Gachet Benoit, Dechartres Agnès, Senneville Eric, Robineau Olivier
Department of Biostatistics, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, Gustave Dron Hospital of Tourcoing, Lille University, Lille, France.
Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, 75013 Paris, France.
J Antimicrob Chemother. 2024 Dec 2;79(12):3091-3099. doi: 10.1093/jac/dkae347.
The management of acute prosthetic joint infections (PJIs) often involves a debridement, antibiotics and implant retention (DAIR) strategy.
Our objective was to conduct a systematic review and a network meta-analysis (NMA) to assess the comparative effectiveness of available oral antimicrobial regimens for the treatment of acute staphylococcal PJIs treated with DAIR.
We conducted a systematic review searching articles from databases creation until 31 December 2023. We included articles on acute staphylococcal PJIs managed with DAIR with an oral antibiotic regimen relaying the initial management. The primary outcome was the remission rate.
Out of the 2421 studies screened, six studies completed the systematic review criteria: one randomized controlled trial and five observational studies. There was heterogeneity in patients' populations, duration and posology of treatments, definition of outcome and length of follow-up. Studies revealed 10 antibiotic regimens and most data focusing on five combinations recommended by the IDSA's guidelines: rifampicin associated to fluoroquinolone, clindamycin, cycline, linezolid or trimethoprim-sulfamethoxazole. Treatment comparisons were often secondary, without adjustment for confounding factors, resulting in a high risk of bias. Owing to inconsistencies a complete analysis, including an NMA was not possible.
The available data highlight five companions to rifampicin, however, there is insufficient evidence to compare them. The literature does not provide a basis for rationalizing alternatives when rifampicin cannot be used.
急性人工关节感染（PJI）的管理通常涉及清创、抗生素和植入物保留（DAIR）策略。
我们的目的是进行系统评价和网络荟萃分析（NMA），以评估可用口服抗菌方案治疗采用DAIR治疗的急性葡萄球菌性PJI的相对有效性。
我们进行了一项系统评价，检索从数据库创建至2023年12月31日的文章。我们纳入了采用DAIR管理急性葡萄球菌性PJI且口服抗生素方案用于初始管理的文章。主要结局是缓解率。
在筛选的2421项研究中，六项研究符合系统评价标准：一项随机对照试验和五项观察性研究。患者人群、治疗持续时间和剂量、结局定义以及随访时间存在异质性。研究揭示了10种抗生素方案，且大多数数据聚焦于美国感染病学会（IDSA）指南推荐的五种组合：利福平联合氟喹诺酮类、克林霉素、四环素、利奈唑胺或复方磺胺甲恶唑。治疗比较通常是次要的，未对混杂因素进行调整，导致偏倚风险较高。由于存在不一致性，无法进行包括NMA在内的完整分析。
现有数据突出了利福平的五种配伍药物，然而，尚无足够证据对它们进行比较。当无法使用利福平时，文献并未为合理化替代方案提供依据。
