Does the duration of antibiotic treatment following one-stage treatment of infected total knee arthroplasty influence the eradication rate? A systematic review.

Objective: The aim of this study was to perform a systematic review of the current literature to elucidate the optimal duration of systemic antibiotic therapy following one-stage revision TKA in the setting of PJI.

Methods: We conducted an electronic search in four databases including Medline (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials without any publication date, language or study design filter on October 1, 2022. The search strategy adhered to PRISMA guidelines and consisted of four main keywords categories which were knee arthroplasty or knee prosthesis, infection and one-stage/single-stage revision. Duration of antibiotic administration were classified to three groups: short-term IV therapy (≤ two weeks), short-term IV therapy plus oral therapy, and long-term IV therapy (minimum six weeks).

Results: We identified 963 studies, of which 21 were included in the systematic review. Coagulase-negative Staphylococcal species were the most frequently isolated pathogens. The mean eradication rate for all the studies analyzed was 88.4% (range, 62.5-100%). Short-term IV + long-term oral antibiotic therapy demonstrated significantly higher eradication rate compared to the other two regimens following one-stage revision TKA (p = 0.023) (Table 4). In the ten studies with great than five years of follow-up, this difference was no longer statistically significant. Subgroup analysis of antibiotic-loaded cement (ABLC) usage demonstrated higher eradication rates with short-term IV + long-term oral (92.8%) and long-term IV antibiotics (89.7%) compared to short-term IV antibiotics alone (p = 0.006).

Conclusions: We demonstrated that short-term IV antibiotics followed by oral antibiotics had similar eradication rates to long-term IV antibiotics in long-term studies, which were both superior to short-term IV antibiotics alone. Nevertheless, there remains a need for prospective and randomized studies to further elucidate a patient-based protocol for the type and duration of antibiotic use following one-stage PJI treatment of the knee.