Four versus six weeks of antibiotic therapy for osteoarticular infections after implant removal: a randomized trial.

Autor:	Benkabouche M; Department of Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Racloz G; Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.; Orthopaedic Service of Surgery, Pourtales Hospital, Neuchâtel, Switzerland., Spechbach H; Department of Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Lipsky BA; Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Gaspoz JM; Department of Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Uçkay I; Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.; Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.; Infectiology, Balgrist University Hospital and Faculty of Medicine, Zurich, Switzerland.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2019 Aug 01; Vol. 74 (8), pp. 2394-2399.
DOI:	10.1093/jac/dkz202
Abstrakt:	Background: The optimal duration of antibiotic therapy for treating orthopaedic implant infections after surgical drainage and complete implant removal is unknown. Methods: This was a single-centre, unblinded, prospective trial randomizing (1:1) eligible patients to either 4 or 6 weeks of systemic, pathogen-targeted antibiotic therapy. Clinical trial registration number: ClinicalTrials.gov (NCT0362209). Results: We analysed 123 eligible patients (62 in the 4 week antibiotic arm and 61 in the 6 week arm) in the ITT analysis. The patients' median age was 64 years, 75 (61%) were men and 38 (31%) were immunocompromised. The most common types of infection treated included: two-stage exchange procedure for prosthetic joint infection (n = 38); orthopaedic plate infection (44) and infected nail implants (11). The median duration of post-explant intravenous antibiotic therapy was 4 days. Overall, 120 episodes (98%) were cured microbiologically and 116 (94%) clinically after a median follow-up period of 2.2 years. During follow-up, four patients had a clinical recurrence with a pathogen other than the initial causative agent. We noted recurrence of clinical infection in four patients in the 4 week arm and three patients in the 6 week arm (4/62 versus 3/61; χ2 test; P = 0.74); in all cases, this occurred at around 2 months following the end of antibiotic treatment. Conclusions: We found no statistically significant difference in the rates of clinical or microbiological remission between patients randomized to only 4 compared with 6 weeks of systemic antibiotic therapy after removal of an infected osteoarticular implant. (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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