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Varenne Y, Corvec S, Leroy AG, Boutoille D, Nguyễn MV, Touchais S, Bémer P, Hamel A, Waast D, Nich C, Gouin F, Crenn V. A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection. Antibiotics (Basel) 2021; 10:768. [PMID: 34202518 PMCID: PMC8300712 DOI: 10.3390/antibiotics10070768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/04/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.
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Affiliation(s)
- Yoann Varenne
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
| | - Stéphane Corvec
- Bacteriology Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (S.C.); (A.-G.L.); (P.B.)
- CRCINA, INSERM, University of Angers, University of Nantes, 44000 Nantes, France
| | - Anne-Gaëlle Leroy
- Bacteriology Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (S.C.); (A.-G.L.); (P.B.)
- Laboratoire EA 3826 “Thérapeutiques Cliniques et Expérimentales des Infections”, IRS2-Nantes Biotech, University of Nantes, 44000 Nantes, France
| | - David Boutoille
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital, 44000 Nantes, France;
| | - Mỹ-Vân Nguyễn
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
| | - Sophie Touchais
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
| | - Pascale Bémer
- Bacteriology Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (S.C.); (A.-G.L.); (P.B.)
| | - Antoine Hamel
- Pediatric Orthopedic Surgery Department, University Hospital, UHC of Nantes, 44903 Nantes, France;
- Anatomy Department, Medical Faculty, 44000 Nantes, France
| | - Denis Waast
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
| | - Christophe Nich
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
- PhyOs 1238, INSERM, University of Nantes, 44000 Nantes, France
| | - François Gouin
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
- Département de Chirurgie, Centre de Lutte Contre le Cancer Léon Bérard, 69008 Lyon, France
| | - Vincent Crenn
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, UHC of Nantes, 44000 Nantes, France; (Y.V.); (M.-V.N.); (S.T.); (D.W.); (C.N.); (F.G.)
- PhyOs 1238, INSERM, University of Nantes, 44000 Nantes, France
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Morris J, Kelly N, Elliott L, Grant A, Wilkinson M, Hazratwala K, McEwen P. Evaluation of Bacteriophage Anti-Biofilm Activity for Potential Control of Orthopedic Implant-Related Infections Caused byStaphylococcus aureus. Surg Infect (Larchmt) 2019; 20:16-24. [DOI: 10.1089/sur.2018.135] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jodie Morris
- Orthopaedic Research Institute of Queensland, Townsville, Australia
- College of Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Natasha Kelly
- College of Public Health Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | | | - Andrea Grant
- Orthopaedic Research Institute of Queensland, Townsville, Australia
| | | | | | - Peter McEwen
- Orthopaedic Research Institute of Queensland, Townsville, Australia
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Malandain D, Bémer P, Leroy AG, Léger J, Plouzeau C, Valentin AS, Jolivet-Gougeon A, Tandé D, Héry-Arnaud G, Lemarié C, Kempf M, Bret L, Burucoa C, Corvec S. Assessment of the automated multiplex-PCR Unyvero i60 ITI ® cartridge system to diagnose prosthetic joint infection: a multicentre study. Clin Microbiol Infect 2017; 24:83.e1-83.e6. [PMID: 28559002 DOI: 10.1016/j.cmi.2017.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/17/2017] [Accepted: 05/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Prosthetic joint infections (PJI) are responsible for significant morbidity and mortality and their number continues to rise. Their management remains complex, especially the microbiological diagnosis. Besides 'homemade' tests developed by several teams, new molecular biology methods are now available with different analytical performance and usability. METHODS We studied the performances of one of these tests: ITI® multiplex PCR (mPCR) by the Curetis® company and compared it to either 'optimized' culture or 16S rRNA PCR. We performed a retrospective multicentre study to assess the contributions of mPCR in the diagnosis of PJI. We randomly selected 484 intraoperative specimens among 1252 of various types (biopsy, bone, tissue around the prosthesis, synovial fluid) from 251 patients in seven different hospitals. Each sample was treated according to the recommendations of the manufacturer. RESULTS In all, 154 out of 164 (93.9%) samples negative in culture were negative with the mPCR. Among the 276 positive samples in culture, 251 (90.9%) were monomicrobial, of which 119 (47.4%) were positive with the mPCR, and 25 (9.1%) were polymicrobial, of which 12 (48%) were positive with the mPCR. The concordance rate of mPCR with culture was 58.1% (53.6%-62.7%) and the concordance rate with 16S rRNA PCR was 70.1% (65.5%-74.6%). CONCLUSION This new standardized molecular test showed a lack of detection when the bacterial inoculum was low (number of positive media per sample and number of colonies per media) but can be useful when patients have received antibiotic therapy previously.
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Affiliation(s)
- D Malandain
- CHU Nantes, Laboratoire de Bactériologie, Nantes, France
| | - P Bémer
- CHU Nantes, Laboratoire de Bactériologie, Nantes, France
| | - A G Leroy
- CHU Nantes, Laboratoire de Bactériologie, Nantes, France
| | - J Léger
- Inserm, CIC 1415, Tours, France
| | - C Plouzeau
- CHU Poitiers, Laboratoire de Bactériologie, Poitiers, France
| | - A S Valentin
- CHU Tours, Laboratoire de Bactériologie, Tours, France
| | | | - D Tandé
- CHU Brest, Laboratoire de Bactériologie, Brest, France
| | - G Héry-Arnaud
- CHU Brest, Laboratoire de Bactériologie, Brest, France
| | - C Lemarié
- CHU Angers, Laboratoire de Bactériologie, Angers, France
| | - M Kempf
- CHU Angers, Laboratoire de Bactériologie, Angers, France
| | - L Bret
- CH Orléans, Laboratoire de Bactériologie, Orléans, France
| | - C Burucoa
- CHU Poitiers, Laboratoire de Bactériologie, Poitiers, France
| | - S Corvec
- CHU Nantes, Laboratoire de Bactériologie, Nantes, France.
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