庆大霉素-富血小板凝胶治疗耐甲氧西林金黄色葡萄球菌感染相关慢性骨髓炎的疗效

Efficacy of gentamicin-platelet-rich gel in treatment of methicillin-resistant Staphylococcus aureus infection-associated chronic osteomyelitis

目的探讨庆大霉素-富血小板凝胶治疗慢性耐甲氧西林金黄色葡萄球菌(MRSA)感染所致骨髓炎的疗效。方法收集2018年1月-2021年1月医院收治的64例慢性MRSA感染所致骨髓炎患者为研究对象,依据治疗方法分为对照组(常规治疗,n=30)、研究组(庆大霉素-富血小板凝胶治疗,n=34)。比较两组疗效、治疗前后血液指标[C-反应蛋白(CRP)、白细胞计数(WBC)、血沉(ESR)]、治疗后6 h细菌减少率、骨缺损愈合时间、体温恢复正常时间,治疗前、治疗后1个月、治疗后3个月、治疗后5个月采用健康调查简表(SF-36评分)评估患者生活质量,并对比两组不良反应。结果两组疗效差异无统计学意义(P=0.146)。治疗后两组CRP、WBC、ESR较治疗前降低,且研究组以上各指标分别为(16.38±1.79)mg/L、(9.32±1.15)×10^(9)/L、(29.27±3.12)mm/h低于对照组(P<0.05);研究组治疗后6 h细菌减少率为(45.09±4.56)%高于对照组,且骨缺损愈合时间、体温恢复正常时间分别为(75.36±8.64)、(1.69±0.22)d短于对照组(P<0.05)。与治疗前比较治疗后两组SF-36评分明显升高,且治疗后1个月、3个月、5个月研究组高于对照组(P<0.05)。研究组不良反应发生率为5.88%低于对照组(P=0.005)。结论庆大霉素-富血小板凝胶治疗慢性MRSA感染所致骨髓炎患者,有效减轻机体炎性反应和感染水平,在提高细菌减少率、促进骨缺损愈合及改善生活质量等方面有优势,或可作为慢性MRSA感染所致骨髓炎患者一种安全有效治疗方案。

OBJECTIVE The aim of this study was to investigate the efficacy of gentamicin-platelet-rich gel in the treatment of osteomyelitis caused by chronic methicillin-resistant Staphylococcus aureus(MRSA)infection.METHODS Sixty-four patients with chronic osteomyelitis caused by MRSA infection who were admitted to the hospital between Jan.2018 and Jan.2021 were selected as the research subjects.According to the treatment method,the patients were divided into control group(conventional treatment,n=30)and study group(gentamicin-platelet-rich gel,n=34).Curative effect,blood indexes(C-reactive protein(CRP),white blood cell count(WBC)and erythrocyte sedimentation rate(ESR)before and after treatment,bacterial reduction rate at 6 h after treatment,bone defect healing time,and time for body temperature recovering were compared between the groups.The MOS 36-item short-form health survey(SF-36)was used to assess quality of life before treatment,at 1 month,3 months and 5 months after treatment.The incidence of adverse reactions was compared between the groups.RESULTS The curative effect classification showed no significant difference between the groups(P=0.146).After treatment,CRP,WBC and ESR were significantly reduced in the two groups.CRP,WBC and ESR in the study group were(16.38±1.79)mg/L,(9.32±1.15)×10^(9)/L and(29.27±3.12)mm/h,significantly lower than those in the control group(P<0.05).The bacterial reduction rate in the study group at 6 h after treatment was(45.09±4.56)%,significantly higher than that in the control group.The bone defect healing time and time for body temperature recovering were(75.36±8.64)d and(1.69±0.22)d,significantly shorter than those in the control group(P<0.05).After treatment,the SF-36 scores of the two groups were significantly increased,and the study group had significantly higher scores than the control group at 1 month,3 months and 5 months after treatment(P<0.05).The incidence of adverse reactions in the study group was 5.88%,significantly lower than that in the control group(P=0.005).CONCLUSION Gentamicin-platelet-rich gel is effective in the treatment of patients with chronic osteomyelitis caused by MRSA infection.It can effectively relieve inflammatory response and infection,with advantages in increasing the bacterial reduction rate,promoting bone defect healing and improving quality of life.It may be a safe and effective treatment for patients with chronic osteomyelitis caused by MRSA infection.