Tours University Hospital, France.
Geneva University Hospitals, Switzerland.
Int J Infect Dis. 2017 Oct;63:37-42. doi: 10.1016/j.ijid.2017.08.002. Epub 2017 Aug 10.
The required duration of antibiotic treatment for prosthetic joint infections (PJI) with debridement and retention of the implant (DAIR procedure) is unknown.
Multicenter retrospective study emphasizing the duration of antibiotic therapy in patients treated with by DAIR.
We included 87 hip or knee PJI episodes in 87 patients from three university hospitals in France and Switzerland. All debridements were performed within 3 weeks of symptom onset. After a mean follow-up of 52.1 months, 60 patients with PJI (69%) remained in remission, with no significant difference between hip and knee cases (73.3% vs. 59.3%, 95% confidence interval (CI), 0.20-1.38), or between patients receiving 6 compared with 12 weeks of antibiotic treatment (70.5% vs.67.4%, 95%CI 0.27-2.10, p=0.60). Methicillin-resistant Staphylococcus aureus was isolated from 13.8% of infections and this was the only variable associated with a poorer outcome (remission in 41.7% vs. 73.3% for those with other pathogens, 95%CI 0.05-0.77, p=0.02).
In patients undergoing DAIR for hip or knee PJI, the likelihood of long-term remission was not significantly different for those receiving 6 versus 12 weeks of antibiotic therapy. Prospective randomized trials are required to confirm this observation.
清创保留假体治疗人工关节感染（DAIR 手术）所需的抗生素治疗时间尚不清楚。
本研究为多中心回顾性研究，重点强调了接受 DAIR 治疗的患者的抗生素治疗持续时间。
我们纳入了法国和瑞士的 3 家大学附属医院的 87 例髋关节或膝关节人工关节感染患者共 87 例感染发作。所有清创术均在症状出现后 3 周内进行。平均随访 52.1 个月后，60 例（69%）患者 PJI 缓解，髋关节和膝关节病例之间无显著差异（73.3% vs. 59.3%，95%CI 0.20-1.38），或接受 6 周与 12 周抗生素治疗的患者之间无显著差异（70.5% vs. 67.4%，95%CI 0.27-2.10，p=0.60）。耐甲氧西林金黄色葡萄球菌感染占 13.8%，这是唯一与较差结局相关的变量（缓解率为 41.7% vs. 73.3%，其他病原体为 95%CI 0.05-0.77，p=0.02）。
对于接受髋关节或膝关节 PJI 行 DAIR 手术的患者，接受 6 周与 12 周抗生素治疗的患者长期缓解的可能性无显著差异。需要前瞻性随机试验来证实这一观察结果。
