Treatment of the Infections on Osteo-articular Prostheses by 6 Versus 12 Weeks of Antibiotherapy

NCT ID: NCT01816009

Last Updated: 2025-12-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

410 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-11-30

Study Completion Date

2017-01-21

Brief Summary

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The study is a prospective, open randomized, non-inferiority trial with two parallel groups, comparing 6 weeks versus 12 weeks of antibiotic treatment following surgery procedure (debridement and retention, 1-stage or 2 stage exchange).

The duration of the treatment antibiotic of prosthetic joint infections is only based on experts' opinion ; this one varies from 6 weeks to several months according to the customs of the influencer.

The principal aim of this study is to explore the efficacy and safety of 6 weeks versus 12 weeks antibiotic therapy duration, both associated with surgical procedure (debridement and retention of implant, one-stage or two stages exchange), in PJI treatment.

The study concerns 410 men or women of more than 18 years include in 34 centres in France.

The duration of the study is of 4 years.

Detailed Description

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Although the infection risk following primary hip and knee arthroplasties is less than 2%, prosthetic joint infections (PJI) have become more frequent due to the increasing number of patients undergoing surgery. PJI remains one of the most serious complications of prosthetic joint implantation. Each PJI episode represents substantial morbidity with a 5.3-7.2-fold higher cost than for the initial arthroplasty. The management of PJI almost always necessitates the need for surgical intervention and prolonged courses of intravenous or oral antimicrobial therapy. Despite a significant amount of basic and clinical research in this field, many questions pertaining to the definition of infection as well as diagnosis and management of these infections remain unanswered. The optimal surgical and antibiotic treatment of PJI remains unclear. The infection of implant is difficult to treat. According to the Infectious Diseases Society America recommendations of Osmon et al. in 2012, antibiotic therapy duration varies: 3 months for hip arthroplasties (6 months for total knee arthroplasties) for PJI with arthroplasty retention, and 6 weeks for two-stage exchanges.

Sometimes, excessive antibiotic treatment durations are performed because recommendations are not evidence-based sensu strictu and only based on experts' opinion. Short therapy should be benefit to ecologic and economic impact.

While the usual treatment is by the parenteral route for the first 2-4 weeks, this attitude is not evidence-based either. Up to one-third of patients with PJI may experience antibiotic-related or catheter-related problems during parenteral treatment. The one-stage and two-stage exchange of the infected implant has rather comparable success rate in the surgical management of the PJI (about 90%). Recent no-randomized studies indicate that short antibiotic therapy (6 weeks) seems to be efficient.

Our proposal study is to explore the efficacy and safety of 6 weeks in the treatment of PJI, after a surgical procedure.

The principal aim of this study is to explore the efficacy and safety of 6 weeks versus 12 weeks antibiotic therapy duration, both associated with surgical procedure (debridement and retention of implant, one-stage or two stages exchange), in PJI treatment.

Treatments antibiotics are chosen according to the germ and according to the consensual recommendations. Used antibiotics already have the AMM in this indication.

Eligible patients have at least one symptom relating to the PJI (such pain, sinus tract, inflammatory surgical scar…) and microbiological documentation of PJI.The primary endpoint is the occurrence of clinical cure at month 24. Secondary endpoints are (i) adequate clinical and biological response at months 6 and 12, (ii) incidence of adverse events in the two groups, (iii) oral and/or intravenous antibiotic therapy efficacy.

Randomization is stratified by the anatomical location of the infected joint (hip or knee) and surgical procedure (debridement and retention, 1-stage or 2 stage exchange).

The follow-up consists on periodic clinical examinations, anamnesis and occasionally laboratory or radiological controls.

Conditions

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Prosthesis-related Infections

Keywords

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infection antibiotic prosthesis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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6 weeks

the duration of antibiotic treatment will be six weeks.

Group Type EXPERIMENTAL

duration of antibiotic treatment

Intervention Type OTHER

Used antibiotics already have the AMM in this indication

12 weeks

the duration of antibiotic treatment will be 12 weeks.

Group Type ACTIVE_COMPARATOR

duration of antibiotic treatment

Intervention Type OTHER

Used antibiotics already have the AMM in this indication

Interventions

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duration of antibiotic treatment

Used antibiotics already have the AMM in this indication

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Men or women over 18, presenting at least one of the following clinical signs: pain, fever, dent or flow of scar
* Bacterial infection on osteo-articular prosthesis (hip or knee)
* Documented basterial infection
* Surgical care optimized with prothesis change or articular washing
* Infection requiring an antibiotic treatment by parenteral way Intravenous injection or per bone
* Treatment effective antibiotic begun in the most previously 21 days
* Signed consent

Exclusion Criteria

* Patient with no proof of osteo-articular infection
* No surgical care
* Patient having more than one prothesis change because of sepsis
* Infection due to mycobactery, fungic infection or brucellienne infection
* Patient with life expectancy supposed lower than 2 years
* Guardianship patient
* Patient included in another study
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Tours

