School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
J Antimicrob Chemother. 2019 Sep 1;74(9):2507-2516. doi: 10.1093/jac/dkz166.
Prosthetic joint infections (PJIs) often require long-course antibiotic therapy. However, recent studies argue against the current practice and raise concerns such as the development of antibiotic resistance, side effects of medications and medical costs.
To review and compare the outcomes of short-course and long-course antibiotics in PJIs.
We conducted a systemic review and meta-analysis using a predefined search term in PubMed and EMBASE databases. Studies that met the inclusion criteria from inception to June 2018 were included. The quality of the included studies was assessed.
A total of 10 articles and 856 patients were analysed, comprising 9 observational studies and 1 randomized controlled trial. Our meta-analysis showed no significant difference between short-course and long-course antibiotics (relative risk = 0.87, 95% CI = 0.62-1.22). Additionally, the older the studied group was, the more short-course antibiotics were favoured.
When treating PJI patients following debridement, antibiotics and implant retention, an 8 week course of antibiotic therapy for total hip arthroplasty and a 75 day course for total knee arthroplasty may be a safe approach. For two-stage exchange, a shorter duration of antibiotic treatment during implant-free periods is also generally safe with the usage of antibiotic-loaded cement spacers.
人工关节感染（PJI）常需要长时间的抗生素治疗。但最近的研究对这一常规做法提出了质疑，并引发了一些担忧，如抗生素耐药性的发展、药物的副作用和医疗费用等。
综述并比较 PJI 短程和长程抗生素治疗的结果。
我们在 PubMed 和 EMBASE 数据库中使用预设的检索词进行了系统综述和荟萃分析。纳入从创建至 2018 年 6 月符合标准的研究。评估纳入研究的质量。
共纳入 10 篇文章和 856 例患者，包括 9 项观察性研究和 1 项随机对照试验。荟萃分析显示，短程和长程抗生素治疗之间无显著差异（相对风险 = 0.87，95%CI = 0.62-1.22）。此外，研究组年龄越大，越倾向于使用短程抗生素。
对于清创、保留抗生素和植入物的 PJI 患者，全髋关节置换术 8 周疗程和全膝关节置换术 75 天疗程的抗生素治疗可能是一种安全的方法。对于二期翻修，在无植入物期间使用抗生素载药水泥间隔器时，抗生素治疗时间较短通常也是安全的。
