目的:系统回顾近年来对膝关节化脓性关节炎治疗的方法,并探讨其作用机 理.方法:综述近年来膝关节化脓性关节炎各种治疗方法的最新研究进展.结果:膝关节化脓性关节炎的治疗应根据病情分期的不同,选择恰当的治疗方案,有利于 病情的治疗.结论:中西医结合疗法在膝关节化脓性关节炎的治疗中具有明显优势.

目的 观察关节镜下清理加术后持续灌洗治疗化脓性膝关节炎的效果,为临床治疗化脓性膝关节炎提供依据.方法 对2010年1月-2012年12月医院18例化脓性膝关节炎患者行关节镜下清理术,术后用生理盐水及庆大霉素灌洗引流1～2周;观察患者治疗期间恢复情 况,并进行疗效评定,使用SPSS 19.0软件进行统计分析;膝关节活动度、Neer评分采用t检验;P＜0.05为差异有统计学意义.结果 所有患者术后2～5 d体温恢复正常,4～7d白细胞计数恢复正常,13～19 d血沉和C反应蛋白恢复正常;所有患者切口Ⅰ期愈合,无窦道形成;平均治疗时间为14.9d;随访12个月,未出现复发病例;患者术后8周屈膝达 (109.8±15.8)°,高于治疗前的(45.1±10.2)°,差异有统计学意义(P＜0.05);患者治疗后Neer膝关节功能评分为 (94.01±4.73)分,高于治疗前的(54.47±3.34)分,差异有统计学意义(P＜0.05);Neer评分优8例、良9例、差1例,优良率 为94.44％.结论 关节镜下清理及术后持续灌洗治疗化脓性膝关节炎恢复快、优良率高,是较理想的治疗方法.

一、骨关节外科相关感染概况 骨和关节感染是指病原菌侵入骨组织或关节造成的感染,可分为非特异性感染和特异性感染。非特异性感染主要有急、慢性的骨髓炎、化脓性关节炎以及与植入物相关的感染,即人工关节的感染和内固定植入物的感染;特异性感染主要是指结核或非结核分支杆菌感染。其他还包括有糖尿病足感染,术后或创伤后感染,脊椎骨髓炎等特殊类型。各种感染的入侵途径包括病原菌经血行播散、临近部位蔓延感染以及直接种植等。

细菌耐药已经成为一个世界性的卫生问题，糖肽类药物替考拉宁一直作为治疗耐甲氧西林金黄色葡萄球菌的首选药物之一。替考拉宁口服不吸收，蛋白结合率高，半衰期长，大部分以原型经肾排出，肾功能不全患者半衰期延长。替考拉宁对多种革兰氏阳性菌敏感，杀菌曲线相对平缓，为非浓度依赖性，杀菌作用呈现持续效应，有明显抗生素后效应。当AUC／MIC≥345时可达到最佳治疗效果，为此，应使用负荷剂量使其快速达到有效谷浓度，同时应重视维持剂量，也可根据不同病原菌的最低抑菌浓度而选择不同的治疗方案。

抗菌药物是导致药物热最常见的药物.在抗感染治疗时,临床上往往容易忽视抗菌药物相关性药物热,而使发热控制不理想.综述抗菌药物相关性药物热的诊断和治疗方法,以期为临床合理判断及治疗抗菌药物相关性药物热提供参考,从而减少不必要的用药.

收集整理129例使用利福平发 生药物热的病例,对其发热情况进行观察统计,总结利福平致药物热的特点,分析其与其他发热的鉴别。护理中采取密切观察体温、科学补液、积极的饮食指导及心 理疏导等措施,对高热和超高热患者注意观察生命体征,防止发生窒息、脑水肿、心力衰竭和消化道出血等严重并发症,积极采取降温措施可减轻患者不适,提高患 者对治疗的依从性,提高疗效。

万古霉素是糖肽类抗菌药物，是临床治疗耐甲氧西林金葡菌的首选药物。近年来国内有文献报道，本品可致药物热，现概述如下。

Abstract BACKGROUND: Vancomycin has reliable antibacterial activity against many gram-positive pathogens but is associated with many adverse events. Teicoplanin, another glycopeptide, is associated with fewer adverse events, but its use in patients with previous vancomycin-induced adverse reactions remains controversial. OBJECTIVES: The aims of this work were to evaluate the clinical characteristics of hospitalized patients with vancomycin-induced fever (ie, drug fever), rash, or neutropenia and to examine the tolerability of teicoplanin in these patients. METHODS: This was a retrospective review of the medical charts of patients aged >or=18 years who were hospitalized between January 2002 and October 2007 at National Cheng Kung University Hospital in Tainan, Taiwan. Patients were included if they experienced drug-induced fever (ie, "drug fever"), rash, or neutropenia during vancomycin treatment. Their antimicrobial therapy was subsequently switched to teicoplanin. Clinical information and the development of drug fever, rash, or neutropenia with teicoplanin were determined from the charts. RESULTS: Antibiotic therapy was switched to teicoplanin in 117 patients with vancomycin-induced fever alone (n = 24), rash alone (n = 77), both drug fever and rash (n = 8), or neutropenia (n = 8). The mean (SD) age of these patients was 53.1 (22.8) years, and 65 (56%) were male. The major clinical indications for vancomycin therapy among these patients were wound infections (21%), respiratory tract infections (14%), and bacteremia (13%). The dosages for vancomycin ranged from 1 g every 5 days to 1 g BID, and for teicoplanin ranged from 400 mg daily to 400 mg q72h, adjusted by the degree of renal dysfunction. Overall, 12 patients with vancomycin-induced fever (n = 2), rash (n = 6), or neutropenia (n = 4) subsequently developed teicoplanin-induced fever (n = 3), rash (n = 3), or neutropenia (n = 6). Specifically, of 8 patients with vancomycin-induced neutropenia, 4 (50%) subsequently developed neutropenia after switching to teicoplanin. Vancomycin- and teicoplanin-induced neutropenia was often noted after 1 week of treatment. Among patients with vancomycin-induced fever, rash, or neutropenia, there were no differences between patients with or without teicoplanin-induced fever, rash, or neutropenia in terms of age, sex, weight, dosage or duration of vancomycin therapy, dosage of teicoplanin, or underlying disease. There was no difference in mortality rates between patients with or without teicoplanin-induced fever, rash, or neutropenia. The cause of all deaths was progression of infectious or underlying disease, unrelated to vancomycin or teicoplanin use. CONCLUSIONS: Based on this retrospective chart review of hospitalized patients with vancomycin-induced fever, rash, or neutropenia, only 10% experienced subsequent teicoplanin-induced fever, rash, or neutropenia. However, it should be noted that half of the patients with vancomycin-induced neutropenia developed teicoplanin-induced neutropenia.

Abstract Methicillin-resistant Staphylococcus is a common cause of orthopaedic implant infections. In such cases, rifampicin is the antibiotic of choice, but it should not be administered alone to avoid the selection of resistant mutants. Linezolid has activity against resistant staphylococci and a high oral bioavailability; therefore, it could be a good option for combining with rifampicin. We describe 2 patients admitted to our hospital due to orthopaedic implant infections, who received combination therapy with linezolid and rifampicin. In both cases, the trough serum concentration of linezolid during rifampicin treatment was below the minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC(90)) for staphylococci, but increased after rifampicin withdrawal. This finding suggests an interaction between rifampicin and linezolid, and a possible explanation is discussed.