1bfcc8fb13282f955081ff1a19aa320f pmc_11047716.pdf 4df6d68b21217bc21000f5376be8550edbcc0649 pmc_11047716.pdf 0a601e1f3e6bbf9f0be64905e0f5c66a750b19fab4e32d9b506cf9bdbbf90885 pmc_11047716.pdf Title: Appropriate Duration of Antimicrobial Treatment for Prosthetic Joint Infections: A Narrative Review Subject: Prosthetic joint infections are considered difficult to treat they needing aggressive surgery and long antimicrobial treatments. However, the exact duration of these therapies has been established empirically. In the last years, several studies have explored the possibility of reducing the length of treatment in this setting, with conflicting results. In this narrative review, we critically appraise the published evidence, considering the different surgical approaches (implant retention [DAIR] and one-step and two-step exchange procedures) separately. In patients managed with DAIR, usually treated for at least 12 weeks, a large, randomized trial failed to show that 6 weeks were non-inferior. However, another randomized clinical trial supports the use of 8 weeks, as long as the surgical conditions are favorable and antibiotics with good antibiofilm activity can be administered. In patients managed with a two-step exchange procedure, usually treated during 6 weeks, a randomized clinical trial showed the efficacy of a 4-week course of antimicrobials. Also, the use of local antibiotics may allow the use of even shorter treatments. Finally, in the case of one-step exchange procedures, there is a trend towards reducing the length of therapy, and the largest randomized clinical trial supports the use of 6 weeks of therapy. Keywords: biofilm; bone and joint infection; antimicrobial stewardship; arthroplasty infection; periprosthetic joint infection; implant-associated infection Author: Jaime Lora-Tamayo, Mikel Mancheño-Losa, María Ángeles Meléndez-Carmona, Pilar Hernández-Jiménez, Natividad Benito and Oscar Murillo Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Mar 27 09:10:32 2024 CET ModDate: Wed Mar 27 09:25:28 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 549381 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- ILUGHX+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 UXAUBV+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 QLBCMW+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 IXEXCC+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 HKBJPQ+VnURWPalladioL Type 1 Custom yes yes yes 32 0 YYFPCJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 49 0 RGBLIV+CMSY10 Type 1 Builtin yes yes yes 72 0 MPUDFL+PazoMath Type 1 Builtin yes yes yes 77 0 ODAMJL+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 100 0 ODBACA+ArialMT TrueType WinAnsi yes yes no 106 0 ODAMJM+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 109 0 ODAMOL+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 115 0 ODAMOM+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 121 0 ODAMON+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 124 0 ODAMOO+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 127 0 ODANAP+PalatinoLinotype-Roman TrueType MacRoman yes yes no 130 0 ODBAAO+Arial-BoldMT TrueType WinAnsi yes yes no 133 0 IUTITA+PazoMath-Italic Type 1 Builtin yes yes yes 146 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-02-06 02:51:22 CET RepresentationInformation: pmc_11047716.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-12-18 02:31:56 CET Size: 549381 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 522 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Search Strategy and Selection Criteria Destination: section.2 Item: Title: Prosthetic Joint Infection Managed with DAIR Destination: section.3 Children: Item: Title: The Standard of Care: At Least Twelve Weeks of Treatment Destination: subsection.3.1 Item: Title: Twelve Weeks versus Eight Weeks of Treatment Destination: subsection.3.2 Item: Title: Twelve Weeks versus Six Weeks of Treatment Destination: subsection.3.3 Item: Title: Prosthetic Joint Infection Managed with a Two-Step Exchange Procedure Destination: section.4 Children: Item: Title: Local Antimicrobials and Shorter Treatments for PJI Destination: subsection.4.1 Item: Title: Shorter Treatments Independent of Local Antimicrobials Destination: subsection.4.2 Item: Title: Large Clinical Trials Destination: subsection.4.3 Item: Title: Prosthetic Joint Infection