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Four versus six weeks of antibiotic therapy for osteoarticular infections after implant removal: a randomized trial.
- Source :
-
The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2019 Aug 01; Vol. 74 (8), pp. 2394-2399. - Publication Year :
- 2019
-
Abstract
- Background: The optimal duration of antibiotic therapy for treating orthopaedic implant infections after surgical drainage and complete implant removal is unknown.<br />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).<br />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.<br />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.<br /> (© 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.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Male
Microbiological Techniques
Middle Aged
Prospective Studies
Prosthesis-Related Infections surgery
Time Factors
Treatment Outcome
Young Adult
Anti-Bacterial Agents administration & dosage
Device Removal
Osteoarthritis drug therapy
Prosthesis-Related Infections drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2091
- Volume :
- 74
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- The Journal of antimicrobial chemotherapy
- Publication Type :
- Academic Journal
- Accession number :
- 31106353
- Full Text :
- https://doi.org/10.1093/jac/dkz202