PDF(Pubmed)
Abstract：
Prosthetic joint infections are considered difficult to treat they needing aggressive surgery and long antimicrobial treatments. However, the exact duration of these therapies has been established empirically. In the last years, several studies have explored the possibility of reducing the length of treatment in this setting, with conflicting results. In this narrative review, we critically appraise the published evidence, considering the different surgical approaches (implant retention [DAIR] and one-step and two-step exchange procedures) separately. In patients managed with DAIR, usually treated for at least 12 weeks, a large, randomized trial failed to show that 6 weeks were non-inferior. However, another randomized clinical trial supports the use of 8 weeks, as long as the surgical conditions are favorable and antibiotics with good antibiofilm activity can be administered. In patients managed with a two-step exchange procedure, usually treated during 6 weeks, a randomized clinical trial showed the efficacy of a 4-week course of antimicrobials. Also, the use of local antibiotics may allow the use of even shorter treatments. Finally, in the case of one-step exchange procedures, there is a trend towards reducing the length of therapy, and the largest randomized clinical trial supports the use of 6 weeks of therapy.
摘要：
人工关节感染被认为难以治疗，需要积极的手术和长期的抗菌治疗。然而,这些治疗的确切持续时间已根据经验确定.在过去的几年里，一些研究探索了在这种情况下缩短治疗时间的可能性，结果相互矛盾。在这篇叙述性评论中，我们批判性地评估发表的证据，分别考虑不同的手术方法（植入物固位[DAIR]和一步和两步交换程序）。在接受DAIR治疗的患者中，通常治疗至少12周，一个大的,随机试验未能显示6周非劣质.然而,另一项随机临床试验支持使用8周，只要手术条件有利并且可以施用具有良好抗生物膜活性的抗生素。在采用两步交换程序管理的患者中，通常在6周内治疗，一项随机临床试验显示了为期4周的抗菌药物治疗的疗效.此外，使用局部抗生素可能允许使用更短的治疗。最后,在一步交换程序的情况下，有减少治疗时间的趋势，最大的随机临床试验支持使用6周的治疗。
