Prosthetic Joint Infections: A Systematic Review

Background/Objectives: The optimal duration of antibiotic therapy, a cornerstone of PJI treatment, remains a topic of considerable debate, with current recommendations often based on limited evidence and expert consensus. Emerging evidence suggests that shorter antibiotic courses may be as effective as prolonged therapies in select cases, provided thorough surgical debridement is performed and biofilm-active agents are used. We aimed to synthesize available data on antibiotic therapy duration based on the surgical technique, along with recall of definitions, diagnosis criteria and classification. Future perspectives on PJI diagnosis have been also presented. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), databases were searched using predefined medical subject headings (MeSH) and PUBMED. Randomized controlled trials (RCTs), observational studies, and expert guidelines have been synthetized. Results: A total of 2305 articles involving observational studies and randomized controlled trials were reviewed. We summarized the results of studies that have compared shorter antibiotic courses to prolonged therapies according to the surgical procedure. Forty five studies were analyzed. Definitions and classification of PJI were mentioned for a better analysis. Future perspectives were also noted. Conclusions: This review highlights the limited data available for evaluating antibiotic duration in the setting of PJI. The most studies found that a shorter antibiotic duration was non-inferior to a longer duration in selected cases but evidence-based guidelines to harmonize practices and improve outcomes for PJI patients are needed.