利福平联合左氧氟沙星在治疗骨科内植物迟发性感染中的应用

Oral rifampin plus levofloxacin for treatment of chronic orthopedic implant-related infections

[目的]总结利福平加左氧氟沙星治疗骨科内植物迟发性感染的有效性、安全性。[方法]2006年3月～2007年12月,采用长期口服利福平加左氧氟沙星(左氧氟沙星200mg3/日口服,利福平600mg2/日口服,疗程6个月)治疗骨科内植物迟发性感染13例。男6例,女7例;年龄17～75岁,平均51.6岁。治疗期间随访观察内容包括:血白细胞不同计数、血沉、C-反应蛋白、肝转氨酶水平及影像学资料。临床治愈标准:无临床感染征象(发热、局部疼痛、红肿、皮温高、窦道感染);血沉<20mm/h,CRP<5mg/L;影像学见骨折无假关节形成,稳定、骨折愈合好,或人工关节治疗随访24个月无脱位、无假体松动。无治愈趋向:不管感染何时发生,再次出现初次病原菌感染的临床征象,或没有微生物感染的证据而出现无法解释的高CRP水平(50mg/L),表明治疗失败。[结果]本组13例病人中除1例骨折感染病例因出现严重胃肠道反应与药物过敏用药2周后停止外,其余12例病人均完成6个月疗程的治疗。10例获得成功,2例骨折感染治疗6个月后仍无骨折愈合倾向且形成假关节改行二期骨折处理。无皮肤过敏、多关节痛等药物副反应。随访6～27个月(平均24个月),总的成功率为83.3%。随诊至今,感染均控制。[结论]采用全身营养支持,长期口服利福平加左氧氟沙星治疗骨科内植物迟发性感染是行之有效的方法。

[ Objective] To examine the effect and safety of the combination of rifampin plus levofloxacin given orally for treating chronic orthopedic implant -related infections. [ Methods] From March 2006 to December 2007, 13 patients with chronic orthopedic implant -related infections were treated orally with rifampin , 600 mg/day, plus levofloxacin, 600mg/day. The study group included 6 males and 7 females, with average age of 51.6 years （range, 17 -75 years） . During treatment, clinical follow -up was performed, including blood and differential counts , erythrocyte sedimentation rate , and hepatic enzyme levels, C - reactive protein levels, and radiological data. Cure was defined as the absence of clinical signs and symptoms of infection （ fever, local pain, redness, warmth, sinus tract infection ） , ESR 〈 20 mm/h and CRP 〈 5 mg/l, and the absence of radiological signs of loosening, pseudoarthrosis （ in ease of fixation device ） , or dislocation of the artificial joint at the final follow - up visit 24 moths after start of the treatment . Treatment failure was defined as the absence of cure , and relapse was defined as the reappearance of infection caused by the same microorganism that caused the original infection, regardless of the timing of this secondary infection, or unexplained high C - reactive protein level （ 〉 50 mg/1） without microbiological documentation of infection. [ Results ] Among 13 patients included in the study and evaluable for safety, one patient had gastrointestinal side effects and was not evaluable for treatment effectiveness. Twelve patients with chronic orthopedic implant - related infections , antibiotics were administrated orally for a total of 6 months. Two patients, on whom pseudoarthrosis presented, were treated with autologous bone graft and internal fixation subsequently. Ten of 12 patients with chronic orthopedic implant - related infections had successful outcomes . Those rates were determined after a post - treatment follow - up of 6 to 27 months （ average, 24 months ） . The overall success rate was 83.3% among 12 patients. Ten cases had been followed up, and no case had infection recurrence. [ Conclusion ] With nutrition support, the combination of rifampin plus levofloxacin given orally for treating chronic orthopedic implant - related infections are effective methods.