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Crepin DM, Chavignon M, Verhoeven PO, Laurent F, Josse J, Butin M. Staphylococcus capitis: insights into epidemiology, virulence, and antimicrobial resistance of a clinically relevant bacterial species. Clin Microbiol Rev 2024; 37:e0011823. [PMID: 38899876 PMCID: PMC11391707 DOI: 10.1128/cmr.00118-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
SUMMARYStaphylococcus capitis is divided into two subspecies, S. capitis subsp. ureolyticus (renamed urealyticus in 1992; ATCC 49326) and S. capitis subsp. capitis (ATCC 27840), and fits with the archetype of clinically relevant coagulase-negative staphylococci (CoNS). S. capitis is a commensal bacterium of the skin in humans, which must be considered an opportunistic pathogen of interest particularly as soon as it is identified in a clinically relevant specimen from an immunocompromised patient. Several studies have highlighted the potential determinants underlying S. capitis pathogenicity, resistance profiles, and virulence factors. In addition, mobile genetic element acquisitions and mutations contribute to S. capitis genome adaptation to its environment. Over the past decades, antibiotic resistance has been identified for S. capitis in almost all the families of the currently available antibiotics and is related to the emergence of multidrug-resistant clones of high clinical significance. The present review summarizes the current knowledge concerning the taxonomic position of S. capitis among staphylococci, the involvement of this species in human colonization and diseases, the virulence factors supporting its pathogenicity, and the phenotypic and genomic antimicrobial resistance profiles of this species.
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Affiliation(s)
- Deborah M Crepin
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Marie Chavignon
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Paul O Verhoeven
- CIRI, Centre International de Recherche en Infectiologie, GIMAP Team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Faculté de Médecine, Université Jean Monnet, St-Etienne, France
- Service des agents infectieux et d'hygiène, Centre Hospitalier Universitaire de St-Etienne, St-Etienne, France
| | - Frédéric Laurent
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Josse
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Marine Butin
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
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Le Pogam A, Medina F, Belkacem A, Raffetin A, Jaafar D, Wodecki P, Corlouer C, Dublanchet A, Caraux-Paz P, Diallo K. Proportion of patients with prosthetic joint infection eligible for adjuvant phage therapy: a French single-centre retrospective study. BMC Infect Dis 2024; 24:923. [PMID: 39237903 PMCID: PMC11378432 DOI: 10.1186/s12879-024-09814-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 08/27/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Bone and joint infections represent a major public health issue due to their increasing prevalence, their functional prognosis and their cost to society. Phage therapy has valuable anti-biofilm properties against prosthetic joint infections (PJI). The aim of this study was to establish the proportion of patients eligible for phage therapy and to assess their clinical outcome judged against all patients presenting with PJI. METHOD . Patients admitted for periprosthetic joint infection (PJI) at a French general hospital between 2015 and 2019 were retrospectively included. Eligibility for phage therapy was determined based on French recommendations, with polymicrobial infections serving as exclusion criteria. Patients were categorized into two groups: those eligible and those ineligible for phage therapy. We analyzed their characteristics and outcomes, including severe adverse events, duration of intravenous antibiotic therapy, length of hospitalization, and relapse rates. RESULTS . In this study, 96 patients with PJI were considered in multidisciplinary medical meetings. Of these, 44% patients (42/96) were eligible for additional phage therapy. This group of patients had a longer duration of intravenous therapy (17 days vs. 10 days, p = 0.02), more severe adverse events (11 vs. 3, p = 0.08) and had a longer hospital stay (43 days vs. 18 days, p < 0.01). CONCLUSION . A large number of patients met eligibility criteria for phage therapy and treatment and follow-up is more complex. A larger epidemiological study would more accurately describe the prognosis of eligible patients.
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Affiliation(s)
- Ambroise Le Pogam
- Department of Infective and Tropical Diseases, Intercommunal Hospital Centre of Villeneuve- Saint-Georges, Villeneuve-Saint-Georges, 94190, France
| | - Fernanda Medina
- Department of Infective and Tropical Diseases, Intercommunal Hospital Centre of Villeneuve- Saint-Georges, Villeneuve-Saint-Georges, 94190, France
| | - Anna Belkacem
- Department of Infective and Tropical Diseases, Intercommunal Hospital Centre of Villeneuve- Saint-Georges, Villeneuve-Saint-Georges, 94190, France
| | - Alice Raffetin
- Department of Infective and Tropical Diseases, Intercommunal Hospital Centre of Villeneuve- Saint-Georges, Villeneuve-Saint-Georges, 94190, France
| | - Danielle Jaafar
- Department of Infective and Tropical Diseases, Intercommunal Hospital Centre of Villeneuve- Saint-Georges, Villeneuve-Saint-Georges, 94190, France
| | - Philippe Wodecki
- Department of Orthopaedic surgery, Intercommunal Hospital Centre of Villeneuve-Saint- Georges, Villeneuve-Saint-Georges, 94190, France
| | - Camille Corlouer
- Department of Bacteriology, Intercommunal Hospital Centre of Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, 94190, France
| | | | - Pauline Caraux-Paz
- Department of Infective and Tropical Diseases, Intercommunal Hospital Centre of Villeneuve- Saint-Georges, Villeneuve-Saint-Georges, 94190, France
| | - Kevin Diallo
- Department of Infective and Tropical Diseases and Dermatology, University Hospital of La Reunion, Saint-Pierre, 97448, France.
