抗生素骨水泥预防高感染风险人群人工髋关节置换术后深部感染的效果分析

目的：探讨抗生素骨水泥预防人工髋关节置换术后深部感染效果、机制及其适用病例。方法将152例(155髋)行人工关节置换术患者分为抗生素骨水泥型假体组(A组)、单纯骨水泥假体组(B组)和生物型假体组(C组),于术前、术后第1、3、7、14d、1月、3月抽血检测红细胞沉降率和C反应蛋白,观察术后感染情况。结果 B组1例发生深部感染。第7、14d及1月时, A组无论血沉还是C反应蛋白都比B组低。结论抗生素骨水泥能有效预防人工髋关节置换术后深部感染,适用于高感染风险人群。     

人工关节置换术后感染的防治体会-附5例报告

目的回顾性分析人工关节置换术后感染的病例，就预防及处理方法做一简单阐述，为临床治疗提供参考。方法自1996年1月-2003年4月对553例人工关节置换术中的感染病例进行随访分析，共5例出现关节感染，其中髋关节2例，膝关节2例，肩关节1例，3例为深部感染，2例为浅部感染。发生率为0．9％。对感染病例采用了静滴抗生素、清创引流、抗生素链植入、抗生素骨水泥的应用、假体取出、关节融合等方法。结果2例浅部(1髋1膝)感染患经清创和使用抗生素后，控制感染，假体得以保存。1例膝关节感染经假体取出抗生素骨水泥链使用后，行关节融合，创面逐渐愈合，感染得到控制。一例肩关节患行假体取出，抗生素链植入，感染控制，但未再行假体置换，关节功能欠佳。另一例全髋置换感染患为肾衰、贫血和低蛋白血症，于术后20个月因反复出现贫血，长期营养不良，低蛋白血症，呼吸循环衰竭而死亡。结论人工关节置换术后感染是灾难性并发症。应注意抗生素骨水泥的使用和假体取出的时机，对发生的浅部感染，可仅行清创，对深部感染应早期假体取出，选择性Ⅰ期或Ⅱ期假体置换，将使人工关节手术的感染得到有效控制。     

多次抗生素骨水泥旷置治疗膝关节置换术后严重感染的临床疗效分析

目的：观察多次使用自制抗生素骨水泥间隔治疗膝关节置换术后严重感染的临床疗效,探索一种经济实用的彻底治愈膝关节置换术后严重感染的旷置翻修术。方法2007年1月到2013年1月我院收治膝关节置换术后严重感染患者7例,均采用一期手术彻底清创,取出假体并多次（2~3次）置入自制可以活动的关节型抗生素骨水泥临时间隔物,术后即可早期活动并可以完全负重。术后选用敏感抗生素静脉滴注2~4周,感染治愈后再置入翻修假体。截至末次随访时,7例患者均获得随访,记录并对比患者术前及术后HSS评分、局部感染症状、抽取关节液细菌培养及术中留取病理组织切片结果,对患者术后定期X线片进行评价。结果7例患者均经过2~3次抗生素骨水泥间隔旷置后,给予行膝关节翻修术,随访时间平均38个月（8~74个月）,未见明显患膝关节感染症状,翻修后膝关节活动范围在伸直0°-屈曲108°之间。结论自制关节型抗生素骨水泥临时间隔物在严重膝关节感染旷置术中操作方便,多次采用可以成功、彻底的治疗膝关节置换术后深部严重感染,在旷置期能够保留关节活动度,可减少术后疼痛,改善关节功能。为二期再置换假体提供方便是一种经济实用的彻底治愈严重膝关节置换术后感染的好方法。     

全膝置换术后感染的处理

感染是全膝置换术后的一个比较少见的合并症,感染率为1%～2%。本文对全膝关节置换术后感染的诊断方法及采取的相应治疗措施进行了全面和系统的介绍。关节置换后持续性疼痛和进行性关节僵直应高度怀疑深部感染。血沉、C反应蛋白及关节穿刺物的培养是诊断感染的重要指标。单纯使用抗生素治疗不能去除深部感染,并且预后较差。使用抗生素骨水泥进行Ⅱ期翻修术是去除感染的最有效治疗方案。     

