312. Comparison of Short Course and Long Course of Antibiotics in Patients With Osteomyelitis: A Systemic Review and Meta-analysis

Abstract

BackgroundCurrent guidelines for treatment of osteomyelitis (OM) suggest antibiotics for 3–6 weeks. However, recent studies provided conflicting evidence about the benefits of the prolonged use of antibiotics. We conducted a systemic review and meta-analysis to assess the outcomes of short- and long-term antibiotics in patients with OM.MethodsWe used three queries to retrieve literature of vertebral OM, chronic OM, and diabetic foot OM from PubMed and Embase databases until December 2017. Each query comprised medical subject headings, title/abstract keywords, and exclusion terms. Two reviewers independently screened literature for three rounds and disagreements were resolved by a third reviewer. Quality of a cohort study and that of a randomized control trial (RCT) were assessed by Newcastle-Ottawa Quality Assessment Form and a modified Jadad scale, respectively.ResultsA total of 7,192 studies were retrieved (Figure 1). Eleven observation studies and five RCTs were included for analysis, including seven articles about vertebral OM, two chronic OM, five pediatric OM, and two diabetic foot OM. Of the 11 observational studies, only five were graded as good or fair quality. Thirteen studies demonstrated no significant difference in outcomes between short- and long-term of antibiotics, while three studies showed favorable outcomes in patients taking long-term antibiotics. The aggregate odds ratio (OR) of mortality was 0.46 (95% CI, 0.21, 1.02) for observational studies and 0.90 (95% CI, 0.58, 1.41) for RCTs, showing no significant benefits of long-term antibiotics in patients with OM (Figure 2). In patients with vertebral OM, outcomes were comparable between short- and long-term of antibiotics (OR 0.51, 95% CI, 0.26, 1.01). In seven studies where only intravenous (IV) antibiotics were used, there was no significant benefit of long-term antibiotics (OR 1.12, 95% CI, 0.68, 1.83). However, in the remaining nine studies where antibiotics were transitioned from IV to oral form, there was marginal benefit of long-term oral antibiotics (OR 0.44, 95% CI, 0.22, 0.91).ConclusionBoth RCTs and observational studies demonstrated that long-term antibiotics use did not generate significantly better outcome as compared with short-term antibiotics in patients with all-cause or a specific type of OM. Disclosures All authors: No reported disclosures.