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Bémer P, Aubry A, Schramm F, Koebel C, Revillet H, Baltes V, Le Brun C, Chazerain P, Zeller V, Hamdad F, Morand PC, Guillouzouic A, Piau C, Roux AL, Soueges S, Martin C, Gaudart A, Hüssler S, Fihman V, Carricajo A, Caruba CG, Bador J, Dauchy FA, Dutronc H, Vignals C, Peuchant O. Clinical features and treatment outcomes of bone and joint nontuberculous mycobacterial infections according to immune status: a 9-year retrospective observational cohort. Int J Infect Dis 2024; 146:107122. [PMID: 38823623 DOI: 10.1016/j.ijid.2024.107122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVES Nontuberculous mycobacteria (NTM) bone and joint infections (BJIs) are uncommon. We evaluated the characteristics of BJIs and identified differences according to immune status. METHODS We performed a multicenter retrospective study in France involving patients with documented NTM BJI over a 9-year period. We collected the clinical and microbiological characteristics, management, and clinical outcomes of the patients. RESULTS Overall, 95 patients were included, of whom 50.5% (48/95) were immunosuppressed. Tenosynovitis was more frequent in the immunocompetent group, and native arthritis more common in the immunosuppressed group. Mycobacerium marinum and M. abscessus complex were significantly more frequent in the immunocompetent group, and M. avium and M. xenopi were significantly more frequent in the immunosuppressed group. The combination of antibiotherapy with surgery tended to be more frequent in the immunocompetent than the immunosuppressed group (63.8% (30/47) vs 47.8% (22/46), respectively); of the latter, 45.7% (21/46) received antimicrobial therapy alone, a higher frequency than in the immunocompetent group (23.4%, 11/47). The median duration of antimicrobial treatment was similar in the two groups (11 months). Mortality was significantly higher in the immunosuppressed group. CONCLUSIONS Although the clinical presentations and the NTM species involved in BJI differed according to immune status, most recovered completely after treatment.
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Affiliation(s)
- Pascale Bémer
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Alexandra Aubry
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France
| | - Frédéric Schramm
- Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Christelle Koebel
- Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Hélène Revillet
- Laboratoire de Bactériologie-Hygiène, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Baltes
- Service d'infectiologie, AP-HP, Hôpital Cochin, Paris, France
| | - Cécile Le Brun
- Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Pascal Chazerain
- Service de rhumatologie, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Farida Hamdad
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Philippe C Morand
- Université Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France; Service de Bactériologie, AP-HP, Hôpital Cochin, Paris, France
| | - Aurélie Guillouzouic
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Caroline Piau
- Service de Bactériologie-Hygiène Hospitalière, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Anne-Laure Roux
- Service de microbiologie, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Sarah Soueges
- Service de Maladies Infectieuses et Tropicales de l'Hôpital de la Croix-Rousse, Centre de Référence des Infections Ostéo-Articulaires Complexes de Lyon (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Christian Martin
- Laboratoire de Bactériologie, Virologie, Hygiène, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Alice Gaudart
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Sophie Hüssler
- Unité de Bactériologie, Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Vincent Fihman
- Unité de Bactériologie, Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Anne Carricajo
- Laboratoire des agents infectieux et Hygiène, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | | | - Julien Bador
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Frédéric-Antoine Dauchy
- Service des Maladies Infectieuses et Tropicales, Centre de Référence CRIOAc GSO, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Hervé Dutronc
- Service des Maladies Infectieuses et Tropicales, Centre de Référence CRIOAc GSO, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Carole Vignals
- Service des Maladies Infectieuses et Tropicales, Centre de Référence CRIOAc GSO, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Olivia Peuchant
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
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Royere AE, Pourrat X, Le Nail LR, Lartigue MF, Lemaignen A, Tuloup V, Lacasse M. Impact of pharmacist-led interventions in a multidisciplinary consultation meeting for bone and joint infection. Infect Dis Now 2024; 54:104958. [PMID: 39069005 DOI: 10.1016/j.idnow.2024.104958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/06/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Management of bone and joint infections (BJI) requires prolonged and high-dose antibiotic therapy to achieve target concentrations in bone tissue. However, these therapies often lead to adverse effects in patients who are frequently fragile, with multiple comorbidities and associated medications. The decision to treat these complex cases is made during a multidisciplinary team meeting at the reference centre for complex osteoarticular infections (CRIOAC). MATERIAL AND METHODS Elaborated by a pharmacist during CRIOAC meetings, a single-centre before-and-after comparative study of drug-related issues observed during pharmaceutical interventions (PIs), was conducted. For each patient included, a retrospective case was added. PIs were independently evaluated by a committee of infectiologists and pharmacists to assess their criticality. RESULTS Sixty patients were included in the intervention group, with 59 controls. The population was homogeneous, with a median age of 65 years. Most BJI cases were complex (65.5 %), primarily involving prosthetic joint infections. Staphylococcus species were the predominant pathogens. Antibiotic therapy adapted to antibiograms was orally relayed for 74 % of patients, with 5.9 % requiring re-hospitalization due to adverse effects. Sixty-two PIs were performed, representing an average of 1.8 PIs per meeting or 34.4 % of patients. Dosage adjustment accounted for 42 % of PIs, drug interactions for 46 %, and treatment availability in community pharmacies for 8 %. Regarding criticality, three PIs were classified as vital, 22 as major, 22 as moderate, and 15 as minor in both groups, with the same distribution between the intervention and control groups. CONCLUSION This study demonstrates that by collaborating with surgeons and infectiologists, pharmacists participating in CRIOAC meetings can strongly help to prevent drug-related problems in patients with BJIs.
