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Short vs. Long Antibiotic Treatment of Implant-free Osteoarticular Infections

NCT03602209 — Not applicable, Completed, 120 participants, University Hospital, Geneva

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RegistryNCT03602209
StatusCompleted
PhaseNot applicable
Study typeInterventional; randomized, parallel, masking: none, treatment
Enrollment120 (Actual)
SponsorUniversity Hospital, Geneva (Other)
ConditionsImplant Infection
InterventionsRemoval of infected implant, Antibiotic durations (Procedure, drug)
Datesstart 2015-03-01, primary completion 2018-02-28, completion 2018-05-18, first posted 2018-07-26, last updated 2018-08-01
Locations1 site in Switzerland

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-Summary

The investigators tested the working hypothesis if 4 weeks of systemic antibiotic treatment in implant-related orthopaedic infections is non-inferior to 6 weeks after complete removal of the infected implant. Randomization 1:1.

The study is completed. It halted prematurely and will not resume; participants are no longer being examined or receiving intervention.

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+Detailed description

Former description of the study (now completed)

Osteoarticular infections related to orthopaedic implants are associated with substantial morbidity, prolongation of hospital stay, and additional costs. Due to the increasing number of patients with orthopaedic implants in Switzerland, similar to the rest of Europe and elsewhere, the number of infections is expected to increase. While the surgical treatment of these infections has been well studied, the ideal duration of antibiotic therapy after removal (explantation) of the infected implant remains unknown. For almost 40 years, the recommended total duration of post-explantation antibiotic therapy has been 6 weeks. This recommendation is based on expert's personal experience rather than on prospective randomized studies. Shorter treatment would decrease antibiotic-related adverse events and costs hospital stay for patients awaiting an eventual reinsertion of a new implant. If physicians and surgeon prescribe antibiotics for 6 weeks, this duration should be at least supported by evidence.

+Arms and interventions

ArmTypeInterventionsDescription
4 weeks of treatmentExperimentalProcedure: Removal of infected implant; Drug: Antibiotic durations
6 weeks of treatmentActive comparatorProcedure: Removal of infected implant; Drug: Antibiotic durations
  • Removal of infected implant (Procedure)
  • Antibiotic durations (Drug)

+Outcome measures

Primary outcomes

  • Remission of infection [12 months]: Clinical evaluation
  • Adverse events [12 months]: Clinical adverse events

+Eligibility

Sex: All, ages: 18 Years to 120 Years

Inclusion Criteria:

* Adult patients (≥17 years old)
* Total removal of the implant

Exclusion Criteria:

* Primary native joint septic arthritis;
* Co-trimoxazole prophylaxis because of immunosuppression;
* Left-side endocarditis;
* Persistent implant material in the infected area.
* Infections with tuberculosis; mycobacteria; fungi; brucellosis; borreliosis; nocardiosis; and mycoplasmal osteosynthesis infections

+Locations (1)

FacilityCityCountryStatus
Geneva University HospitalsGenevaSwitzerland

+Publications

  • Al-Mayahi M, Betz M, Muller DA, Stern R, Tahintzi P, Bernard L, Hoffmeyer P, Suva D, Uckay I. Remission rate of implant-related infections following revision surgery after fractures. Int Orthop. 2013 Nov;37(11):2253-8. doi: 10.1007/s00264-013-2092-1. Epub 2013 Sep 20. PMID 24052163

+Investigators

  • Ilker Uçkay, MD, Principal investigator, University Hospital, Geneva

My Notes