含抗生素骨水泥假体在人工关节术后感染中的应用

目的 回顾分析含抗生素骨水泥假体(PROSTALAC)治疗人工关节置换术后感染的疗效。方法 对16例髋和膝关节置换术后感染的病例采用PROSTALAC方法，进行二期翻修治疗并进行随访。结果 16例髋和膝关节置换术后感染中，有14例于治疗后接受二期全髋或全膝关节翻修术，经平均46月的随访，感染无复发，成功率达87．5％。术后Harris髋关节评分平均达82．9分，膝关节评分平均达90．5分。结论 在PROSTALAC基础上进行的二期全髋和全膝关节翻修手术能成功地治疗人工关节术后感染，并且保持术后关节的功能。     

低频超声下万古霉素骨水泥的抗菌性能及安全性的研究

抗生素骨水泥广泛用于治疗人工关节置换术后感染。有研究发现，全髋关节一期或二期翻修间期使用抗生素骨水泥，术后感染的复发率可达10．4％、15．1％。低频超声被用于控制药物穿透生物屏障。本研究旨在观察低频连续型超声（continuous wave ultrasound，CWU）作用下，万古霉素骨水泥（vancomycin-loaded bone cement，VLBC）的抗菌性能及安全性。     

髋关节置换术后深部感染(附7例分析)

目的 探讨人工全髋关节置换术后深部感染的诊断和治疗方法。方法 回顾性分析2000—07-2006—06收治的7例人工髋关节置换术后感染的病例,通过对临床表现、实验室检查、影像学检查、关节穿刺液培养、术中病灶组织涂片及培养综合分析,明确诊断为人工髋关节置换术后深部感染。治疗包括：保留假体的感染灶清除术1例;工期翻修4例,均用抗生素骨水泥固定;11期翻修2例,取出假体彻底清创后,1例安置自制抗生素骨水泥团,另1例未放置间隔器,给予置管抗生素液冲洗引流,感染控制后安放翻修假体,抗生素骨水泥固定。结果术后全部患者得到随访,随访时间7-72个月,平均18．6个月,感染均无复发。Harris评分平均为85．3（58—96）。结论 人工髋关节置换术后深部感染诊断和治疗都是困难的,保留假体感染灶清除术的选择要慎重,Ⅰ、Ⅱ期翻修术是治疗的有效方法。     

13例人工髋关节翻修术的感染控制策略

目的探讨人工髋关节置换并发感染后翻修时再次感染的控制策略。方法对13例人工髋关节置换后感染的患者进行关节腔穿刺和关节液细菌培养,Ⅰ期清创时取出假体及骨水泥,彻底切除关节囊瘢痕组织、坏死组织及明显充血水肿组织,与此同时取脓液或明显炎性组织进行细菌培养,在Ⅱ期翻修前分离出致病菌,使用敏感抗生素,确认感染被控制后进行Ⅱ期翻修。Ⅱ期翻修时置入含抗生素的骨水泥占位器4~6周,术后使用敏感抗生素。结果 13例患者中经术前穿刺和术中脓液或组织细菌培养有10例患者发现致病菌,经敏感抗生素治疗,感染被控制后Ⅱ期置入人工关节。随访6个月至10年,无关节感染复发,假体无明显松动或下沉,Harris评分由术前平均47.6±6.4增加到术后随访时的87.3±12.5(P<0.01)。结论人工髋关节置换术后感染Ⅱ期翻修的关键环节是彻底清创的基础上根据细菌培养结果合理使用有效抗生素。     

