Treatment of the Infections on Osteo-articular Prostheses by 6 Versus 12 Weeks of Antibiotherapy
Condition: Prosthesis-related Infections
MeSH terms: Infections; Communicable Diseases; Prosthesis-Related Infections
Study type: Interventional
Phase: Phase 3

Summary: 
      The study is a prospective, open randomized, non-inferiority trial with two parallel groups,
      comparing 6 weeks versus 12 weeks of antibiotic treatment following surgery procedure
      (debridement and retention, 1-stage or 2 stage exchange).

      The duration of the treatment antibiotic of prosthetic joint infections is only based on
      experts' opinion ; this one varies from 6 weeks to several months according to the customs of
      the influencer.

      The principal aim of this study is to explore the efficacy and safety of 6 weeks versus 12
      weeks antibiotic therapy duration, both associated with surgical procedure (debridement and
      retention of implant, one-stage or two stages exchange), in PJI treatment.

      The study concerns 410 men or women of more than 18 years include in 34 centres in France.

      The duration of the study is of 4 years.
    

Detailed description: 
      Although the infection risk following primary hip and knee arthroplasties is less than 2%,
      prosthetic joint infections (PJI) have become more frequent due to the increasing number of
      patients undergoing surgery. PJI remains one of the most serious complications of prosthetic
      joint implantation. Each PJI episode represents substantial morbidity with a 5.3-7.2-fold
      higher cost than for the initial arthroplasty. The management of PJI almost always
      necessitates the need for surgical intervention and prolonged courses of intravenous or oral
      antimicrobial therapy. Despite a significant amount of basic and clinical research in this
      field, many questions pertaining to the definition of infection as well as diagnosis and
      management of these infections remain unanswered. The optimal surgical and antibiotic
      treatment of PJI remains unclear. The infection of implant is difficult to treat. According
      to the Infectious Diseases Society America recommendations of Osmon et al. in 2012,
      antibiotic therapy duration varies: 3 months for hip arthroplasties (6 months for total knee
      arthroplasties) for PJI with arthroplasty retention, and 6 weeks for two-stage exchanges.

      Sometimes, excessive antibiotic treatment durations are performed because recommendations are
      not evidence-based sensu strictu and only based on experts' opinion. Short therapy should be
      benefit to ecologic and economic impact.

      While the usual treatment is by the parenteral route for the first 2-4 weeks, this attitude
      is not evidence-based either. Up to one-third of patients with PJI may experience
      antibiotic-related or catheter-related problems during parenteral treatment. The one-stage
      and two-stage exchange of the infected implant has rather comparable success rate in the
      surgical management of the PJI (about 90%). Recent no-randomized studies indicate that short
      antibiotic therapy (6 weeks) seems to be efficient.

      Our proposal study is to explore the efficacy and safety of 6 weeks in the treatment of PJI,
      after a surgical procedure.

      The principal aim of this study is to explore the efficacy and safety of 6 weeks versus 12
      weeks antibiotic therapy duration, both associated with surgical procedure (debridement and
      retention of implant, one-stage or two stages exchange), in PJI treatment.

      Treatments antibiotics are chosen according to the germ and according to the consensual
      recommendations. Used antibiotics already have the AMM in this indication.

      Eligible patients have at least one symptom relating to the PJI (such pain, sinus tract,
      inflammatory surgical scar…) and microbiological documentation of PJI.The primary endpoint is
      the occurrence of clinical cure at month 24. Secondary endpoints are (i) adequate clinical
      and biological response at months 6 and 12, (ii) incidence of adverse events in the two
      groups, (iii) oral and/or intravenous antibiotic therapy efficacy.

      Randomization is stratified by the anatomical location of the infected joint (hip or knee)
      and surgical procedure (debridement and retention, 1-stage or 2 stage exchange).

      The follow-up consists on periodic clinical examinations, anamnesis and occasionally
      laboratory or radiological controls.
    

Intervention name(s): duration of antibiotic treatment
Intervention type(s): Other
Intervention description(s): Used antibiotics already have the AMM in this indication
Intervention MeSH terms: Anti-Bacterial Agents
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: infection; antibiotic; prosthesis