细菌假肢关节感染的治疗持续时间:对当前证据的叙述性审查
Hajer Harrabi1, Christel Mamona-Kilu1, Eloïse Meyer1
1Infectious Disease Department, Raymond-Poincaré University Hospital, APHP Paris Saclay, 92380 Garches, France.
Antibiotics (Basel, Switzerland)
|November 27, 2025
概括
对假肢关节感染 (PJI) 的最佳抗生素持续时间进行了辩论. 虽然较短的疗程提供了好处,12周仍然是大多数患者最安全的持续时间,特别是保留硬件,等待进一步的证据.
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 (PJI) 治疗持续时间有争议,目前建议的证据有限.
- 较短的抗生素疗程可能会减少耐药性,不良反应和成本,但需要仔细评估风险.
- 对于PJI的手术策略包括DAIR,一阶段交换,两阶段交换和没有再植入的切除.
研究的目的:
- 根据外科手术策略,审查PJIs抗生素治疗持续时间的证据.
- 确定个性化和可能缩短的抗生素疗程的参数.
- 综合现有证据,指导PJI管理中的临床决策.
主要方法:
- 在PubMed,Embase和Cochrane图书馆数据库中进行全面的文献搜索,直到2025年1月.
- 包括观察性研究,随机对照试验和国际指南.
- 从关键文章中对参考列表进行选,以确保彻底收集数据.
主要成果:
- 时间:建议使用更长的疗程 (8-12周),特别是对于葡萄球菌感染 (DATIPO试验).
- 一阶段交换:有限的证据表明,在某些情况下,6周可能足够,但缺乏专门的试验.
- 两个阶段的交换和切除:可变的持续时间,有限的可靠数据;回顾性系列显示,局部抗生素的短疗程很有希望,但RCT倾向于更长的疗程.
- 方法上的弱点 (样本规模小,回顾性设计,缺乏分层) 限制了大多数研究.
结论:
- 在PJI中缩短抗生素持续时间的高质量证据是有限的.
- 对于大多数患者来说,12周是最安全的参考持续时间,特别是在保留硬件的情况下,直到有更多随机试验为止.
- 未来的研究应该根据感染类型,生物体和宿主因素进行分层,以定制,基于证据的抗生素策略.
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