髋关节置换术后深部感染的手术治疗

目的 探讨髋关节置换术后的深部感染的手术治疗方法及其效果.方法 本组15例(15髋)髋关节置换术后的深部感染,均采用二期翻修手术,均使用抗生素骨水泥或骨水泥加抗生素占位器,3-6个月后,二期重建,术后静脉滴注抗生素4-6周后改口服抗生素1-2个月,应用X线及Harris评分进行评价.结果 所有患者平均随访10.5个月(6-18个月),Harris评分,平均85.3分(78-93分),与术前相比平均提高40.3分(P＜0.05).X线复查,术前有骨溶解的5例病例,术后均稳定,无继续破坏征象.其余病例无骨溶解、假体松动等迹象,在最后随访期间,没有再次感染的病例.结论 对于髋关节置换术后感染的治疗,二期翻修手术是有效合理的方法,抗生素骨水泥占位器,对于控制感染以及术后缩短抗生素应用时间起到至关重要的作用.     

含抗生素骨水泥假体在人工关节术后感染中的应用

目的回顾分析含抗生素骨水泥假体(PROSTALAC)治疗人工关节置换术后感染的疗效.方法对16例髋和膝关节置换术后感染的病例采用PROSTALAC方法,进行二期翻修治疗并进行随访.结果16例髋和膝关节置换术后感染中,有14例于治疗后接受二期全髋或全膝关节翻修术,经平均46月的随访,感染无复发,成功率达87.5%.术后Harris髋关节评分平均达82.9分,膝关节评分平均达90.5分.结论在PROSTALAC基础上进行的二期全髋和全膝关节翻修手术能成功地治疗人工关节术后感染,并且保持术后关节的功能.     

多发性骨髓瘤医院感染132例临床研究

目的研究多发性骨髓瘤(MM)患者医院感染的临床特点。方法对住院的132例多发性骨髓瘤患者发生医院感染进行回顾性统计分析。结果132例中38例发生医院感染,感染率28.78%,粒细胞缺乏组的医院感染率91.67%,致死率16.67%,显著高于非粒细胞缺乏组(P<0.01)。感染部位以下呼吸道为主,致病菌以革兰氏阴性菌为主。结论多发性骨髓瘤医院感染率高,粒细胞缺乏是主要危险因素,应采取积极的预防措施,缩短粒缺时间,早期、合理使用敏感抗生素防治感染。     

Oral immunotherapy with yolk antibodies to prevent infections in humans and animals

There is an increasing prevalence of antibiotic-resistant bacteria, which makes traditional antibiotics less effective. It is thus important to find an alternative to the use of antibiotics. Oral administration of specific antibodies is an attractive approach to establish protective immunity against gastrointestinal pathogens in humans and animals. Immunotherapy can also be used against pathogens that are difficult to treat with traditional antibiotics. Laying hens are good producers of specific antibodies. After immunisation, the specific antibodies are transported to the egg yolk from which the antibodies (IgY) can be purified in large quantities. Eggs are also normal dietary components and thus there is practically no risk of toxic side effects of IgY. Yolk antibodies have been shown in several studies to prevent both bacterial and viral infections. We have treated one patient with yolk antibodies against P. aeruginosa daily for more than eight years, which shows that it is possible to use yolk immunotherapy over long treatment periods.     

How far does prophylaxis against infection in total joint replacement offset its cost?

Selection of a cost effective method of prophylaxis against infection for patients undergoing total joint replacement was shown to depend on the number of arthroplasties performed each year at individual hospitals. When 100 arthroplasties were performed each year the prophylactic use of systemic antibiotics minimised the total costs of the department--that is, the combined costs of prophylaxis and reoperation for deep sepsis. Some departments also used local antibiotic prophylaxis in the form of polymethylmethacrylate cement impregnated with gentamicin or a combination of systemic and local prophylaxis at almost as low a total cost and with comparable effect. Selection of a method of prophylaxis should not be determined solely on the basis of reducing costs. When a value was assigned to the effects of loss of health an economic optimum was established that allowed selection of a more costly method of prophylaxis together with further reductions in the incidence of infection and the need for reoperation.     

