Appropriate Duration of Antimicrobial Treatment for Prosthetic Joint Infections : A Narrative Review
Lora-Tamayo, Jaime (Instituto de Salud Carlos III)
Mancheño-Losa, Mikel (Hospital 12 de Octubre (Madrid))
Meléndez-Carmona, María Ángeles (Hospital 12 de Octubre (Madrid))
Hernández-Jiménez, Pilar (Hospital 12 de Octubre (Madrid))
Benito, Natividad (The University of Queensland (Brisbane, Austràlia))
Murillo Rubio, Oscar (Hospital Universitari de Bellvitge)

Data:	2024
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Biofilm ; Bone and joint infection ; Antimicrobial stewardship ; Arthroplasty infection ; Periprosthetic joint infection ; Implant-associated infection
Publicat a:	Antibiotics, Vol. 13 (march 2024) , ISSN 2079-6382

DOI: 10.3390/antibiotics13040293
PMID: 38666969

16 p, 536.5 KB

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