Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland.
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Switzerland.
Int J Infect Dis. 2022 Jul;120:179-186. doi: 10.1016/j.ijid.2022.03.049. Epub 2022 Mar 28.
We investigated the impact of the total length of systemic antibiotic therapy (ABT) and its initial intravenous (IV) part on clinical failure (CF) and microbiological failure (MF) in diabetic foot infections (DFIs).
In this single-center, retrospective, unmatched case-control study, we included DFI episodes treated with a combined surgical-antibiotic approach.
We included 721 DFI episodes, 537 with osteomyelitis (DFO). CF occurred in 191 (26.5%) and MF in 42 (5.8%) episodes. Multivariate Cox regression analysis showed that a short ABT of 8-21 days (hazard ratio [HR] 0.4; 95% CI 0.2-0.7) was inversely associated with CF. This was also applicable for IV ABT with relatively short durations of 2-7 days (HR 0.5; 95% CI 0.3-0.8) or 8-14 days (HR 0.6; 95% CI 0.4-0.9). We failed to detect a minimal threshold of total or IV ABT predictive for CF or MF.
Compared with total ABT of more than 84 days and IV therapy of more than 14 days, shorter total and IV ABT yielded no enhanced risk of CF or MF. Considering the "bias by indication" that is inherent to retrospective DFI studies, the best study design concerning the duration of ABT would be a stratified, prospective randomized trial, which is currently under way in our medical center.
我们研究了全身抗生素治疗（ABT）的总时长及其初始静脉（IV）部分对糖尿病足感染（DFI）的临床失败（CF）和微生物失败（MF）的影响。
在这项单中心、回顾性、非匹配病例对照研究中，我们纳入了采用联合手术-抗生素方法治疗的 DFI 发作。
我们纳入了 721 例 DFI 发作，其中 537 例有骨髓炎（DFO）。191 例（26.5%）发生 CF，42 例（5.8%）发生 MF。多变量 Cox 回归分析表明，8-21 天的短 ABT（风险比 [HR] 0.4；95%置信区间 0.2-0.7）与 CF 呈负相关。这也适用于持续时间相对较短的 2-7 天（HR 0.5；95%置信区间 0.3-0.8）或 8-14 天（HR 0.6；95%置信区间 0.4-0.9）的 IV ABT。我们未能检测到总 ABT 或 IV ABT 的最小阈值可预测 CF 或 MF。
与总 ABT 超过 84 天和 IV 治疗超过 14 天相比，较短的总 ABT 和 IV ABT 不会增加 CF 或 MF 的风险。考虑到回顾性 DFI 研究中固有的“指示性偏倚”，关于 ABT 持续时间的最佳研究设计将是分层、前瞻性随机试验，目前正在我们的医学中心进行。