心脏病医院真菌感染分析

目的了解医院真菌感染的状况、病原菌分布、危险因素及耐药情况。方法对184例医院真菌感染患者进行了分析。结果医院真菌感染以白色假丝酵母菌64．1％、热带假丝酵母菌13．0％、光滑假丝酵母菌10．3％为主；CCU、ICU、术后病房呼吸系统感染率较高，感染率分别为30．4%、27．7％、25．5％，其中冠心病患者感染率40．2％最高；危险因素为广谱抗生素广泛运用、留置导尿管、静脉插管、气管插管及切开、手术治疗、住院时间长等；真菌感染对两性霉素、制霉菌素、氟康唑和5-氟胞嘧啶的敏感性较高，对酮康唑的耐药性较高。结论采用有效的防范措施，重视消除诱发因素，合理运用抗生素，早期诊断和治疗刻不容缓。     

恶性肿瘤患者医院感染120例临床分析

目的 探讨恶性肿瘤患者粒细胞缺乏期发生医院感染的特点及防治对策。方法 回顾性分析我院1997年1月~2003年12月收治的120例恶性肿瘤患者化疗后粒细胞缺乏期医院感染发生的特点,分析感染发生的因素及感染种类等以及治疗效果。结果 发生院内感染的恶性肿瘤患者中,急性白血病患者、肺癌为主(70/120)。感染部位以呼吸道感染最多,占78.89%,其次是口腔粘膜、胃肠道、皮肤及腹腔等。感染种类以细菌为主,真菌感染有明显上升趋势。导致感染的病原菌主要为G-菌,对美罗培南、亚胺培南/西司他丁较敏感。结论 恶性肿瘤患者院内感染机率较高,作好基础护理,肠道消毒及粒细胞刺激因子等,合理使用抗生素,警惕真菌感染等是预防和治疗恶性肿瘤患者医院感染的重要措施。     

恶性肿瘤患者医院感染120例临床分析

目的探讨恶性肿瘤患者粒细胞缺乏期发生医院感染的特点及防治对策。方法回顾性分析我院1997年1月～2003年12月收治的120例恶性肿瘤患者化疗后粒细胞缺乏期医院感染发生的特点，分析感染发生的因素及感染种类等以及治疗效果。结果发生院内感染的恶性肿瘤患者中，急性白血病患者、肺癌为主(70／120)。感染部位以呼吸道感染最多．占78．89％，其次是口腔粘膜、胃肠道、皮肤及腹腔等。感染种类以细菌为主，真菌感染有明显上升趋势。导致感染的病原菌主要为G-菌，对美罗培南、亚胺培南／两司他丁较敏感。结论恶性肿瘤患者院内感染机率较高，作好基础护理，肠道消毒及粒细胞刺激因子等，合理使用抗生素，警惕真菌感染等是预防和治疗恶性肿瘤患者医院感染的重要措施。     

Treatment of sore throat in light of the Cochrane verdict: is the jury still out?

There are few good-quality studies of the effectiveness of antibiotic treatment of proven group A streptococcal (GAS) pharyngitis in children; available data suggest that antibiotics may reduce symptom duration. While there is limited justification for antibiotic treatment of GAS pharyngitis to prevent acute rheumatic fever in non-Indigenous Australians, there is no justification for routine antibiotic treatment of all patients with sore throat. Two strategies are open to clinicians: not to treat GAS pharyngitis with antibiotics, in which case no investigations should be done; or to treat cases of sore throat with clinical features that suggest GAS, in which case diagnosis should be confirmed with a throat swab, and penicillin started while awaiting the result. Penicillin should be discontinued if the swab is negative, or continued for 10 days if it is positive for GAS. Surveillance of GAS infections and acute rheumatic fever is needed in Australia, as are further studies of effectiveness (including cost-effectiveness) of antibiotic treatment of proven GAS pharyngitis.     

