万古霉素预防假体周围感染的研究进展

Research progress in vancomycin used for prevention of periprosthetic joint infection

摘要:

全关节置换术 (total joint arthroplasty, TJA) 是 20 世纪最成功的临床手术技术，其数量仍在不断增加。假体周围感染(periprosthetic joint infection, PJI)是 TJA 后最常见和最具破坏性的并发症之一，革兰氏阳性菌，尤其是耐甲氧西林金黄色葡萄球菌 (methicillin-resistant staphylocouus anrens, MRSA) 是多数 PJI 感染的主要原因。万古霉素能对引起 PJI 的大部分病原菌达到覆盖，随着 MRSA 导致的 PJI 的发生率上升，万古霉素在 PJI 预防方面的作用越来越重要。万古霉素局部使用来辅助预防 PJI 的方式越来越全面，这些方法的有效性、安全性已在动物实验和/或回顾性试验中证实，但都缺乏更充分有力的证据来证明。未来的研究应侧重大型多中心随机试验，进一步证明万古霉素用于 PJI 预防的有效性。

Abstract:

The total joint arthroplasty (TJA) is the most successful clinical surgical technique in the 20th century, and keeps increasing in number of cases. However, periprosthetic joint infection (PJI) is one of the most common and devastating complications after TJA, which mainly induced by Gram-positive bacteria, especially Staphylococcus aureus. Vancomycin may cover most of the pathogens causing PJI and plays an increasingly important role in the prevention of PJI with the increasing incidence of PJI caused by MRSA. The local administration of vancomycin to assist in the prevention of PJI is becoming more and more comprehensive with effectiveness and safety confirmed in animal experiments and/or retrospective trials, despite of lacking more robust evidence. Future studies should focus on large multicenter randomized trials to demonstrate effectiveness of vancomycin for PJI prevention further.