Estudo comparativo entre o tempo de antibioticoterapia adjuvante e a taxa de recidiva de infecção nas osteomielites pós-traumáticas aguda e crônica

Abstract

Introduction: The duration of antibiotic therapy in patients with post-traumatic osteomyelitis (PTO) is based on studies of low quality. The purpose of this study was to assess whether the recurrence rate of infection differs among patients treated with antibiotics for six, 12 and 24 weeks. Other outcomes assessed were the incidence of adverse events and the relationship between recurrence rate and whether the infection was acute/chronic or is polymicrobial. Method: A prospective randomized longitudinal study included patients with PTO who received antibiotic therapy for six, 12 and 24 weeks following surgical treatment. Patients were followed up for 12 months after the end of antibiotic treatment. Patients were allocated into three groups according to duration of antibiotic treatment: I) 6 weeks (n = 80); II) 12 weeks (n = 59); and III); and 24 weeks (n = 24). Statistical analysis was performed using SPSS software. Results: There was no difference regarding the recurrence rate of infection among the three groups. Patients who received antibiotics for 24 weeks showed a higher incidence of adverse effects in comparison to patients who received six (z-score, p = 0.017) and 12 weeks (z-score, p = 0.005). Polymicrobial infections were more common in patients with acute than chronic PTO (Chi-square, p = 0.03; odds ratio = 4.6; CI 1.02-20.8). There was no association between recurrence of infection and whether it is acute or chronic. Discussion: The study results supported the recommendation for six weeks of adjuvant antibiotic therapy to PTO and showed that antimicrobial therapy longer than 12 weeks increased the incidence of adverse effects. The study evaluated patients with PTO who underwent surgical treatment. Conclusions: Duration of antimicrobial therapy longer than six weeks did not reduce the recurrence of infection in patients with PTO. The rate of adverse effects was higher in patients who received 24 weeks of antibiotic therapy in comparison to six and twelve weeks. Polymicrobial infection or whether it is acute or chronic did not influence the recurrence rate.