐甲氧西林金黄色葡萄球菌、表皮葡萄球菌和肠球菌引起的感染发病率不断上升，促使我们在择期全关节置换术中使用替考拉宁预防感染。对111例患者在手术前静脉注射单次剂量10mg/kg的替考拉宁。在术后14个月的随访中未发现假体深部感染。有2例患者伤口浅表感染分离出以下微生物：表皮葡萄球菌（对甲氧西林敏感）、铜绿假单胞菌和肠杆菌属。无一例患者需要进行翻修手术。手术期间替考拉宁的血清浓度在治疗范围内，16例患者手术期间松质骨（6.2mg/kg，范围3.8 - 10.9mg/kg）和皮质骨（7.1mg/kg，范围2.6 - 12.1mg/kg）中的替考拉宁组织水平超过了耐甲氧西林菌株报道的耐甲氧西林菌株90%最小抑菌浓度（MIC90）。根据我们的经验，替考拉宁单剂量方案是髋关节置换术中一种安全有效的抗生素预防方法，尤其是在存在耐甲氧西林细菌的情况下。