Managed with a Single-Step Exchange Procedure Destination: section.5 Item: Title: Discussion and Future Directions Destination: section.6 Item: Title: References Destination: section.7 Info: Title: Appropriate Duration of Antimicrobial Treatment for Prosthetic Joint Infections: A Narrative Review Author: Jaime Lora-Tamayo, Mikel Mancheño-Losa, María Ángeles Meléndez-Carmona, Pilar Hernández-Jiménez, Natividad Benito and Oscar Murillo Subject: Prosthetic joint infections are considered difficult to treat they needing aggressive surgery and long antimicrobial treatments. However, the exact duration of these therapies has been established empirically. In the last years, several studies have explored the possibility of reducing the length of treatment in this setting, with conflicting results. In this narrative review, we critically appraise the published evidence, considering the different surgical approaches (implant retention [DAIR] and one-step and two-step exchange procedures) separately. In patients managed with DAIR, usually treated for at least 12 weeks, a large, randomized trial failed to show that 6 weeks were non-inferior. However, another randomized clinical trial supports the use of 8 weeks, as long as the surgical conditions are favorable and antibiotics with good antibiofilm activity can be administered. In patients managed with a two-step exchange procedure, usually treated during 6 weeks, a randomized clinical trial showed the efficacy of a 4-week course of antimicrobials. Also, the use of local antibiotics may allow the use of even shorter treatments. Finally, in the case of one-step exchange procedures, there is a trend towards reducing the length of therapy, and the largest randomized clinical trial supports the use of 6 weeks of therapy. 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Subtype: Link Rect: 254, 511, 291, 522 Annotation: Subtype: Link Rect: 298, 511, 334, 522 Annotation: Subtype: Link Rect: 59, 477, 96, 487 Annotation: Subtype: Link Rect: 102, 477, 138, 487 Annotation: Subtype: Link Rect: 480, 453, 517, 464 Annotation: Subtype: Link Rect: 515, 442, 552, 453 Annotation: Subtype: Link Rect: 59, 420, 96, 430 Annotation: Subtype: Link Rect: 245, 396, 282, 407 Annotation: Subtype: Link Rect: 289, 396, 325, 407 Annotation: Subtype: Link Rect: 461, 373, 498, 384 Annotation: Subtype: Link Rect: 505, 373, 541, 384 Annotation: Subtype: Link Rect: 131, 338, 168, 349 Annotation: Subtype: Link Rect: 175, 338, 211, 349 Annotation: Subtype: Link Rect: 470, 315, 508, 326 Annotation: Subtype: Link Rect: 514, 315, 550, 326 Annotation: Subtype: Link Rect: 284, 292, 321, 303 Annotation: Subtype: Link Rect: 327, 292, 363, 303 Annotation: Subtype: Link Rect: 208, 269, 246, 280 Annotation: Subtype: Link Rect: 252, 269, 288, 280 Annotation: Subtype: Link Rect: 286, 246, 323, 257 Annotation: Subtype: Link Rect: 387, 223, 425, 234 Annotation: Subtype: Link Rect: 496, 200, 533, 211 Annotation: Subtype: Link Rect: 164, 178, 202, 188 Annotation: Subtype: Link Rect: 178, 154, 215, 165 Annotation: Subtype: Link Rect: 221, 154, 257, 165 Annotation: Subtype: Link Rect: 157, 108, 194, 119 Annotation: Subtype: Link Rect: 407, 74, 443, 85 Annotation: Subtype: Link Rect: 449, 74, 484, 85 Page: Sequence: 16 Annotations: Annotation: Subtype: Link Rect: 173, 718, 210, 729 Annotation: Subtype: Link Rect: 217, 718, 253, 729 Annotation: Subtype: Link Rect: 278, 684, 315, 694 Annotation: Subtype: Link Rect: 321, 684, 357, 694 Annotation: Subtype: Link Rect: 161, 650, 199, 660 Annotation: Subtype: Link Rect: 131, 627, 168, 637 Annotation: Subtype: Link Rect: 326, 603, 364, 614 Annotation: Subtype: Link Rect: 118, 569, 155, 579 Annotation: Subtype: Link Rect: 225, 535, 262, 545 Annotation: Subtype: Link Rect: 269, 535, 305, 545 Annotation: Subtype: Link Rect: 467, 511, 504, 522 Annotation: Subtype: Link Rect: 510, 511, 546, 522 Annotation: Subtype: Link Rect: 312, 488, 350, 499 Annotation: Subtype: Link Rect: 356, 488, 392, 499 Annotation: Subtype: Link Rect: 102, 466, 140, 476 Annotation: Subtype: Link Rect: 146, 466, 182, 476 Annotation: Subtype: Link Rect: 157, 430, 194, 441 Checksum: 410a2854 Type: CRC32 Checksum: 1bfcc8fb13282f955081ff1a19aa320f Type: MD5 Checksum: 4df6d68b21217bc21000f5376be8550edbcc0649 Type: SHA-1 Checksum: 0a601e1f3e6bbf9f0be64905e0f5c66a750b19fab4e32d9b506cf9bdbbf90885 Type: SHA-256