Title:Efficacy and Safety of Different Antibiotic Therapies for Bone and Joint Infections:
A Network Meta-analysis of Randomized Controlled Trials
Volume: 29
Issue: 29
Author(s): Xiangwen Shi, Yipeng Wu, Haonan Ni, Minzheng Guo, Qi Cheng and Yongqing Xu*
Affiliation:
- Laboratory of Yunnan Traumatology and Orthopedics Clinical Medical Center, Yunnan Orthopedics
and Sports Rehabilitation Clinical Medical Research Center, Department of Orthopedic Surgery, 920th Hospital of Joint Logistics
Support Force of PLA, Kunming, China
Keywords:
Bone and joint infections, antibiotic, efficacy, safety, network meta-analysis, RCTs.
Abstract:
Background: Although an increasing number of antibiotics are being used to treat bone and joint
infections, their specific efficacy remains controversial. Thus, we aimed to systematically compare the efficacy
and safety of antibiotic therapies for orthopedic infections.
Methods: PubMed, Embase, The Cochrane Library, and Web of Science databases were searched from inception
to April 2022. Two authors independently and rigorously conducted the screening, data extraction, and
quality assessment of the relevant studies. All the extracted data were evaluated using traditional metaanalysis
and network meta-analysis by STATA SE 16.0.
Results: A total of eleven randomized controlled trials (RCTs) involving 1,063 patients were included for data
analysis. The analysis results from the NMA indicated that in terms of the clinical effectiveness rate, linezolid
(OR: 1.75, 95% CI: 1.01 to 3.02) showed significant efficacy compared to ampicillin/sulbactam. With regard
to the microbiological eradication rate, linezolid showed significant efficacy compared to cephalosporins (OR:
8.13, 95% CI: 1.16 to 57.09) and quinolones (OR: 3.51, 95% CI: 1.18 to 10.49). Similar findings were obtained
for subgroup populations with diabetic foot infections (DFI). However, linezolid was significantly related
to higher adverse events than ampicillin/sulbactam (OR: 3.25, 95% CI: 1.68 to 6.30) and cephalosporins
(OR: 18.29, 95% CI: 1.59 to 209.76).
Conclusion: Linezolid appeared to be the most promising treatment regimen for staphylococcal bone and
joint infections. However, due to the overall limited evidence, the research results need further high-quality
RCTs for confirmation.
