3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。https://note.mu/twin1980。

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

JACから

インプラント除去後の骨関節感染症に対する4週間対6週間の抗生物質療法:無作為化試験

 

 

f:id:akinohanayuki:20190601061550j:plain

 

感想

 

小規模RCTですが、4週と6週で差がなかった好ましい結果。

 

Shorter is better

 

しかし、知り合いの整形外科医は、まだまだ安心できないとのこと。

術後感染は、重要なのでかなり慎重になります。

さらなる報告を期待します。

 

 

Abstract


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.  

 

 

akinohanayuki.hatenablog.com

 

 

akinohanayuki.hatenablog.com