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Affiliation(s)
| | - Xavier Pourrat
- Pharmacy Department, Logipôle Trousseau, CHRU Tours, France
| | | | - Marie-Frederique Lartigue
- Bacteriology-Virology-Hygiene Service, Trousseau Hospital, CHRU Tours, France; ISP, UMR1282, Tours University, INRAE, Tours, F-37032, France
| | - Adrien Lemaignen
- Infectious Disease and Internal Medicine Service, Bretonneau Hospital, CHRU Tours, France; Education - Ethic - Health, EA7505, Tours University, Tours, France
| | - Vianney Tuloup
- Pharmacy Department, Logipôle Trousseau, CHRU Tours, France; Inserm U1327 ISCHEMIA "Membrane signalling and inflammation in reperfusion injuries", Université de Tours, Tours, France.
| | - Marion Lacasse
- Education - Ethic - Health, EA7505, Tours University, Tours, France
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Ren H, Wang P, Huang H, Huang J, Lu Y, Wu Y, Xie Z, Tang Y, Cai Z, Shen H. N-Halaminated spermidine-containing polymeric coating enables titanium to achieve dual functions of antibacterial and osseointegration. Biomater Sci 2024; 12:2648-2659. [PMID: 38573023 DOI: 10.1039/d4bm00061g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Titanium (Ti) and its alloys have been widely employed in the treatment of orthopedics and other hard tissue diseases. However, Ti-based implants are bioinert and suffer from bacterial infections and poor osseointegration in clinical applications. Herein, we successfully modified Ti with a porous N-halaminated spermidine-containing polymeric coating (Ti-SPD-Cl) through alkali-heat treatment, surface grafting and chlorination, and it has both excellent antibacterial and osteogenic abilities to significantly enhance osseointegration. The as-obtained Ti-SPD-Cl contains abundant N-Cl groups and demonstrates effective antibacterial ability against S. aureus and E. coli. Meanwhile, due to the presence of the spermidine component and construction of a porous hydrophilic surface, Ti-SPD-Cl is also beneficial for maintaining cell membrane homeostasis and promoting cell adhesion, exhibiting good biocompatibility and osteogenic ability. The rat osteomyelitis model demonstrates that Ti-SPD-Cl can effectively suppress bacterial infection and enhance bone-implant integration. Thus, Ti-SPD-Cl shows promising clinical applicability in the prevention of orthopedic implant infections and poor osseointegration.
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Affiliation(s)
- Hang Ren
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Peng Wang
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Hanwen Huang
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Junshen Huang
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Yuheng Lu
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Yanfeng Wu
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Zhongyu Xie
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Youchen Tang
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Zhaopeng Cai
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Huiyong Shen
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
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Bouiller K, Jacko NF, Shumaker MJ, Talbot BM, Read TD, David MZ. Factors associated with foreign body infection in methicillin-resistant Staphylococcus aureus bacteremia. Front Immunol 2024; 15:1335867. [PMID: 38433826 PMCID: PMC10904584 DOI: 10.3389/fimmu.2024.1335867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Background We aimed to compare patient characteristics, MRSA sequence types, and biofilm production of MRSA strains that did and did not cause a foreign body infection in patients with MRSA bloodstream infections (BSI). Methods All adult patients with MRSA BSI hospitalized in two hospitals were identified by clinical microbiology laboratory surveillance. Only patients who had at least one implanted foreign body during the episode of BSI were included. Results In July 2018 - March 2022, of 423 patients identified with MRSA BSI, 118 (28%) had ≥1 foreign body. Among them, 51 (43%) had one or more foreign body infections. In multivariable analysis, factors associated with foreign body infection were history of MRSA infection in the last year (OR=4.7 [1.4-15.5], p=0.012) community-associated BSI (OR=68.1 [4.2-1114.3], p=0.003); surgical site infection as source of infection (OR=11.8 [2-70.4], p=0.007); presence of more than one foreign body (OR=3.4 [1.1-10.7], p=0.033); interval between foreign body implantation and infection <18 months (OR=3.3 [1.1-10], p=0.031); and positive blood culture ≥48h (OR=16.7 [4.3-65.7], p<0.001). The most prevalent sequence type was ST8 (39%), followed by ST5 (29%), and ST105 (20%) with no significant difference between patients with or without foreign body infection. Only 39% of MRSA isolates formed a moderate/strong biofilm. No significant difference was observed between patients with foreign body infection and those without foreign body infection. In multivariable analysis, subjects infected with a MRSA isolate producing moderate/strong in vitro biofilm were more likely to have a history of MRSA infection in the last year (OR=3.41 [1.23-9.43]), interval between foreign body implantation and MRSA BSI <18 months (OR=3.1 [1.05-9.2]) and ST8 (OR=10.64 [2-57.3]). Conclusion Most factors associated with foreign body infection in MRSA BSI were also characteristic of persistent infections. Biofilm-forming isolates were not associated with a higher risk of foreign-body infection but appeared to be associated with MRSA genetic lineage, especially ST8.
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Affiliation(s)
- Kevin Bouiller
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Université de Franche-Comté, CHU Besançon, UMR-CNRS 6249 Chrono-environnement, Department of Infectious and Tropical Diseases, Besançon, France
| | - Natasia F Jacko
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Margot J Shumaker
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Brooke M Talbot
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Timothy D Read
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Duployez C, Millière L, Senneville E, Piantoni L, Migaud H, Wallet F, Loïez C. Evolution of antibiotic susceptibility profiles of staphylococci from osteoarticular infections: A 10-year retrospective study. Orthop Traumatol Surg Res 2023; 109:103512. [PMID: 36528264 DOI: 10.1016/j.otsr.2022.103512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/12/2022] [Accepted: 10/17/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Knowledge of the antibiotic susceptibility profiles of the bacteria responsible for osteoarticular infections is crucial for choosing the appropriate empirical antibiotic regimen. Wide use of broad spectrum antibiotics in these infections may have lead to selection of resistant bacteria. The aim of our study was to answer to these questions: (1) Did the bacterial pathogens isolated from osteoarticular infections (OAIs) and their antibiotic susceptibility profile change over the 10-year period in our University Hospital, particularly for Staphylococcus aureus and Coagulase negative staphylococci? (2) Are the antibiotics used for post-operative antibiotic therapy still effective against staphylococci involved in OAIs? (3) Are the antibiotics used for documented therapy still effective against staphylococci involved in OAIs? HYPOTHESIS We hypothetise that bacterial epidemiology and antibiotic resistance rates have changed little thanks to a reasoned prescription of antibiotics in our Center. MATERIALS AND METHODS We performed a retrospective study describing the antibiotic susceptibility profile of bacteria isolated from osteoarticular infections over 10years in our University Hospital, with a focus on the Staphylococcus genus. RESULTS A total of 3474 staphylococci were included (2373 coagulase negative staphylococci and 1101 S. aureus), 34.8% (1207/3469) of which were resistant to methicillin. Antibiotic susceptibility profiles remained quite stable between 2010 and 2019, except for rifampicin (14.1% (45/318) versus 5.7% (23/401), p=0.0001) and fluoroquinolones (35.3% (109/309) versus 20.3% (81/399), p=0.000008) for which resistance rates significantly decreased even among methicillin-resistant strains. DISCUSSION In spite of wide use of antibiotics in orthopaedic units, overall resistance rates did not increase over the last 10years. The prescription of these molecules in combination regimens guided by the antibiotic susceptibility patterns performed on reliable samples and on the basis of multidisciplinary discussions may explain these results. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Claire Duployez
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France; University Hospital of Lille, 59037 Lille, France.
