Two weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial.

Authors:
Konstantinos Vakalopoulos
Konstantinos Vakalopoulos
Erasmus University Medical Center
Morgan Gauthier
Morgan Gauthier
Service d'orthopédie et traumatologie de l'appareil moteur
Cindy Bouvet
Cindy Bouvet
Geneva University Hospitals and Faculty of Medicine
Switzerland
Amanda Gonzalez
Amanda Gonzalez
Geneva University Hospitals and Faculty of Medicine
Christina Steiger
Christina Steiger
University Hospital of Geneva

Ann Rheum Dis 2019 Apr 16. Epub 2019 Apr 16.

Service of Infectious Diseases, Hopitaux Universitaires de Geneve, Geneva, Switzerland

Objective: The optimal duration of postsurgical antibiotic therapy for adult native joint bacterial arthritis remains unknown.

Methods: We conducted a prospective, unblinded, randomised, non-inferiority study comparing either 2 or 4 weeks of antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. Excluded were implant-related infections, episodes without surgical lavage and episodes with a follow-up of less than 2 months.

Results: We enrolled 154 cases: 77 in the 4-week arm and 77 in the 2-week arm. Median length of intravenous antibiotic treatment was 1 and 2 days, respectively. The median number of surgical lavages was 1 in both arms. Recurrence of infection was noted in three patients (2%): 1 in the 2-week arm (99% cure rate) and 2 in the 4-week arm (97% cure rate). There was no difference in the number of adverse events or sequelae between the study arms. Of the overall 154 arthritis cases, 99 concerned the hand and wrist, for which an additional subgroup analysis was performed. In this per-protocol subanalysis, we noted three recurrences: one in the 2-week arm (97 % cure); two in the 4-week arm (96 % cure) and witnessed sequelae in 50% in the 2-week arm versus 55% in the 4-week arm, of which five (13%) and six (13%) needed further interventions.

Conclusions: After initial surgical lavage for septic arthritis, 2 weeks of targeted antibiotic therapy is not inferior to 4 weeks regarding cure rate, adverse events or sequelae and leads to a significantly shorter hospital stay, at least for hand and wrist arthritis.

Trial Registration Number: NCT03615781.

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http://dx.doi.org/10.1136/annrheumdis-2019-215116DOI Listing
April 2019
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