Hoveidaei Amir Human, Ghaseminejad-Raeini Amirhossein, Jebeli-Fard Roham, Hosseini-Asl Seyed Hossein, Luo Tianyi David, Sandiford Nemandra A, Adolf Jakob, Citak Mustafa
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Arch Orthop Trauma Surg. 2024 Dec 16;145(1):53. doi: 10.1007/s00402-024-05691-x.
The aim of this study was to perform a systematic review of the current literature to elucidate the optimal duration of systemic antibiotic therapy following one-stage revision TKA in the setting of PJI.
We conducted an electronic search in four databases including Medline (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials without any publication date, language or study design filter on October 1, 2022. The search strategy adhered to PRISMA guidelines and consisted of four main keywords categories which were knee arthroplasty or knee prosthesis, infection and one-stage/single-stage revision. Duration of antibiotic administration were classified to three groups: short-term IV therapy (≤ two weeks), short-term IV therapy plus oral therapy, and long-term IV therapy (minimum six weeks).
We identified 963 studies, of which 21 were included in the systematic review. Coagulase-negative Staphylococcal species were the most frequently isolated pathogens. The mean eradication rate for all the studies analyzed was 88.4% (range, 62.5-100%). Short-term IV + long-term oral antibiotic therapy demonstrated significantly higher eradication rate compared to the other two regimens following one-stage revision TKA (p = 0.023) (Table 4). In the ten studies with great than five years of follow-up, this difference was no longer statistically significant. Subgroup analysis of antibiotic-loaded cement (ABLC) usage demonstrated higher eradication rates with short-term IV + long-term oral (92.8%) and long-term IV antibiotics (89.7%) compared to short-term IV antibiotics alone (p = 0.006).
We demonstrated that short-term IV antibiotics followed by oral antibiotics had similar eradication rates to long-term IV antibiotics in long-term studies, which were both superior to short-term IV antibiotics alone. Nevertheless, there remains a need for prospective and randomized studies to further elucidate a patient-based protocol for the type and duration of antibiotic use following one-stage PJI treatment of the knee.
本研究旨在对当前文献进行系统综述，以阐明在人工关节感染（PJI）情况下一期翻修全膝关节置换术（TKA）后全身抗生素治疗的最佳持续时间。
2022年10月1日，我们在四个数据库（包括Medline（PubMed）、Scopus、Web of Science和Cochrane对照试验中央注册库）中进行了电子检索，未设置任何出版日期、语言或研究设计筛选条件。检索策略遵循PRISMA指南，由四个主要关键词类别组成，即膝关节置换术或膝关节假体、感染和一期/单期翻修。抗生素给药持续时间分为三组：短期静脉治疗（≤2周）、短期静脉治疗加口服治疗和长期静脉治疗（至少6周）。
我们识别出963项研究，其中21项纳入系统综述。凝固酶阴性葡萄球菌是最常分离出的病原体。所有分析研究的平均根除率为88.4%（范围为62.5%-100%）。在一期翻修TKA后，短期静脉联合长期口服抗生素治疗的根除率明显高于其他两种治疗方案（p=0.023）（表4）。在随访时间超过五年的十项研究中，这种差异不再具有统计学意义。对抗生素骨水泥（ABLC）使用情况的亚组分析显示，与单独使用短期静脉抗生素相比，短期静脉联合长期口服抗生素（92.8%）和长期静脉抗生素（89.7%）的根除率更高（p=0.006）。
我们证明，在长期研究中，短期静脉抗生素后口服抗生素的根除率与长期静脉抗生素相似，两者均优于单独使用短期静脉抗生素。然而，仍需要进行前瞻性随机研究，以进一步阐明基于患者的一期膝关节PJI治疗后抗生素使用类型和持续时间的方案。