| | - Laurine Millière
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France
| | - Eric Senneville
- University Hospital of Lille, 59037 Lille, France; Infectious Diseases Department, Gustave Dron Hospital, Rue du Président Coty, 59200 Tourcoing, France
| | - Luc Piantoni
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France
| | - Henri Migaud
- Orthopaedic Department, Lille University Hospital, Hôpital Salengro, Rue Emile Laine, 59037 Lille, France
| | - Frédéric Wallet
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France
| | - Caroline Loïez
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France
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Hervochon C, Hennart B, Leroy AG, Corvec S, Boutoille D, Senneville É, Sotto A, Illes G, Chavanet P, Dubée V, Bleibtreu A, De Carné MC, Talarmin JP, Revest M, Castan B, Bellouard R, Dailly É, Allorge D, Dinh A, Le Turnier P, Gregoire M. Dalbavancin plasma concentrations in 133 patients: a PK/PD observational study. J Antimicrob Chemother 2023; 78:2919-2925. [PMID: 37864551 DOI: 10.1093/jac/dkad331] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023] Open
Abstract
OBJECTIVES Limited pharmacokinetics data support dalbavancin long-term use in off-label indications and the optimal dosing regimen is debated. We aimed to describe dalbavancin concentrations in an observational retrospective multicentre study. METHODS Patients from 13 French hospitals, treated with 1500 mg doses of dalbavancin and for whom therapeutic drug monitoring was performed from June 2018 to March 2021 were included. Dalbavancin plasma concentrations were described at peak and 1, 2, 3, 4, 6 and 8 weeks after the last 1500 mg dose. Concentrations in patients weighing more or less than 75 kg and with a GFR greater or less than 60 mL/min were compared. Microbiological data were collected and dalbavancin MIC was measured when possible. RESULTS One hundred and thirty-three patients were included (69% treated for bone and joint infections, 16% for endocarditis). Thirty-five patients received a single dose of dalbavancin and 98 received several administrations. Two, 3 and 4 weeks after the last dose, median plasma concentrations were respectively 25.00, 14.80 and 9.24 mg/L for the first doses and 34.55, 22.60 and 19.20 mg/L for the second or subsequent doses. Weight and renal function had an impact on pharmacokinetics. Infection was documented in 105 patients (Staphylococcus spp. in 68% of cases). Staphylococcus aureus was isolated in 32.5% of cases (median MIC: 0.047 mg/L) and Staphylococcus epidermidis in 27% of cases (median MIC of 0.047 mg/L). CONCLUSIONS Plasma concentrations of dalbavancin were consistent with those described in clinical trials and those sought during the industrial development of the molecule.
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Affiliation(s)
- Charles Hervochon
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique, 9 quai Moncousu 44093, F-44000 Nantes, France
| | - Benjamin Hennart
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59037 Lille, France
| | - Anne-Gaëlle Leroy
- Nantes Université, CHU Nantes, INCIT 1302, Service de Bactériologie et Contrôles Microbiologiques, F-44000 Nantes, France
- Laboratoire de Microbiologie, CHU Sud Réunion, Saint-Pierre, La Réunion, France
| | - Stéphane Corvec
- Nantes Université, CHU Nantes, INCIT 1302, Service de Bactériologie et Contrôles Microbiologiques, F-44000 Nantes, France
| | - David Boutoille
- Nantes Université, CHU Nantes, INSERM, Service de Maladies Infectieuses et Tropicales, CIC 1413, F-44000 Nantes, France
| | - Éric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Albert Sotto
- Infectious Diseases Department, Nîmes University Hospital, Nîmes, France
| | - Gabriella Illes
- Infectious Disease Unit, Hospital of Mont-de-Marsan, Mont-de-Marsan, France
| | - Pascal Chavanet
- Infectious Diseases Department, Dijon University Hospital, Dijon, France
| | - Vincent Dubée
- Department of Infectious Diseases, University Hospital of Angers, Angers, France
| | - Alexandre Bleibtreu
- Department of Infectious and Tropical Diseases, Sorbonne Université, Pitié-Salpêtrière hospital, Assistance Publique-Hôpitaux de Paris, Emergence and diffusion of multiple resistance against antibiotics, CIMI, INSERM U1135, Paris, France
| | - Marie-Charlotte De Carné
- Service de Maladies Infectieuses et Tropicales - Médecine Interne, CH Versailles André Mignot, Le Chesnay, France
| | | | - Matthieu Revest
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France
| | - Bernard Castan
- Département de Maladies infectieuses et Tropicales, CHG, 24000 Périgueux, France
| | - Ronan Bellouard
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique, 9 quai Moncousu 44093, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, F-44000 Nantes, France
| | - Éric Dailly
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique, 9 quai Moncousu 44093, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, F-44000 Nantes, France
| | - Delphine Allorge
- CHU Lille, Unité Fonctionnelle de Toxicologie, F-59037 Lille, France
| | - Aurélien Dinh
- Infectious Disease Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Paul Le Turnier
- Nantes Université, CHU Nantes, INSERM, Service de Maladies Infectieuses et Tropicales, CIC 1413, F-44000 Nantes, France
- Infectious Diseases Department, Cayenne Hospital, Cayenne, French Guiana
| | - Matthieu Gregoire
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique, 9 quai Moncousu 44093, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR 1155, F-44000 Nantes, France
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9
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Blersch BP, Barthels M, Schuster P, Fink B. A Low Rate of Periprosthetic Infections after Aseptic Knee Prosthesis Revision Using Dual-Antibiotic-Impregnated Bone Cement. Antibiotics (Basel) 2023; 12:1368. [PMID: 37760665 PMCID: PMC10525338 DOI: 10.3390/antibiotics12091368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