Resistance to antibiotics: are we in the post-antibiotic era?

Serious infections caused by bacteria that have become resistant to commonly used antibiotics have become a major global healthcare problem in the 21st century. They not only are more severe and require longer and more complex treatments, but they are also significantly more expensive to diagnose and to treat. Antibiotic resistance, initially a problem of the hospital setting associated with an increased number of hospital-acquired infections usually in critically ill and immunosuppressed patients, has now extended into the community causing severe infections difficult to diagnose and treat. The molecular mechanisms by which bacteria have become resistant to antibiotics are diverse and complex. Bacteria have developed resistance to all different classes of antibiotics discovered to date. The most frequent type of resistance is acquired and transmitted horizontally via the conjugation of a plasmid. In recent times new mechanisms of resistance have resulted in the simultaneous development of resistance to several antibiotic classes creating very dangerous multidrug-resistant (MDR) bacterial strains, some also known as "superbugs". The indiscriminate and inappropriate use of antibiotics in outpatient clinics, hospitalized patients and in the food industry is the single largest factor leading to antibiotic resistance. In recent years, the number of new antibiotics licensed for human use in different parts of the world has been lower than in the recent past. In addition, there has been less innovation in the field of antimicrobial discovery research and development. The pharmaceutical industry, large academic institutions or the government are not investing the necessary resources to produce the next generation of newer safe and effective antimicrobial drugs. In many cases, large pharmaceutical companies have terminated their anti-infective research programs altogether due to economic reasons. The potential negative consequences of all these events are relevant because they put society at risk for the spread of potentially serious MDR bacterial infections.     

Management in the wound-care center outpatient setting of a diabetic patient with forefoot osteomyelitis using Cerament Bone Void Filler impregnated with vancomycin: off-label use

Several nonbiodegradable and biodegradable antibiotic cement delivery systems are available for the delivery of antibiotics for adjunctive therapy in the management of osteomyelitis. A major nonbiodegradable delivery system is polymethylmethacrylate beads. Antibiotics that can be incorporated into this delivery system are limited to the heat-stable antibiotics vancomycin and aminoglycosides, tobramycin being the most popular. Calcium sulfate and hydroxyapatite (Cerament Bone Void Filler) is a unique biocompatible and biodegradable ceramic bone void filler that can successfully deliver heat-stable and heat-unstable antibiotics in musculoskeletal infections. The use of Cerament as antibiotic beads has not been previously reported. An off-label case of diabetic foot osteomyelitis successfully managed with surgical bone resection and vancomycin Cerament antibiotic beads is presented. Subsequent surgery for the bone infection and staged removal of the antibiotic beads was not necessary.     

铜绿假单胞菌临床分离株的耐药性分析

目的:分析242株铜绿假单胞菌(PA)的临床来源分布及耐药现状,为临床预防医院感染及合理应用抗生素提供依据。方法:标本获得纯培养后,用法国bio.Merieux公司的Vitek-AMS微生物全自动分析仪进行鉴定和药敏,药敏试验采用Vitek-AMS的Mic法与纸片琼脂扩散(K-B)法相结合的方法,以求结果更为精确。结果:PA所致的呼吸道感染是院内感染的重要途径。其对抗菌药物表现为多重耐药性;敏感率最高的抗生素是亚胺培南(90.1%),其次为哌拉西林他唑巴坦(85.9%)。左氧氟沙星与环丙沙星(83.1%与81.4%),妥布霉素(83.1%),头孢三代的头孢他啶和四代的头孢吡肟也有颇高的敏感率(75.6%和74.4%);而耐药率最高的是头孢唑啉和头孢替坦(均为98.8%)。次为氨苄西林(91.7%)、复方新诺明(90.1%)及头孢曲松(64.9%)。结论:必须健全医院消毒隔离制度,预防PA的医院感染,且根据药敏试验结果合理选用抗生素。以遏止其耐药率的攀升。