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与胃肠外抗生素相比,口服抗生素在治疗骨与关节感染方面的成功率和并发症发生率相似:一项系统评价与荟萃分析。

Oral antibiotics demonstrate similar rates of success and complications compared to parenteral antibiotics for bone and joint infections: a systematic review and meta-analysis.

作者信息

Schreiner Gabriella, Fucaloro Stephen, Meija Jesus, Krivicich Laura, Salzler Matthew

机构信息

Tufts University School of Medicine, Boston, MA, USA.

Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA.

出版信息

Infection. 2025 May 15. doi: 10.1007/s15010-025-02517-9.


DOI:10.1007/s15010-025-02517-9
PMID:40372606
Abstract

PURPOSE: Bone and joint infections (BJIs) cause significant morbidity, and current guidelines suggest treatment with parenteral antibiotics for 4-6 weeks. However, utility of oral antibiotics as a potential alternative has yet to be thoroughly investigated. To provide a statistical appraisal of literature comparing treatment success and complication rates of oral antibiotics to parenteral antibiotics for BJIs. METHODS: PubMed, Embase, Cochrane, and Web of Science databases were queried for studies published by November 12, 2024. Randomized controlled trials (RCTs) comparing parenteral to oral regimens for the entire treatment duration were included, as well as comparative studies evaluating "early switch" therapy, defined as switching from parenteral to oral antibiotics within 28 days. Data was pooled and sub-analyzed according to design (RCTs or early switch cohorts). Treatment successes and complications for parenteral and oral groups were assessed via DerSimonian-Laird binary random-effects modeling with a p-value < 0.05 indicating significance. RESULTS: Six RCTs (1,310 patients) compared treatment success of parenteral or oral regimens for the duration of the infection treatment, and six retrospective cohort studies (1,106 patients) compared parenteral therapy to early switch therapy. Meta-analysis of RCTs demonstrated no significant difference for treatment success rates for oral versus parenteral antibiotics (OR 1.09 [0.79-1.51], p = 0.93, I = 0.00%). Six early switch cohort studies demonstrated that oral antibiotics had significantly higher success (OR = 1.70 [1.13-2.54], p = 0.01, I = 0.00%). Meta-data of both RCTs and early switch cohort studies demonstrated no significant difference in complication rates. CONCLUSION: No difference in treatment success rates or complication rates was found when comparing oral and parenteral antibiotics. Oral antibiotics are a possible option for treatment of BJIs.

摘要

目的:骨与关节感染(BJIs)会导致严重的发病率,当前指南建议采用肠外抗生素治疗4至6周。然而,口服抗生素作为一种潜在替代方案的效用尚未得到充分研究。旨在对比较口服抗生素与肠外抗生素治疗BJIs的治疗成功率和并发症发生率的文献进行统计学评估。 方法:检索了截至2024年11月12日发表在PubMed、Embase、Cochrane和Web of Science数据库中的研究。纳入了比较整个治疗期间肠外与口服治疗方案的随机对照试验(RCTs),以及评估“早期转换”疗法的比较研究,“早期转换”疗法定义为在28天内从肠外抗生素转换为口服抗生素。根据设计(RCTs或早期转换队列)对数据进行汇总和亚组分析。通过DerSimonian-Laird二元随机效应模型评估肠外和口服组的治疗成功率和并发症,p值<0.05表示具有显著性。 结果:六项RCTs(1310例患者)比较了感染治疗期间肠外或口服方案的治疗成功率,六项回顾性队列研究(1106例患者)比较了肠外治疗与早期转换疗法。RCTs的荟萃分析表明,口服抗生素与肠外抗生素的治疗成功率无显著差异(OR 1.09 [0.79 - 1.51],p = 0.93,I = 0.00%)。六项早期转换队列研究表明,口服抗生素的成功率显著更高(OR = 1.70 [1.13 - 2.54],p = 0.01,I = 0.00%)。RCTs和早期转换队列研究的元数据均表明并发症发生率无显著差异。 结论:比较口服和肠外抗生素时,治疗成功率和并发症发生率没有差异。口服抗生素是治疗BJIs的一种可能选择。

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本文引用的文献

[1]
Diabetic Osteomyelitis: Oral versus Intravenous Antibiotics at a Single Level 1 Academic Medical Trauma Center.

J Foot Ankle Surg. 2024

[2]
Prosthetic joint infections: 6 weeks of oral antibiotics results in a low failure rate.

J Antimicrob Chemother. 2024-2-1

[3]
Switching from intravenous vancomycin to oral antibiotics reduces adverse events in a retrospective cohort of outpatients with orthopedic infections.

Pharmacotherapy. 2023-12

[4]
Mortality, patient-reported outcome measures, and the health economic burden of prosthetic joint infection.

EFORT Open Rev. 2023-9-1

[5]
Early switching from intravenous to oral antibiotic therapy in bone and joint infections associated with methicillin-susceptible Staphylococcus aureus bacteremia.

Infect Dis Now. 2023-9

[6]
Excellent Outcomes With the Selective Use of Oral Antibiotic Therapy for Bone and Joint Infections: A Single-Center Experience.

Cureus. 2022-7-18

[7]
Oral Versus Standard Antimicrobial Treatment for Pyogenic Native Vertebral Osteomyelitis: A Single-Center, Retrospective, Propensity Score-Balanced Analysis.

Open Forum Infect Dis. 2022-7-27

[8]
Is oral antibiotic therapy as effective as intravenous treatment in bacterial osteomyelitis? A real-life experience.

Eur Rev Med Pharmacol Sci. 2022-6

[9]
Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review.

Am J Med. 2022-3

[10]
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Syst Rev. 2021-3-29

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