Role of Suppressive Oral Antibiotics in Orthopedic Hardware Infections for Those Not Undergoing Two-Stage Replacement Surgery.
Role of Suppressive Oral Antibiotics in Orthopedic Hardware Infections for Those Not Undergoing Two-Stage Replacement Surgery.
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DOI：
10.1093/ofid/ofw176
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发表时间：
2016-10
影响因子：
4.2
通讯作者：
Auwaerter PG
中科院分区：
文献类型：
--
作者：
Keller SC;Cosgrove SE;Higgins Y;Piggott DA;Osgood G;Auwaerter PG
在骨科硬件感染诊断后一年，至少三个月，但不是至少六个月的抑制性口服抗生素与治疗成功相关。 背景：使用抑制性抗生素治疗骨科内固定器械感染（OHIs），包括脊柱内固定器械感染、人工关节感染和内固定器械感染，存在争议。 方法：在2个学术医疗中心，对接受清创术和保留硬件组件、一期更换或不手术治疗的OHI患者进行了4年的研究，以确定诊断后至少6个月口服抗生素是否影响诊断后1年感染的成功治疗。 结果：在研究的89例患者中，42例（47.2%）在首次诊断后1年内未发生临床感染。 诊断后使用抑制性抗生素至少6个月与无临床感染无关（调整后的比值比[aOR]，5.29; 95%置信区间[CI]，0.74 -37.80），但在诊断后至少3个月使用抑制性抗生素与无临床感染相关（OR，3.50; 95% CI，1.30-9.43）。致病微生物影响成功的可能性;耐甲氧西林金黄色葡萄球菌和革兰氏阴性杆菌患者在术后1年时均不太可能获得临床成功（分别为aOR = 0.018，95% CI = 0.0017 - 0.19和aOR = 0.20，95% CI = 0.039 - 0.99）。 结论：口服抑制性抗生素治疗OHI伴内固定3个月而非6个月，诊断后增加了治疗成功的可能性。 感染中涉及的微生物直接影响治疗成功的可能性。
Suppressive oral antibiotics for at least three months, but not at least six months, are associated with treatment success at one year post-diagnosis of orthopedic hardware infection. Background. The use of suppressive antibiotics in treatment of orthopedic hardware infections (OHIs), including spinal hardware infections, prosthetic joint infections, and infections of internal fixation devices, is controversial. Methods. Over a 4-year period at 2 academic medical centers, patients with OHI who were treated with debridement and retention of hardware components, with single-stage exchange, or without surgery were studied to determine whether use of oral antibiotics for at least 6 months after diagnosis impacts successful treatment of the infection at 1 year after diagnosis. Results. Of 89 patients in the study, 42 (47.2%) were free of clinical infection 1 year after initial diagnosis. Suppressive antibiotics used for at least 6 months after diagnosis was not associated with being free of clinical infection (adjusted odds ratio [aOR], 5.29; 95% confidence interval [CI], .74–37.80), but being on suppressive antibiotics at least 3 months after diagnosis was associated with being free of clinical infection (OR, 3.50; 95% CI, 1.30–9.43). Causative organisms impacted the likelihood of success; patients with methicillin-resistant Staphylococcus aureus as well as with Gram-negative rods were both less likely to have achieved clinical success at 1 year after surgery (aOR = 0.018, 95% CI = .0017–.19 and aOR = 0.20, 95% CI = .039–.99, respectively). Conclusions. Oral suppressive antibiotic therapy in treatment of OHI with retention of hardware for 3 months, but not 6 months, postdiagnosis increases the likelihood of treatment success. The organisms implicated in the infection directly impact the likelihood of treatment success.
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影响因子：
14.2
作者：
Rodriguez-Pardo, D.;Pigrau, C.;Ariza, J.
通讯作者：
Ariza, J.
影响因子：
120.7
作者：
Zimmerli, W;Widmer, AF;Ochsner, PE
通讯作者：
Ochsner, PE
影响因子：
14.2
作者：
Aboltins, C. A.;Dowsey, M. M.;Stanley, P. A.
通讯作者：
Stanley, P. A.
影响因子：
2.8
作者：
Chaichana, Kaisorn L.;Bydon, Mohamad;Witham, Timothy
通讯作者：
Witham, Timothy
DOI：
10.1097/00002517-200002000-00009
发表时间：
2000-02-01
期刊：
JOURNAL OF SPINAL DISORDERS
影响因子：
--
作者：
Picada, R;Winter, RB;Perra, JH
通讯作者：
Perra, JH