Septic Arthritis
Conditions
Keywords
Septic Arthritis of native joint, short antibiotic treatment, native joint, septic arthritis
Brief summary
In France, the incidence of native joint infections is about 10 per 100 000 person-years, most commonly caused by S.aureus followed by b-haemolytic streptococci. French and international antibiotic guidelines, based on expert advice and retrospective studies, recommend intravenous antibiotics for two weeks, then oral for 4 weeks without evident link between intravenous, prolonged oral treatment and cure. Long term exposure to antibiotics increases bacterial resistance, a major problem of public health. Several studies show that serious infectious can be treated safely by a shorter treatment and with oral antibiotics. There is no randomized controlled trial to establish the duration of antibiotics in native joint infections. Moreover, no consensus prevails on the administration route and duration of antimicrobial therapy. Although most clinicians acknowledge the interest of oral antibiotics and shorter treatment duration, randomized controlled trials are necessary to evaluate this practice. The SHASAR project aims to evaluate whether a shorter antibiotic treatment (3 week treatment) is safe and not inferior to the conventional 6 week treatment in native joint infections. If successful, this would represent a major advance in terms of patients' quality of life; decreased rate of health-care-related infections and complications, bacterial resistance and cost.
Detailed description
This trial is a nationwide, non inferiority, multicenter French randomized, open-label, controlled trial comparing two treatment durations, 3 versus 6 weeks, in septic arthritis of native joints. Patients who fulfill inclusion criteria will be randomized between day0 and day5. Day 0 is the time when effective intravenous antibiotic treatment is started. Effective treatment is defined by active antibiotics on the identified bacteria according to the susceptibility. The randomisation (1:1 ratio) will be stratified on early planned drainage. Follow-up will include 6 visits and will consist in clinical, biological, radiological, health quality of life (EQ-5D-3L score) and adverse events record. After collection, validation of data and population description, analysis will be conducted on the per-protocol population (patients receiving the planned duration of antibiotic +/-3days). This study will not be carried out blind for feasibility reasons. According to statistical considerations (by accounting for 5% of subjects lost to follow-up), the required sample size will be of 350 patients overall.
Interventions
OTHERShort antibiotics treatment
Patients randomized in this arm will pursue antibiotic administration until visit 3 weeks after D0
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Septic arthritis of native joint defined by: 1) clinical signs (hot and/or swollen and/or tender and painful joint (measured by a visual analogue scale)) and 2) microbiologically confirmed pyogenic arthritis (microorganism cultured in the synovial fluid joint or in the blood with complete bacterial susceptibility) * Patients aged of 18 years or older * Informed, written consent obtained from the patient * Patient having the rights to French social insurance
Exclusion criteria
* Prosthetic joints * Septic arthritis in the past 12 months * Osteomyelitis * Diabetic foot * Septic choc * Arthritis due to bacteria resistant to available oral antibiotics * Arthritis due to the following microorganisms: Mycobacterium, fungi, Brucella, Borrelia, Neisseria gonorrhoeae, Neisseria meningitidis, Nocardia, Mycoplasma spp, Pseudomonas aeruginosa. * Glomerular filtration rate \< 30ml/min/1,73m2 * Neutrophils \< 500/mm3 * Difficulties regarding compliance with oral antibiotics * Contraindication to oral antibiotics necessary to treat joint infection * Pregnancy or lactating woman * Curator or guardianship * Participation in other interventional research during the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cure at 16 weeks (4 months) after the beginning of the treatment | 16 weeks after Day 0 | Cure is defined as absence of clinical signs of joint infection, absence of treatment failure, absence of relapse |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Treatment failure and relapse and relapse rates | 6,16,24 weeks after Day 0 | % of relapse at 6,16,24 weeks |
| The patient's quality of life | 3,6,16,24 weeks after Day 0 | assessed by a quality of life questionnaire on 3,6,16,24 weeks. The EQ-5D-3L descriptive system comprises the following five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, and extreme problems. The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions. This decision results into a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state. |
| Cure at 24 weeks | 24 weeks after Day 0 | Cure is defined as absence of clinical signs of joint infection, absence of treatment failure, absence of relapse |
| hospital length of stay and total treatments costs | through study completion, an average of 3 years | To compare cost-effectiveness and cost utility of 3-week vs 6-week antibiotic strategies for patients with arthritis of native joints |
| joint mobility | at 16 and 24 weeks after Day 0 | joint mobility is assessed by good mobility, few mobility, no mobility |
| The residual joint pain in the affected joint | at 16 and 24 weeks after Day 0 | The residual joint pain is measured by a numerical scale. 0 means no pain at all and 10 pain as bad as it could be. |
Countries
France
Outcome results
None listed