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  1. 1. Prophylactic Antibiotics Do Not Affect Cultures in the Treatment of an Infected TKA: A Prospective Trial TKA 感染预防性使用抗生素不影响细菌培养 一项前瞻性试验 R. Stephen J. Burnett MD, FRCS(C), Ajay Aggarwal MD, Stephanie A. Givens RN, J. Thomas McClure MD, Patrick M. Morgan MD, Robert L. Barrack MD Symposium: Papers Presented at the Annual Meetings of the Knee Society Online First ™ - August , 2009
  2. 2. Prophylactic antibiotics are frequently withheld until cultures are obtained in revision total knee arthroplasty (TKA). We undertook a prospective study to determine whether prophylactic preoperative intravenous antibiotics would affect the results of cultures obtained intraoperatively. A bstract
  3. 3. 在全膝关节置换( TKA )翻修手术中获得培养之前,常常停止预防性使用抗生素。我们进行了一项前瞻性研究,以确定术前预防性静脉应用抗生素是否会影响术中细菌培养的结果。 摘 要
  4. 4. We enrolled 25 patients with 26 infected TKAs, a known preoperative infecting organism, and no recent antibiotic therapy. Reaspiration of the infected TKA was performed after anesthesia and sterile preparation. Intravenous antibiotic prophylaxis was then administered and the tourniquet inflated. Intraoperative culture swabs and tissue were obtained at arthrotomy. The timing of events was recorded. Pre- and postantibiotic culture data were analyzed to determine the effect of intravenous preoperative prophylactic antibiotics on cultures obtained intraoperatively. Infections were acute postoperative (four), chronic (19), and acute hematogenous (three). A bstract
  5. 5. 25 位患者共 26 个 TKA 感染,术前已知感染的细菌,近期没有抗生素治疗。感染的全膝置换在麻醉和消毒后再抽吸。静脉预防性使用抗生素并对止血带充气。术中培养拭子和组织在关节切开后采取。记录操作的时间。分析抗生素使用前后的培养数据,以确定术前预防性使用抗生素对细菌培养结果的影响。感染包括术后急性感染 4 例、慢性 19 例、急性血源性 3 例。 摘 要
  6. 6. The most common infecting organism was cloxacillin-sensitive Staphylococcus aureus (nine knees [35%]). Preoperative prophylactic antibiotics did not affect the results of intraoperative cultures and we therefore believe should not be withheld before surgery for an infected TKA when an organism has been identified on aspiration preoperatively, and there has been no recent (4 weeks) antimicrobial therapy. A bstract
  7. 7. 最常见的是对氯唑西林敏感的金黄色葡萄球菌( 9 膝 [35 % ] )感染。术前预防性使用抗生素不影响术中细菌培养的结果,因此,我们认为当术前已知感染 TKA 的细菌,且最近( 4 周)没有抗菌治疗,术前不应该停止抗生素的使用。 摘 要
  8. 10. <ul><li>图 . 1A–E A </li></ul><ul><li>66 岁男性患者行双膝置换术后 20 周发生感染,术前与术中细菌培养均为对氯唑西林敏感的金黄色葡萄球菌(术前预防性的使用了抗生素) </li></ul><ul><li>术前正位片示胫骨假体松动 . </li></ul><ul><li>术前侧位同样显示松动 . </li></ul><ul><li>清创取出股骨与胫骨假体,并行灌洗,应用静态式骨水泥抗生素间隔物。静脉使用抗生素 6 周后血沉、 C- 反应蛋白正常。 10 周后再抽吸培养结果为阴性 </li></ul><ul><li>术后 12 周再次行 TKA </li></ul><ul><li>术后侧位片 </li></ul>
  9. 11. Thank you!