As an Infectious Disease physician, I see many patients with osteomyelitis, or infection of the bone. It’s a common infection especially in patients with diabetes, poor circulation, and following joint replacement.
It’s not often I am struck by what appears to be a game-changing study. The OVIVA study should be practice changing for patients with bone infections. This Oral Versus Intravenous Antibiotics for Bone and Joint Infection trial just found that oral antibiotics are as efficacious as IV (intravenous) antibiotics, so should greatly improve the quality of life for patients, as well as reducing hospitalization costs. OVIVA is better than earlier studies as it was randomized and more representative of clinical practice.
Osteomyelitis can occur by several routes—spread by a bloodstream infection, following trauma, especially if there is an open wound (like with diabetes or poor circulation), from spread of an adjacent infection, or postoperatively.
In the US, there were 332,000 total hip and 719,000 total knee replacement surgeries in 2010—and the numbers are expected to increase to 572,000 and 3.48 million by 2030, given the aging population. The incidence of postoperative joint infection is 1-2%, with most occurring in the first two years following surgery. Risk factors for infection include age, obesity, diabetes, and other immunosuppression.
Consequences of infection are significant—infections of bones and joints often require surgical as well as medical treatment. Prosthetic joint infections are often treated with removal of the implant followed by at least six weeks IV and localized antibiotics before a prosthesis can be reimplanted, or replaced. Sometimes, an immediate reimplantation of a prosthesis was done after an infected one was removed. This “one-stage revision” occurred in ~8% of study patients and 23% were able to only have the one surgery to replace the infected joint. This is higher than what I have seen in consultation, where a 2-stage revision is more common.
Complications of osteomyelitis treatment include infections from IV lines, blood clots, and problems from prolonged inpatient stays, as many of these patients have to stay in a nursing home because of Medicare’s arcane rules, which don’t cover home IV antibiotic therapy, although it is safer and cheaper than institutionalization.
Dr. Paul Sax, of Harvard’s Brigham and Women’s Hospital explains the OVIVA study findings in a quite humorous and creative fashion, reporting results as an “interview,” where he is playing both roles. At one year’s follow-up, treatment failures occurred in 15% of those receiving IV antibiotics vs. 13% in the oral group.
In this British study, 1054 patients were randomized to oral or IV antibiotic therapy after initiating treatment with IV drugs. Specific drugs were at the discretion of the treating physician—a real world scenario.
Source: Forbes Healthcare
