Six weeks antibiotic therapy for all bone infections: results of a cohort study

Abstract

There is no consensus on the antibiotic therapy for bone infection due to the heterogeneous spectrum of diseases. Most authors suggest different durations of treatment based on pathophysiological considerations. However, adverse effects are related, at least in part, to the duration of treatment. We, therefore, investigated a 6 weeks antibiotic combination therapy for all cases of bone infection. Herewith, we report the results of this therapeutic approach. This is a cohort study including all patients presenting with bone infection, regardless of the mechanism involved. The diagnosis was based on bone biopsy obtained through invasive procedures. Chronic bone infection was defined as a history of disease of over 1 month duration. The duration of clinical follow-up following treatment discontinuation was at least 6 months. Cured bone infection was defined as the absence of relapse after antibiotic discontinuation. One hundred and eighteen patients were included between July 2005 and March 2009; 61 presented with bone infection following prosthetic implant (52%) and the 57 remaining patients had bone infection without foreign material (48%). Surgery was required for 80 patients (68%). Microbial agents were identified in 116/118 patients, with 24 patients presenting with polymicrobial sepsis (20%). The mean duration of antibiotic treatment was 42 +/- 0.2 days and the mean clinical follow-up was 27 +/- 14 months. The treatment success rate was 91.5% (108/118). Six weeks of antimicrobial therapy appears to be effective for nearly all bone infections, regardless of the pathophysiology. These results encourage us to pursue attempts to simplify the management of bone infection without obvious prejudice to the patient.

Orthopaedic device-related infection: current and future interventions for improved prevention and treatment

“…Nevertheless, a duration of six weeks may be sufficient. 48-50 Long-term suppression therapy is used alternatively in cases of inoperable patients, multi drug-resistant bacteria, 51 but also in specific fracture cases where consolidation of the fracture has not yet occurred and the surgical treatment consistent of debridement with implant retention. 52 On the other hand, successful experiences from single centres with a very short duration of systemic antibiotic therapy of less than one week, or solely intra-articular application of antibiotics, have been reported.…”

Protocol of a short post-surgical antibiotic therapy in spine infections - prospective, randomized, unblinded, non-inferiority trials(SASI trials)

“…Farhad et al resumed that six weeks of antibiotic therapy was sufficient for all bone-related infections [14]; together with an early switch of oral medication [6]. These emerging and relatively short durations are equally acknowledged by international consensus meetings [30] of surgeons and infectious diseases physicians, who treat these infections and who perform research on them.…”

Antibiotic Treatment and Timing of Reimplantation

“…Once this goal is met and there is clinical evidence of improvement, some IV antibiotic regimens can be switched to oral regimens. There is scarce literature reporting on the use of oral (combined or single) antibiotic therapy for the treatment of PJIs without an initial IV regimen . Most of these studies were conducted in cases where the prosthesis was retained.…”

“…There is adequate evidence to support the use of rifampin in combination with other antibiotics for the treatment of staphylococcal PJI, especially in the setting of retained hardware . Evidence supporting its use when infected hardware has been removed is less convincing.…”

“…Single‐stage exchange arthroplasty for PJI has the advantage of being only one major procedure, thus decreasing cost and the risk of complications that could arise from multiple surgeries . No evidence is available regarding the ideal length of antibiotic therapy .…”