Session Title: Infection Related Rheumatic Diseases
Session Type: Abstract Submissions (ACR)
As for most of bone and joint infection, optimal treatment duration for vertebral osteomyelitis (VO) is unknown. In an era of increasing bacterial resistance, we compare the effectiveness of 6 and 12 weeks antibiotic treatment.
We carried out anational, open blind, randomized controlled non-inferiority multicentre trial in 2 parallel groups comparing 6 versus 12 weeks of antibiotic treatment duration.
Adult patients with clinical and radiologic diagnosis of VO (MRI or CT) and a reliable microbiological identification (positive and significative blood culture or needle biopsy) were recruited since 2007 to 2011. At one year, after the end of antibiotic therapy, cure was define as the absence of clinical and biological signs related to VO without the need for additional or alternative antibiotic therapy.
359 patients were randomized, 175 in the group 12 weeks treatment group and 176 in the group 6 weeks; 240 (69%) were male with mean age 61 years old. Eight patients were secondarily excluded. Median duration between first symptoms and diagnosis was 49 (1-80) days; 182 (52%) patients were febrile at diagnosis and 237 (68%) had positive blood culture. Infective endocarditis was present in 70 (20%) cases. Main bacteria involved were Staphylococcus aureus (n=143, 41%), Coagulase negativeStaphylococci (n=52, 15%) and Streptococcus non enterococcus (n=63, 18%).
At baseline, characteristics were similar in both group of treatment duration. During follow up, difference was non significative in both groups regarding median duration of parenteral antibiotictherapy, median length of hospitalization stay, most frequent antibiotics for oral treatment (rifadin and fluoroquinolon). Adverse events occurred in 100 cases of whom 26 deaths. In the intention to treat analysis, cure rates in the 6 weeks treatment group and in the 12 weeks treatment group were respectively 91% (159/171) and 91% (160/176)with a difference non significative between the two groups.
We have demonstrated in this large multicentre randomized clinical trial that 6 weeks of antibiotic treatment duration is as effective as 12 for VO.
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/management-of-vertebral-osteomyelitis-a-randomized-clinical-trial-comparing-6-versus-12-weeks-of-antibiotic-treatment/