Background: Current guidelines for treatment of prosthetic joint infection (PJI) suggest a combination of intravenous (IV) antibiotics for 2 to 6 weeks and oral antibiotics for 3 to 6 months. However, recent studies did not find significant benefits of prolonged use of antibiotics for patients with PJI. We conducted a systemic review and meta-analysis to assess the outcomes of short- and long-term antibiotics in patients with PJI.
Methods: We designed three queries to retrieve literature of PJI from PubMed and Embase databases until December 2017. Each query comprised medical subject headings, title/abstract keywords, and exclusion terms. Two reviewers independently screened literatures for three rounds and disagreements were resolved by a third reviewer. Quality of a cohort study and that of a randomized control trial (RCT) were assessed by Newcastle-Ottawa Quality Assessment Form and a modified Jadad scale respectively.
Results: 3,309 studies were retrieved, and 9 observation studies and 1 RCT were included for final analysis (Figure 1). 9 of the 10 studies investigated total hip arthroplasty and/or total knee arthropathy, while 1 study further included shoulder, elbow and ankle arthroplasty. 5 studies focused on patients receiving debridement and implant retention (DAIR) procedure, 3 studies on staged exchange arthroplasty (SEA), and 2 studies on mixed procedures. 8 of the 10 studies were graded as good or fair quality. All of the 10 studies found equivalent outcomes in patients prescribed with short- and long-term antibiotics, regardless of IV or oral form of antibiotics. The aggregate odds ratio (OR) in our meta-analysis was 1.04 (95% CI, 0.70, 1.55), showing no significant difference in outcomes between short-term and long-term antibiotics (Figure 2).
Conclusion: Our meta-analysis demonstrated that patients prescribed with short-term antibiotics for PJI had similar outcomes as compared to those prescribed with long-term antibiotics.
C. Y. Huang, None
C. C. Lee, None