304. Comparison of Short and Long Courses of Antibiotics in Patients with Prosthetic Joint Infection: A Systemic Review and Meta-analysis

Abstract

Background. Current guidelines for treatment of prosthetic joint infection (PJI) suggest a combination of intravenous (IV) antibiotics for 2-6 weeks and oral antibiotics for 3-6 months. However, recent studies did not fnd signifcant benefts from prolonged use of antibiotics for patients with PJI. We conducted a systemic review and meta-analy-sis 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 literature 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 modifed Jadad scale respectively. Results. A total of 3,309 studies were retrieved, and nine observation studies and one RCT were included for fnal analysis (Figure 1). Nine of the 10 studies investigated total hip arthroplasty and/or total knee arthropathy, while one study further included shoulder, elbow, and ankle arthroplasty. Five studies focused on patients receiving debridement and implant retention (DAIR) procedure, three studies on staged exchange arthroplasty (SEA), and two studies on mixed procedures. Eight 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 signifcant diference 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 when compared with those prescribed with long-term antibiotics.