在全膝关节关节整形术后,同时发生的双边甲素耐药黄金葡萄球菌感染成功通过持续局部抗生素 perfusion 治疗:一个病例报告
Kohei Motono1, Tomoyuki Matsumoto1, Keisuke Oe1
1Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
The American journal of case reports
|October 27, 2025
概括
连续局部抗生素输液 (CLAP) 成功治疗膝关节置换后双边MRSA周围假肢关节感染. 这种方法为复杂的关节感染提供了可行的选择,显示出出色的患者结果.
科学领域:
- 整形外科手术 整形外科手术
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 在全膝关节整形术 (TKA) 后的周围假肢关节感染 (PJI) 是一个重大的临床挑战.
- 持续局部抗生素 perfusion (CLAP) 使用高度的 gentamicin 进行有效的细菌抑制.
- 关于PJI的CLAP存在有限的数据,特别是罕见的双边甲素耐药黄金葡萄球菌 (MRSA) 病例.
研究的目的:
- 报告CLAP在TKA后的同时双边MRSA PJI治疗中的成功应用.
- 在复杂的骨科感染场景中评估CLAP的疗效和结果.
主要方法:
- 一名69岁的双边MRSA PJI后TKA的男性患者同时接受了除菌,灌,插入交换和CLAP.
- 关节内珍塔素被给予了14天,并补充了全身万科米辛和口服米诺环素.
- 在手术后的一年内监测临床和实验室参数.
主要成果:
- 术内培养证实了两条膝盖中的MRSA.
- 患者经历了成功的感染根除,在一年内没有复发.
- 炎症标志物 (WBC,CRP) 和膝盖运动范围 (0-130度) 显著改善.
结论:
- CLAP是一种可行和有效的治疗策略,用于由MRSA引起的周围假肢关节感染.
- 这个案例突出了使用CLAP成功管理罕见的双边同时发生的MRSA PJI.
- 在具有挑战性的PJI案件中,CLAP展示了改善结果的潜力.
相关概念视频
01:29Staphylococcal Skin Infections
Staphylococcus aureus is a Gram-positive coccus that resides harmlessly on the skin and mucous membranes of healthy individuals. When the skin barrier is breached, it can shift from a commensal to an opportunistic pathogen. This transition is facilitated by surface adhesins, such as clumping factor B and S. aureus surface protein G (SasG), which bind to structural proteins, including loricrin and cytokeratin, in the damaged epidermis. Protein A, another key factor, binds the Fc region of...
01:25Mechanism of Antibiotic Resistance in MRSA
Antibiotic resistance in bacteria arises when microorganisms evolve the ability to withstand drugs designed to kill them or inhibit their growth, rendering once-effective treatments useless. This phenomenon, driven by genetic change and selection under antibiotic exposure, poses a profound threat to modern medicine. Mechanisms include drug-inactivating enzymes (e.g., β-lactamases), efflux pumps that eject antibiotics, mutations altering antibiotic targets, decreased drug uptake, and acquisition...
01:25Clinical Significance of Antibiotic Resistance
Methicillin-resistant Staphylococcus aureus (MRSA) presents a critical public health threat, arising from its capacity to resist β-lactam antibiotics due to acquisition of the mecA gene within the staphylococcal cassette chromosome mec (SCCmec). This gene encodes penicillin-binding protein 2a (PBP2a), which impairs binding efficacy of methicillin and other β-lactams. MRSA has evolved into distinct clonal lineages impacting humans and animals alike, reinforcing its significance within the One...