AIM The incidence of periprosthetic joint infections (PJI) following aseptic knee revision arthroplasty lies between 3% and 7.5%. The aim of this study was to verify the hypothesis that the use of dual-antibiotic-impregnated cement in knee revision arthroplasty leads to a lower rate of periprosthetic joint infections. METHODS We retrospectively reviewed 403 aseptic revision knee arthroplasties performed between January 2013 and March 2021 (148 revisions of a unicompartmental prosthesis, 188 revisions of a bicondylar total knee arthroplasty (TKA), 41 revisions of an axis-guided prosthesis, and 26 revisions of only one component of a surface replacement prosthesis). The bone cement Copal G+C (Heraeus Medical, Wertheim, Germany) with two antibiotics-gentamycin and clindamycin-was used for the fixation of the new implant. The follow-up period was 53.4 ± 27.9 (4.0-115.0) months. RESULTS Five patients suffered from PJI within follow-up (1.2%). The revision rate for any reason was 8.7%. Survival for any reason was significantly different between the types of revision (p = 0.026, Log-Rank-test), with lower survival rates after more complex surgical procedures. The 5-year survival rate with regard to revision for any reason was 91.3% [88.2-94.4%] and with regard to revision for PJI 98.2% [98.7-99.9%], respectively. CONCLUSION The use of the dual-antibiotic-impregnated bone cement Copal G+C results in a lower rate of periprosthetic infections after aseptic knee prosthesis replacement than that reported in published prosthesis revisions using only one antibiotic in the bone cement.
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Affiliation(s)
- Benedikt Paul Blersch
- Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; (B.P.B.); (M.B.); (P.S.)
| | - Michael Barthels
- Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; (B.P.B.); (M.B.); (P.S.)
| | - Philipp Schuster
- Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; (B.P.B.); (M.B.); (P.S.)
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Prof. Ernst Nathan Straße 1, 90419 Nuremberg, Germany
| | - Bernd Fink
- Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; (B.P.B.); (M.B.); (P.S.)
- Orthopaedic Department, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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10
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Coustillères F, Renault V, Corvec S, Dupieux C, Simões PM, Lartigue MF, Plouzeau-Jayle C, Tande D, Lamoureux C, Lemarié C, Chenouard R, Laurent F, Lemaignen A, Bémer P. Clinical, Bacteriological, and Genetic Characterization of Bone and Joint Infections Involving Linezolid-Resistant Staphylococcus epidermidis: a Retrospective Multicenter Study in French Reference Centers. Microbiol Spectr 2023; 11:e0419022. [PMID: 37133395 PMCID: PMC10269892 DOI: 10.1128/spectrum.04190-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/09/2023] [Indexed: 05/04/2023] Open
Abstract
The choice of the best probabilistic postoperative antibiotics in bone and joint infections (BJIs) is still challenging. Since the implementation of protocolized postoperative linezolid in six French referral centers, linezolid-resistant multidrug-resistant Staphylococcus epidermidis (LR-MDRSE) strains were isolated in patients with BJI. We aimed here to describe clinical, microbiological, and molecular patterns associated with these strains. All patients with at least one intraoperative specimen positive for LR-MDRSE between 2015 and 2020 were included in this retrospective multicenter study. Clinical presentation, management, and outcome were described. LR-MDRSE strains were investigated by MIC determination for linezolid and other anti-MRSA antibiotics, characterization of genetic determinants of resistance, and phylogenetic analysis. Forty-six patients (colonization n = 10, infection n = 36) were included in five centers, 45 had prior exposure to linezolid, 33 had foreign devices. Clinical success was achieved for 26/36 patients. Incidence of LR-MDRSE increased over the study period. One hundred percent of the strains were resistant to oxazolidinones, gentamicin, clindamycin, ofloxacin, rifampicin, ceftaroline, and ceftobiprole, and susceptible to cyclins, daptomycin, and dalbavancin. Susceptibility to delafloxacin was bimodal. Molecular analysis was performed for 44 strains, and the main mutation conferring linezolid resistance was the 23S rRNA G2576T mutation. All strains belonged to the sequence type ST2 or its clonal complex, and phylogenetic analysis showed emergence of five populations corresponding geographically to the centers. We showed the emergence of new clonal populations of highly linezolid-resistant S. epidermidis in BJIs. Identifying patients at risk for LR-MDRSE acquisition and proposing alternatives to systematic postoperative linezolid use are essential. IMPORTANCE The manuscript describes the emergence of clonal linezolid-resistant strains of Staphylococcus epidermidis (LR-MDRSE) isolated from patients presenting with bone and joint infections. Incidence of LR-MDRSE increased over the study period. All strains were highly resistant to oxazolidinones, gentamicin, clindamycin, ofloxacin, rifampicin, ceftaroline, and ceftobiprole, but were susceptible to cyclins, daptomycin, and dalbavancin. Susceptibility to delafloxacin was bimodal. The main mutation conferring linezolid resistance was the 23S rRNA G2576T mutation. All strains belonged to the sequence type ST2 or its clonal complex, and phylogenetic analysis showed emergence of five populations corresponding geographically to the centers. LR-MDRSE bone and joint infections seem to be accompanied by an overall poor prognosis related to comorbidities and therapeutic issues. Identifying patients at risk for LR-MDRSE acquisition and proposing alternatives to systematic postoperative linezolid use become essential, with a preference for parenteral drugs such as lipopeptids or lipoglycopeptids.
