Gramberg Meryl Cinzía Tila Tamara, Torensma Bart, van Asten Suzanne, Sieswerda Elske, Sabelis Louise Willy Elizabeth, den Heijer Martin, de Vries Ralph, de Groot Vincent, Peters Edgar Josephus Gerardus
Division of Infectious Diseases, Department Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.
Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Antibiotics (Basel). 2024 Dec 4;13(12):1173. doi: 10.3390/antibiotics13121173.
The optimal antimicrobial treatment duration for diabetes-related foot osteomyelitis (DFO) currently needs to be determined. We systematically reviewed the effects of short and long treatment durations on outcomes of DFO. We performed a systematic review searching Cochrane, CENTRAL, MEDLINE, Embase, and CINAHL Plus from inception up to 19 January 2024. Two independent reviewers screened the titles and abstracts of the studies. Studies comparing short (<6 weeks) and long (>6 weeks) treatment durations for DFO were included. The primary outcome was amputation; the secondary outcomes were remission, mortality, costs, quality of life, and adverse events. Risk of bias and GRADE were assessed. We identified 2708 references, of which 2173 remained after removing duplicates. Two studies were included. Differences in methodology precluded a meta-analysis. The primary outcome, major amputation, was reported in one study, with a rate of 10% in both the intervention and comparison groups ( = 1.00), regardless of treatment duration. For the secondary outcome, remission rates, the first study reported 60% in the intervention group versus 70% in the comparison group ( = 0.50). In the second study, remission rates were 84% in the intervention group versus 78% in the comparison group ( = 0.55). Data for the outcomes mortality, costs, and quality of life were not available. Short treatment duration may lead to fewer adverse events. The risk of bias was assessed as low to moderate, and the level of evidence ranged from very low to moderate. Our findings suggest that for DFO, there is no difference between a shorter and more prolonged duration of antimicrobial treatment regarding amputation and remission, with potentially fewer adverse events with shorter treatment durations. However, the uncertainty stems from limited, heterogeneous studies and generally low-quality evidence marred by moderate biases, imprecision, and indirectness. More high-quality studies are needed to substantiate these findings.
目前需要确定糖尿病相关足部骨髓炎（DFO）的最佳抗菌治疗疗程。我们系统回顾了短疗程和长疗程治疗对DFO治疗结果的影响。我们进行了一项系统回顾，检索了从创刊至2024年1月19日的Cochrane、CENTRAL、MEDLINE、Embase和CINAHL Plus数据库。两名独立评审员筛选了研究的标题和摘要。纳入了比较DFO短疗程（<6周）和长疗程（>6周）治疗的研究。主要结局是截肢；次要结局是缓解、死亡率、成本、生活质量和不良事件。评估了偏倚风险和GRADE。我们识别出2708篇参考文献，去除重复文献后剩余2173篇。纳入了两项研究。方法学上的差异使得无法进行荟萃分析。一项研究报告了主要结局，即大截肢率，干预组和对照组均为10%（RR = 1.00），与治疗疗程无关。对于次要结局缓解率，第一项研究报告干预组为60%，对照组为70%（RR = 0.50）。在第二项研究中，干预组缓解率为84%，对照组为78%（RR = 0.55）。未获得死亡率、成本和生活质量结局的数据。短疗程治疗可能导致较少的不良事件。偏倚风险评估为低到中度，证据水平从极低到中度不等。我们的研究结果表明，对于DFO，在截肢和缓解方面，较短和较长疗程的抗菌治疗没有差异，短疗程治疗可能不良事件较少。然而，不确定性源于研究有限、异质性大，以及普遍存在的中度偏倚、不精确性和间接性导致的低质量证据。需要更多高质量研究来证实这些发现。
