This article systematically reviews the latest evidence on the duration of antibiotic treatment for bacterial prosthetic joint infections (PJI) under different surgical strategies, highlighting the potential benefits and risk balance of shortening the treatment period. It provides a comprehensive analysis of high-quality randomized controlled trials and observational studies, offering important references for clinical individualized treatment.
Literature Overview
This article, titled 'Treatment Duration in Bacterial Prosthetic Joint Infections: A Narrative Review of Current Evidence,' published in the 'Antibiotics' journal, reviews and summarizes existing evidence on antibiotic treatment duration under different surgical interventions (e.g., DAIR, one-stage exchange, two-stage exchange). It particularly focuses on the impact of infection type, pathogen species, and host factors on treatment outcomes.
Background Knowledge
Prosthetic joint infection (PJI) is a severe and challenging complication following orthopedic surgery. Its treatment involves complex surgical interventions and prolonged antibiotic therapy. PJI is often caused by biofilm-forming organisms (e.g., Staphylococcus aureus), making treatment even more challenging. Although several guidelines (e.g., IDSA 2013) recommend treatment durations ranging from 3 to 6 months, recent studies suggest that under specific conditions, the antibiotic course could be shortened. There is currently no uniform standard for treatment duration across different surgical strategies, and most existing studies are retrospective or based on small samples, lacking randomized controlled trial (RCT) data. This review, incorporating findings from multiple observational studies and RCTs (e.g., DATIPO and SOLARIO trials), proposes a potential pathway for individualized treatment and highlights the need for future multicenter RCTs to define the optimal treatment duration.
Research Methods and Experiments
This study systematically searched PubMed, Embase, and the Cochrane Library databases up to January 2025, including observational studies, randomized controlled trials, and international guidelines. A total of 45 studies were included in the analysis. The research evaluated the duration of antibiotic treatment following different surgical approaches, including debridement, antibiotics, and implant retention (DAIR), one-stage exchange, two-stage exchange, and resection arthroplasty. The efficacy was assessed by stratifying based on pathogen type (e.g., Gram-positive, drug-resistant organisms), infection stage (acute vs. chronic), and surgical approach.
Key Conclusions and Perspectives
Research Significance and Prospects
The study highlights the potential benefits of shortening antibiotic duration in PJI management, such as reducing drug resistance, adverse effects, and treatment costs. However, high-quality evidence is still lacking, particularly for one-stage and two-stage exchange procedures. Future research should involve multicenter, randomized, and stratified clinical trials to determine optimal treatment durations for different infection subtypes and to evaluate the synergistic effects of local and systemic antibiotic therapies.
Conclusion
Although the number of studies exploring shorter antibiotic durations for bacterial prosthetic joint infections (PJI) is growing, high-quality evidence remains limited. Current recommendations still suggest that 12 weeks is the safest reference treatment duration for most patients, especially those retaining hardware. Future studies should incorporate stratification by infection type, pathogen, and host factors to formulate more individualized and evidence-based treatment strategies. Multicenter RCTs, such as the ROADMAP trial, are expected to provide clearer guidance to optimize antimicrobial use, improve cure rates, and reduce adverse events.