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Affiliation(s)
- François Coustillères
- Service des Maladies Infectieuses, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
| | - Victor Renault
- Service de Bactériologie et des Contrôles microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Nantes, France
| | - Stéphane Corvec
- Service de Bactériologie et des Contrôles microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Nantes, France
| | - Céline Dupieux
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Bactériologie, Centre National de Référence des Staphylocoques, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOAC Lyon), France
| | - Patricia Martins Simões
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Bactériologie, Centre National de Référence des Staphylocoques, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOAC Lyon), France
| | - Marie Frédérique Lartigue
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
| | - Chloé Plouzeau-Jayle
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Poitiers, France
| | - Didier Tande
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Brest, France
| | - Claudie Lamoureux
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Brest, France
| | - Carole Lemarié
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Angers, France
| | - Rachel Chenouard
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Angers, France
| | - Frédéric Laurent
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Bactériologie, Centre National de Référence des Staphylocoques, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOAC Lyon), France
| | - Adrien Lemaignen
- Service des Maladies Infectieuses, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
| | - Pascale Bémer
- Service de Bactériologie et des Contrôles microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Nantes, France
| | - the CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest) Study Team
- Service des Maladies Infectieuses, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
- Service de Bactériologie et des Contrôles microbiologiques, Hôtel-Dieu, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Nantes, France
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Bactériologie, Centre National de Référence des Staphylocoques, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOAC Lyon), France
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Régional Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Tours, France
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Poitiers, France
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Brest, France
- Service de Bactériologie et d’Hygiène, Centre Hospitalier Universitaire, Centre Régional de Référence pour la prise en charge des IOA complexes (CRIOGO), Angers, France
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11
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Serrier H, Huot L, Brosset S, Batailler C, Ferry T. Cost-effectiveness of a bone substitute delivering gentamicin in the treatment of chronic osteomyelitis of long bones: Protocol for the CONVICTION randomized multicenter study. Front Med (Lausanne) 2023; 10:1116711. [PMID: 37064036 PMCID: PMC10101228 DOI: 10.3389/fmed.2023.1116711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionChronic osteomyelitis is a serious osteoarticular infection that most often occurs in the long bones, responsible for significant morbidity with the risk of fracture and amputation. Despite advances in both antibiotics and surgical treatment, the probability of recurrence of infection remains at around 20%. Cerament-G (BONESUPPORT AB, Sweden) is a synthetic bone substitute that fills the bone void left by surgery, prevents infection and promotes bone regeneration within this space. Cerament-G also provides the local delivery of high doses of gentamicin over several weeks. Two prospective observational studies described a number of infectious recurrences of 4 and 5% after the use of Cerament-G. Although available in France, Cerament-G is currently not reimbursed and its high cost constitutes a barrier to its use. We hypothesize that the use of Cerament-G will lead to fewer costs to the collectivity while improving patient utility and, as an innovative strategy, will be superior to standard of care on recurrence of infection.Methods and analysisThe Conviction Study is a prospective, multicenter, randomized, single blind study conducted in 14 French Reference Centers for Complex Osteoarticular infections. The main objective is to evaluate the cost-effectiveness of using Cerament-G in the treatment of chronic long bone osteomyelitis by comparing this innovative strategy to standard of care. A cost-utility analysis from the collective perspective will be conducted over a 24-month time horizon after the initial surgery. The outcome for the main medico-economic evaluation will be Quality Adjusted Life Years (QALYs).DiscussionThe study is being conducted throughout the CRIOAc network in France, in referral centers for the management of complex infections which will facilitate patient recruitment. This study has several limitations: the investigators have to be trained to handle the device, and it was impossible to blind the surgeon.ConclusionIf the use of Cerament-G is demonstrated to be superior to leaving the dead space empty during surgery for patients with stage III chronic long bone osteomyelitis, its use will be recommended to improve the prognosis of such patients, and this device may eventually qualify for reimbursement through the French Health Insurance scheme.Ethics and disseminationThis protocol received authorization from the Ethics Committee CPP Sud Méditerranée V on April 27, 2021 (21.03.10.77652) and the French National Agency for Medicines and Health Products on May 6, 2021 (2020-A02299-30). Results will be disseminated to the scientific community through congresses and publication in peer-reviewed journals.
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Affiliation(s)
- Hassan Serrier
- Health Economic Evaluation Service, Hospices Civils de Lyon, Lyon, France
- *Correspondence: Hassan Serrier,
| | - Laure Huot
- Health Economic Evaluation Service, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Research on Healthcare Performance RESHAPE, Lyon, France
| | - Sophie Brosset
- Centre interrégional de référence pour la prise en charge des infections ostéoarticulaires complexes, CRIOAc Lyon, Hospices Civils de Lyon, Lyon, France
- Department of Plastic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cécile Batailler
- Centre interrégional de référence pour la prise en charge des infections ostéoarticulaires complexes, CRIOAc Lyon, Hospices Civils de Lyon, Lyon, France
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, Bron, France
| | - Tristan Ferry
- Centre interrégional de référence pour la prise en charge des infections ostéoarticulaires complexes, CRIOAc Lyon, Hospices Civils de Lyon, Lyon, France
- Infectious Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- CIRI–Centre International de Recherche en Infectiologie, Inserm, Université́ Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
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12
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Meyer-Schwickerath C, Jochimsen D, Jung N. [Update bone infections]. Dtsch Med Wochenschr 2023; 148:313-317. [PMID: 36878230 DOI: 10.1055/a-1853-4777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Bone and joint infections are becoming of great concern in an elderly population with growing numbers of prosthetic joints and comorbidities. This paper summarizes recently published literature on periprosthetic joint infections, vertebral osteomyelitis and diabetic foot infections. According to a new study, in the presence of a hematogenous periprosthetic infection and other inserted joint prostheses that are unremarkable on clinical examination, further invasive or imaging diagnostics may not be necessary. Periprosthetic infections that occur late (> 3 months after joint installation) have a worse outcome. New studies tried to identify factors when prosthesis preservation might still be an option. A new randomized landmark trial from France failed to show non-inferiority for 6 versus 12 weeks of therapy length. Thus, it can be assumed that this will currently become the standard therapy length for all surgical modalities (retention or replacement). Vertebral osteomyelitis is a rather rare bone infection, but the incidence has continued to rise sharply in recent years. A retrospective study from Korea provides information on the distribution of pathogens in different age groups and with selected comorbidities; this could help in the selection of an empiric therapy when pathogen identification is not successful before starting the treatment. The guidelines by the "International Working Group on the Diabetic Foot (IWGDF)" have been updated with a slightly different classification. New practice recommendations of the German society of diabetology emphasize an early interdisciplinary interprofessional management. Empirical therapy continues to be based on the severity of the infection and other risk factors (such as previous therapies or ischemia). Microbiological diagnosis from tissue samples is described as superior to smears. According to a randomized pilot study, 3 weeks therapy length for osteomyelitis after debridement appears to be noninferior to 6 weeks.
