Department of Medicine, College of Medicine, National Taiwan University, No. 1 Jen Ai Road, Taipei 100, Taiwan.
Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA.
Int J Antimicrob Agents. 2019 Mar;53(3):246-260. doi: 10.1016/j.ijantimicag.2019.01.007. Epub 2019 Jan 10.
Current practice of long-term antibiotic use in patients with osteomyelitis is controversial. Recent studies showed short-term antibiotic use to be non-inferior to long-term use, but the results of these studies have been inconsistent. In this review, the PubMed and Embase databases were searched from inception through to June 2018 for randomised controlled trials (RCTs), cohort studies or case-control studies comparing two different durations of antibiotic use. Short antibiotic courses were defined as antibiotics administered for a shorter period than the recommended 4-6 weeks. A random-effects model was used to calculate summary odds ratios (ORs) of treatment failure in patients treated with short-course antibiotics compared with long-course antibiotics. A total of 15 articles (5 RCTs and 10 observational studies) and 3598 patients were included. The overall OR of treatment failure in patients receiving short-course antibiotics was 1.50 [95% confidence interval (CI) 0.97-2.34]. Subgroup analysis revealed that a short course of antibiotic treatment was associated with an increased treatment failure rate in vertebral osteomyelitis (OR = 2.06, 95% CI 1.18-3.57) while having a similar rate to a long antibiotic course in acute osteomyelitis of childhood (OR = 1.86, 95% CI 0.75-4.64). Meta-regression found a higher proportion of Staphylococcus aureus infection was related to a higher risk of treatment failure in patients with vertebral osteomyelitis (Coef. = 4.996; P = 0.032). Short-course antibiotics are safe and effective in children with acute osteomyelitis. Long-course antibiotics may still be preferred in vertebral osteomyelitis, especially in patients with S. aureus infection.
目前，骨髓炎患者长期使用抗生素的做法存在争议。最近的研究表明，短期使用抗生素与长期使用效果相当，但这些研究结果并不一致。在本综述中，我们检索了 PubMed 和 Embase 数据库，检索时间从建库至 2018 年 6 月，纳入比较两种不同抗生素使用时间长短的随机对照试验（RCT）、队列研究或病例对照研究。短疗程抗生素定义为使用时间短于推荐的 4-6 周的抗生素。使用随机效应模型计算接受短疗程抗生素治疗与长疗程抗生素治疗的患者治疗失败的汇总比值比（OR）。共纳入 15 篇文章（5 项 RCT 和 10 项观察性研究）和 3598 例患者。接受短疗程抗生素治疗的患者治疗失败的总体 OR 为 1.50（95%置信区间 0.97-2.34）。亚组分析显示，短疗程抗生素治疗与脊柱骨髓炎患者的治疗失败率增加相关（OR=2.06，95%CI 1.18-3.57），而在儿童急性骨髓炎中，与长疗程抗生素治疗的失败率相似（OR=1.86，95%CI 0.75-4.64）。Meta 回归发现，金黄色葡萄球菌感染比例较高与脊柱骨髓炎患者治疗失败风险较高相关（Coef.=4.996；P=0.032）。短疗程抗生素在儿童急性骨髓炎中安全有效。对于脊柱骨髓炎，长疗程抗生素可能仍然是首选，特别是在金黄色葡萄球菌感染的患者中。
