ORAL RIFAMPIN PLUS OFLOXACIN FOR TREATMENT OF STAPHYLOCOCCUS-INFECTED ORTHOPEDIC IMPLANTS
ORAL RIFAMPIN PLUS OFLOXACIN FOR TREATMENT OF STAPHYLOCOCCUS-INFECTED ORTHOPEDIC IMPLANTS
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DOI：
10.1128/aac.37.6.1214
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发表时间：
1993-06-01
影响因子：
4.9
通讯作者：
RAOULT, D
中科院分区：
文献类型：
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作者：
DRANCOURT, M;STEIN, A;RAOULT, D
我们研究了口服利福平和氧氟沙星联合治疗骨科假体植入物葡萄球菌感染的有效性和安全性。前瞻性队列研究是在1985年至1991年期间在一家提供日间护理服务的转介公立医院进行的。从骨科植入物中分离出对研究药物敏感的葡萄球菌微生物且无治疗禁忌症的连续性患者有资格参加本研究。所有患者均口服利福平900 mg/d+氧氟沙星600 mg/d。髋关节假体感染的患者治疗6个月，治疗5个月后取出任何不稳定的假体;膝关节假体感染的患者治疗9个月，治疗6个月后取出假体;骨板感染的患者治疗6个月，治疗3个月后取出骨板，如有必要。每月进行一次临床评估，直至治疗完成，并在治疗后6、12、24、36、48和60个月进行随访或电话采访。通过临床评价、感染部位采样进行培养和抗生素活性测量以及瘘管造影（如果可能）记录治疗失败。治愈定义为治疗完成后6个月无感染的临床、生物学和放射学证据，治疗失败定义为无治愈，复发定义为由引起原始感染的相同葡萄球菌分离株引起的感染再次出现，无论继发感染的时间。在纳入研究并可评价安全性的51例患者中，4例患者出现副作用，无法评价治疗有效性; 47例患者的总体成功率为74%，其中髋关节假体组的成功率为81%，膝关节假体组为69%，接骨器械组为69%。8例治疗失败与耐药细菌的分离有关。利福平口服联合氧氟沙星是治疗骨科植入物葡萄球菌感染的传统长期静脉治疗的合适替代方案。
We examined the effectiveness and safety of the combination of rifampin plus ofloxacin given orally for treating prosthetic orthopedic implants infected with staphylococci. The prospective cohort study was conducted in a referral public hospital with ambulatory care services between 1985 and 1991. Consecutive patients from whom Staphylococcus organisms susceptible to the study drugs were isolated from their orthopedic implants and who had no contraindication to the treatment were eligible for the study. All patients were treated orally with rifampin, 900 mg/day, plus ofloxacin, 600 mg/day. Patients with hip prosthesis infection were treated for 6 months, with removal of any unstable prostheses after 5 months of treatment; patients with knee prosthesis infection were treated for 9 months, with removal of the prosthesis after 6 months of treatment; and patients with infected bone plates were treated for 6 months, with removal of the plate after 3 months of treatment, if necessary. Monthly clinical evaluations were conducted until the completion of the treatment and follow-up or telephone interviews were conducted at 6, 12, 24, 36, 48, and 60 months thereafter. Treatment failures were documented by clinical evaluation, sampling of the infected site for culture and antibiotic activity measurement, and fistulography, if possible. Cure was defined as the absence of clinical, biological, and radiological evidence of infection 6 months after the completion of treatment, treatment failure was defined as the absence of cure, and relapse was defined as the reappearance of infection caused by the same Staphylococcus isolate that caused the original infection, regardless of the timing of this secondary infection. Among 51 patients included in the study and evaluable for safety, 4 patients had side effects and were not evaluable for treatment effectiveness; the overall success rate was 74% among 47 patients, with a success rate of 81% for the hip prosthesis group, 69% for the knee prosthesis group, and 69% for the osteosynthesis device group. Eight treatment failures were related to the isolation of a resistant bacterium. The combination of rifampin administered orally plus ofloxacin is a suitable alternative to the conventional long-term intravenous therapy for treatment of orthopedic implants infected with staphylococci.