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Affiliation(s)
| | - Dorothee Jochimsen
- Klinik I für Innere Medizin, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln
| | - Norma Jung
- Klinik I für Innere Medizin, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln
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13
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Sun L, Zhuang H, Di L, Ling X, Yin Y, Wang Z, Chen M, Jiang S, Chen Y, Zhu F, Wang H, Ji S, Sun L, Wu D, Yu Y, Chen Y. Transmission and microevolution of methicillin-resistant Staphylococcus aureus ST88 strain among patients, healthcare workers, and household contacts at a trauma and orthopedic ward. Front Public Health 2023; 10:1053785. [PMID: 36699930 PMCID: PMC9868773 DOI: 10.3389/fpubh.2022.1053785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Surgical sites infections (SSIs) caused by Methicillin-resistant Staphylococcus aureus (MRSA) constitute a major clinical problem. Understanding the transmission mode of MRSA is important for its prevention and control. Aim We investigated the transmission mode of a MRSA outbreak in a trauma and orthopedic hospital ward. Methods Clinical data were collected from patients (n = 9) with MRSA infection in a trauma and orthopedic ward from January 1, 2015 to December 31, 2019. The wards (n = 18), patients (n = 48), medical staff (n = 23), and their households (n = 5) were screened for MRSA. The transmission mode of MRSA isolates was investigated using next-generation sequencing and phylogenetic analyses. The resistance genes, plasmids, and single-nucleotide variants of the isolates were analyzed to evaluate microevolution of MRSA isolates causing SSIs. The MRSA colonization-positive doctor was asked to suspend his medical activities to stop MRSA spread. Findings Nine MRSA infected patients were investigated, of which three patients were diagnosed with SSI and had prolonged hospitalization due to the persistent MRSA infection. After screening, MRSA isolates were not detected in environmental samples. The surgeon in charge of the patients with SSI caused by MRSA and his son were positive for MRSA colonization. The MRSA from the son was closely related to the isolates detected in MRSA-induced SSIs patients with 8-9 single-nucleotide variants, while ST88-MRSA isolates with three different spa types were detected in the surgeon's nasal cavity. Comparative genomic analysis showed that ST88-MRSA isolates acquired mutations in genes related to cell wall synthesis, colonization, metabolism, and virulence during their transmission. Suspending the medical activity of this surgeon interrupted the spread of MRSA infection in this ward. Conclusion Community-associated MRSA clones can invade hospitals and cause severe postoperative nosocomial infections. Further MRSA surveillance in the households of health workers may prevent the transition of MRSA from colonization to infection.
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Affiliation(s)
- Long Sun
- Department of Clinical Laboratory, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Zhejiang, China
| | - Hemu Zhuang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingfang Di
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Department of Clinical Laboratory, Tongxiang First People's Hospital, Tongxiang, Zhejiang, China
| | - Xia Ling
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Blood Center of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yiping Yin
- Hospital Infection Control Office, Hospital of Zhejiang People's Armed Police, Zhejiang, China
| | - Zhengan Wang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengzhen Chen
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shengnan Jiang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiyi Chen
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feiteng Zhu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiping Wang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shujuan Ji
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Sun
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dandan Wu
- Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Yunsong Yu ✉
| | - Yan Chen
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China,Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,*Correspondence: Yan Chen ✉
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14
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Tresson P, Valour F, Millon A. Arterial and Vascular Graft Infections: Stressing the Need for Dedicated Multidisciplinary Reference Centers. Ann Vasc Surg 2022; 87:e1-e2. [PMID: 36058462 DOI: 10.1016/j.avsg.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Philippe Tresson
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Chirurgie Vasculaire et Endovasculaire, Bron Cedex, France; Centre de Référence des Infections Vasculaire Complexes (CRIVasc Network), Lyon Cedex, France
| | - Florent Valour
- Centre de Référence des Infections Vasculaire Complexes (CRIVasc Network), Lyon Cedex, France; Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Unité des Maladies Infectieuses et Tropicales, Lyon Cedex, France; Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, France; Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Antoine Millon
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Chirurgie Vasculaire et Endovasculaire, Bron Cedex, France; Centre de Référence des Infections Vasculaire Complexes (CRIVasc Network), Lyon Cedex, France; Université Claude Bernard Lyon 1, Villeurbanne, France
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15
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Saade A, Urvoy JM, Luque Paz D, Baldeyrou M, Common H, Ropars M, Tattevin P, Jolivet-Gougeon A, Arvieux C. Microbiology and antibiotics after second-stage revision of periprosthetic joint infections: A two-year follow-up cohort. Infect Dis Now 2022; 52:358-364. [DOI: 10.1016/j.idnow.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
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16
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Romanò CL, Tsantes AG, Papadopoulos DV, Tsuchiya H, Benzakour T, Benevenia J, Del Sel H, Drago L, Mavrogenis AF. Infectious disease specialists and teamwork strategies worldwide: the World Association against Infection in Orthopedics and Trauma (WAIOT) and SICOT continue to cooperate in fighting musculoskeletal infections. SICOT J 2022; 8:E1. [PMID: 35969121 PMCID: PMC9377213 DOI: 10.1051/sicotj/2022031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Abstract
Bone and joint infections are associated with a devastating global burden. The successful treatment of these infections requires a multidisciplinary approach between orthopedic surgeons and experts of different disciplines. This multidisciplinary approach has gained ground over the past decades in modern infection units as a more effective treatment strategy, yielding better outcomes regarding infection eradication rates, length of hospital stay, and overall cost of treatments. Additionally, preventing and managing musculoskeletal infections requires strong connections between medical associations, biological laboratories, and the pharmaceutical industry worldwide. In this context, SICOT and World Association against Infection in Orthopaedics and Trauma (WAIOT) relationships have been increasing. The present editorial article discusses the multidisciplinary approach for managing bone and joint infections worldwide, explores the controversies in practices in terms of training, area of expertise, and extent of clinical involvement, and emphasizes the role of societies in research, prevention and management of musculoskeletal infections. The purpose is to acknowledge what orthopedics can obtain from specialists dealing with bone and joint infections and to consolidate their practice to provide the best care for orthopedic patients.
