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Review
. 2023 May 7;10(5):ofad246.
doi: 10.1093/ofid/ofad246. eCollection 2023 May.

The Impact of Antimicrobial Therapy Duration in the Treatment of Prosthetic Joint Infections Depending on Surgical Strategies: A Systematic Review and Meta-analysis

Flaminia Olearo  1 , Veronica Zanichelli  2 , Aimilia Exarchakou  3 , Anna Both  1 , Ilker Uςkay  4 , Martin Aepfelbacher  1 , Holger Rohde  1
Affiliations
Review

The Impact of Antimicrobial Therapy Duration in the Treatment of Prosthetic Joint Infections Depending on Surgical Strategies: A Systematic Review and Meta-analysis

Flaminia Olearo et al. Open Forum Infect Dis. .

Abstract

The aim of this systematic review was to address the question if short antibiotic treatment (SAT; at least 4 but <12 weeks) versus long antibiotic treatment (LAT) affects outcomes in prosthetic joint infections (PJIs). Database research (Medline, Embase, Web of Science, Scopus, Cochrane) retrieved 3740 articles, of which 10 studies were included in the analysis. Compared to LAT, 11% lower odds of treatment failure in the SAT group were found, although the difference was not statistically significant (pooled odds ratio, 0.89 [95% confidence interval, .53-1.50]). No difference in treatment failure was found between SAT and LAT once stratified by type of surgery, studies conducted in the United States versus Europe, study design, and follow-up. There is still no conclusive evidence that antibiotic treatment of PJIs for 12 weeks or longer is associated with better outcomes, irrespective of the type of surgical procedure. Most recent, high-quality studies tend to favor longer antibiotic courses, making them preferable in most situations.

Keywords: DAIR; antibiotic therapy duration; meta-analysis; prosthetic joint infection; systematic review.

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Conflict of interest statement

Potential conflicts of interest. The authors: No reported conflicts of interest.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. aBrucella spp, Mycobacterium tuberculosis, Borrelia burgdorferi, and Neisseria gonorrhoeae. Abbreviation: PJI, prosthetic joint–associated infection.
Figure 2.
Figure 2.
Forest plot of the random-effects meta-analysis comparing the effect of short versus long courses of antibiotics on treatment failure. For each trial, the square area is proportional to the weight of the study. The diamond represents the overall random-effects summary odds ratio (OR). The confidence interval is given by the width of the diamond. The unbroken vertical line is the null value (OR = 1, meaning no effect). Abbreviations: CI, confidence interval; LAT, long antibiotic treatment group; REML, Restricted Maximum Likelihood; SAT, short antibiotic treatment group.
Figure 3.
Figure 3.
Forest plot of the random-effects meta-analysis comparing the effect of short versus long courses of antibiotics on treatment failure stratified by type of surgery (debridement, antibiotics, and implant retention vs 1- or 2-stage exchange, A), geographic location (United States vs Europe, B), study design (observational vs randomized controlled trial, C), duration of follow-up (<2 vs ≥2 years, D), and year of publication (before vs after 2015, E). Abbreviations: CI, confidence interval; DAIR, debridement, antibiotics, and implant retention; LAT, long antibiotic treatment group; REML, Restricted Maximum Likelihood; SAT, short antibiotic treatment group; USA, United States.
See this image and copyright information in PMC

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