假肢关节感染抗菌治疗的适当持续时间:叙述性审查
Jaime Lora-Tamayo1,2,3, Mikel Mancheño-Losa1,2, María Ángeles Meléndez-Carmona4
1Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12 Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, 28041 Madrid, Spain.
Antibiotics (Basel, Switzerland)
|April 26, 2024
概括
治疗假肢关节感染需要仔细考虑抗微生物药物治疗的持续时间. 有证据表明,较短的治疗疗程可能对两步交换程序 (4周) 和一步交换 (6周) 有效,但并不总是对除bridement,抗生素和植入物保留 (DAIR) 有效.
科学领域:
- 整形外科 整形外科 整形外科
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 假肢关节感染 (PJIs) 的治疗具有挑战性,需要进行积极的手术和长时间的抗菌疗法.
- 目前对于PJI的抗菌治疗持续时间在很大程度上是经验性的.
- 最近的研究探讨了缩短PJI抗菌治疗的方法,结果各不相同.
研究的目的:
- 批判性地审查关于PJIs抗菌治疗持续时间的现有证据.
- 根据不同的手术管理策略分析最佳治疗长度:除bridement,抗生素和植入物保留 (DAIR),单步交换和双步交换程序.
主要方法:
- 一个关于PJI抗菌药物治疗持续时间的已发表研究的叙述性综述.
- 单独分析DAIR,单步交换和双步交换程序的证据.
- 包括随机临床试验的数据和抗生素特征的评估.
主要成果:
- 对于DAIR,一项大型试验发现6周的时间不低于更长的时间,而另一项试验则表明,在有利的条件和抗菌膜抗生素下,8周可能有效.
- 对于两步交换,一项随机试验表明,抗菌药物治疗4周是有效的,局部抗生素可能更短.
- 对于一阶段交换,证据支持向更短的疗法趋势,一项大型试验表明6周是有效的.
结论:
- 对PJIs的抗菌药物治疗持续时间可能会缩短,特别是在两步和一步的交换程序中.
- 优化手术条件和使用具有强抗菌膜活性的抗生素对于更短的有效治疗持续时间至关重要.
- 需要进行进一步的研究,以确定所有PJI管理策略中减少抗菌药物治疗持续时间的最终基于证据的指南.
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