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Service de chirurgie orthopédique et traumatologique, CHU d'AMIENS

Amiens, , France

Site Status

Service des maladies infectieuses et tropicales, CHU d'ANGERS

Angers, , France

Site Status

Département de Médecine Interne et Maladies Infectieuses, hôpital privé d'Antony

Antony, , France

Site Status

Service des maladies infectieuses et tropicales, CHU de BESANCON

Besançon, , France

Site Status

Service de médecine interne, CH de BEZIERS

Béziers, , France

Site Status

Service de chirurgie orthopédique et traumatologique, Polyclinique de BLOIS

Blois, , France

Site Status

Service de Maladies Infectieuses et de Médecine Tropicale, Hôpital Pellegrin, CHU de Bordeaux

Bordeaux, , France

Site Status

Service de chirurgie orthopédique et traumatologique, CH de BOURG EN BRESSE

Bourg-en-Bresse, , France

Site Status

Service de Maladies Infectieuses, CH de BOURG EN BRESSE

Bourg-en-Bresse, , France

Site Status

Service de médecine interne et de maladies infectieuses, CHU de BREST

Brest, , France

Site Status

Service des maladies infectieuses et tropicales, CHU de CAEN

Caen, , France

Site Status

Service des maladies infectieuses et tropicales - médecine interne, CH de CHAMBERY

Chambéry, , France

Site Status

Service de médecine interne, rhumatologie, Centre Hospitalier Chalon sur Saône William Morey

Châlon Sur Saone, , France

Site Status

Service de Chirurgie Orthopédique et Traumatologique, APHP Hôpital Antoine Béclère

Clamart, , France

Site Status

Service de Médecine Interne et Immunologie Clinique, APHP Hôpital Antoine Béclère

Clamart, , France

Site Status

Service des maladies infectieuses et tropicales, CH de CLERMONT-FERRAND

Clermont-Ferrand, , France

Site Status

Centre de chirurgie orthopédique et de la main, CHRU de STRASBOURG

Illkirch-Graffenstaden, , France

Site Status

Unité de Traumatologie -Orthopédie septique, CHRU de LILLE

Lille, , France

Site Status

Service de Maladies Infectieuses, CHU de LIMOGES

Limoges, , France

Site Status

Centre de vaccinations internationales et de médecine des voyages du Tonkin

Lyon, , France

Site Status

Service des Maladies Infectieuses et tropicales, CHU de MONTPELLIER

Montpellier, , France

Site Status

Service des Maladies Infectieuses et tropicales, CHU de NANCY

Nancy, , France

Site Status

Service des maladies infectieuses et tropicales Hôtel-Dieu, CHU de Nantes

Nantes, , France

Site Status

Service de Chirurgie orthopédique Hôpital Lariboisière

Paris, , France

Site Status

Service des maladies infectieuses et tropicales CH Saint-Jean

Perpignan, , France

Site Status

Service de médecine interne, maladies infections et tropicales, CHU de POITIERS

Poitiers, , France

Site Status

Service de médecine interne, PONTOISE

Pontoise, , France

Site Status

Service des maldies infectieuses, CH d'ANNECY

Pringy, , France

Site Status

Service de Maladies Infectieuses, CHU de REIMS

Reims, , France

Site Status

Service des Maladies Infectieuses, CHU de RENNES

Rennes, , France

Site Status

Service de pneumologie - maladies infectieuses et tropicales, CH de ST QUENTIN

Saint-Quentin, , France

Site Status

Service d'infectiologie, CH de TOULON

Toulon, , France

Site Status

Service de Chirurgie Orthopédique et Traumatologique

Toulouse, , France

Site Status

Service des maladies infectieuses CH Gustave Dron

Tourcoing, , France

Site Status

Service de Chirurgie Orthopédique et traumatologie, hôpital Trousseau

Tours, , France

Site Status

Service de Médecine Interne et de Maladies Infectieuses, CHRU de TOURS

Tours, , France

Site Status

Service de chirurgie orthopédique, CH de VERSAILLES

Versailles, , France

Site Status

Countries

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France

References

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Bernard L, Arvieux C, Brunschweiler B, Touchais S, Ansart S, Bru JP, Oziol E, Boeri C, Gras G, Druon J, Rosset P, Senneville E, Bentayeb H, Bouhour D, Le Moal G, Michon J, Aumaitre H, Forestier E, Laffosse JM, Begue T, Chirouze C, Dauchy FA, Devaud E, Martha B, Burgot D, Boutoille D, Stindel E, Dinh A, Bemer P, Giraudeau B, Issartel B, Caille A. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med. 2021 May 27;384(21):1991-2001. doi: 10.1056/NEJMoa2020198.

Reference Type RESULT
PMID: 34042388 (View on PubMed)

Other Identifiers

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2010-021242-22

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

A101472-32

Identifier Type: OTHER

Identifier Source: secondary_id

PHRN09 - LB / DATIPO

Identifier Type: -

Identifier Source: org_study_id