Two weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial
Two weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial
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DOI：
10.1136/annrheumdis-2019-215116
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发表时间：
2019-08-01
影响因子：
27.4
通讯作者：
Uckay, Ilker
中科院分区：
文献类型：
--
作者：
Gjika, Ergys;Beaulieu, Jean-Yves;Uckay, Ilker
目的 成人天然关节细菌性关节炎术后抗生素治疗的最佳持续时间仍不清楚。方法我们进行了一项前瞻性、非盲法、随机、非劣效性研究，比较成人天然关节细菌性关节炎手术引流后 2 周或 4 周的抗生素治疗。排除与种植体相关的感染、未经手术灌洗的发作以及随访时间少于 2 个月的发作。结果 我们纳入了 154 例病例：4 周组 77 例，2 周组 77 例。静脉注射抗生素治疗的中位时间分别为 1 天和 2 天。双臂手术灌洗次数中位数均为 1 次。 3 名患者 (2%) 出现感染复发：2 周组 1 名（治愈率 99%），4 周组 2 名（治愈率 97%）。研究组之间的不良事件或后遗症数量没有差异。在总共 154 例关节炎病例中，99 例涉及手和腕部，对此进行了额外的亚组分析。在此按方案进行的子分析中，我们注意到 3 例复发：1 例发生在 2 周组（97% 治愈）；1 例发生在 2 周组（97% 治愈）；1 例发生在 2 周组（97% 治愈）。 4 周组中有 2 例（治愈率 96%），2 周组有 50% 出现后遗症，而 4 周组有 55%，其中 5 例（13%）和 6 例（13%）需要进一步干预。 结论 在对化脓性关节炎进行初次手术灌洗后，2 周的靶向抗生素治疗在治愈率、不良事件或后遗症方面并不逊色于 4 周，并且可显着缩短住院时间，至少手部和腕部是这样。关节炎。
Objective The optimal duration of postsurgical antibiotic therapy for adult native joint bacterial arthritis remains unknown.Methods We conducted a prospective, unblinded, randomised, non-inferiority study comparing either 2 or 4 weeks of antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. Excluded were implant-related infections, episodes without surgical lavage and episodes with a follow-up of less than 2 months.Results We enrolled 154 cases: 77 in the 4-week arm and 77 in the 2-week arm. Median length of intravenous antibiotic treatment was 1 and 2 days, respectively. The median number of surgical lavages was 1 in both arms. Recurrence of infection was noted in three patients (2%): 1 in the 2-week arm (99% cure rate) and 2 in the 4-week arm (97% cure rate). There was no difference in the number of adverse events or sequelae between the study arms. Of the overall 154 arthritis cases, 99 concerned the hand and wrist, for which an additional subgroup analysis was performed. In this per-protocol subanalysis, we noted three recurrences: one in the 2-week arm (97 % cure); two in the 4-week arm (96 % cure) and witnessed sequelae in 50% in the 2-week arm versus 55% in the 4-week arm, of which five (13%) and six (13%) needed further interventions.Conclusions After initial surgical lavage for septic arthritis, 2 weeks of targeted antibiotic therapy is not inferior to 4 weeks regarding cure rate, adverse events or sequelae and leads to a significantly shorter hospital stay, at least for hand and wrist arthritis.