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Affiliation(s)
- Carlo L Romanò
- Studio Medico Cecca-Romano - Corso Venezia, 20121 Milano, Italy
| | - Andreas G Tsantes
- Department of Microbiology, Saint Savvas Oncology Hospital, 115 22 Athens, Greece
| | | | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery - Graduate School of Medical Sciences, Kanazawa University, 920-0293 Kanazawa, Japan
| | | | - Joseph Benevenia
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Hernán Del Sel
- Department of Orthopaedics, British Hospital Buenos Aires, C1280 AEB Buenos Aires, Argentina
| | - Lorenzo Drago
- Clinical Microbiology, University of Milan, 20122 Milano, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Greece
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17
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Prophylactic Antibiofilm Activity of Antibiotic-Loaded Bone Cements against Gram-Negative Bacteria. Antibiotics (Basel) 2022; 11:antibiotics11020137. [PMID: 35203740 PMCID: PMC8868455 DOI: 10.3390/antibiotics11020137] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
Gram-negative bacilli can be responsible for prosthetic joint infection (PJI) even if staphylococci are the main involved pathogens. Gram-negative PJIs (GN-PJI) are considered difficult-to-treat infections due to the increase in antimicrobial resistance and biofilm formation. To minimize the risk of infection in cases of arthroplasties with cemented prosthesis, bone cement can be loaded with antibiotics, especially gentamicin. In this study, we aimed to compare the prophylactic antibiofilm activity of ready-to-use antibiotic-loaded bone cements (ALBC), already commercialized or new prototypes. We compared ALBCs containing gentamicin alone, gentamicin plus vancomycin, gentamicin plus clindamycin, gentamicin plus Fosfomycin, and fosfomycin alone, to plain cement (no antibiotic); these comparisons were conducted to investigate the biofilm formation of three strains of Escherichia coli, three strains of Pseudomonas aeruginosa and two strains of Klebsiella pneumoniae, with or without specific resistance to gentamicin or fosfomycin. We reported that ALBC containing gentamicin and clindamycin (COPAL G+C) seems to be the most interesting ALBC of our tested panel for the prevention of biofilm formation by gentamicin-susceptible strains, even if clindamycin is not effective against Gram-negative bacteria. However, gentamicin-resistant strains are still a problem, and further studies are needed to identify an antibiotic to associate with gentamicin for an efficient dual ALBC against Gram-negative bacteria.
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18
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Pham TT, Mabrut E, Cochard P, Chardon P, Serrier H, Valour F, Huot L, Tod M, Leboucher G, Chidiac C, Ferry T. Cost of off-label antibiotic therapy for bone and joint infections: a 6-year prospective monocentric observational cohort study in a referral centre for management of complex osteo-articular infections. J Bone Jt Infect 2021; 6:337-346. [PMID: 34513571 PMCID: PMC8428084 DOI: 10.5194/jbji-6-337-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/25/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction:
Costs related to bone and joint infection (BJI) management are increasing
worldwide, particularly due to the growing use of off-label antibiotics that are expensive treatments (ETs), in conjunction with increasing incidence of multi-drug-resistant pathogens. The aim of this study was to evaluate the whole costs related to these treatments during the patient route, including those attributed to the rehabilitation centre (RC) stay in one regional referral centre in France. The total annual cost of ETs for managing complex BJIs in France was then estimated. Material and methods:
A prospective monocentric observational study was conducted from 2014 to 2019 in a referral centre for BJI management (CRIOAc – Centre de Référence des Infections OstéoArticulaires complexes). Costs related to expensive treatments (“old” ETs, i.e. ceftaroline, ertapenem, daptomycin, colistin, tigecycline, and linezolid and “new” ETs, defined as those used since 2017, including ceftobiprole, ceftazidime-avibactam, ceftolozane-tazobactam, tedizolid, and dalbavancin) were prospectively recorded. In all cases, the use of these ETs was validated during multidisciplinary meetings. Results:
Of the 3219 patients treated, 1682 (52.3 %) received at least one ET, and 21.5 % of patients who received ET were managed in RCs. The overall cost of ETs remained high but stable (EUR 1 033 610 in 2014; EUR 1 129 862 in 2019), despite the increase of patients treated by ETs (from 182 in 2014 to 512 in 2019) and in the cumulative days of treatment (9739 to 16 191 d). Daptomycin was the most prescribed molecule (46.2 % of patients in 2014 and 56.8 % in 2019, with 53.8 % overall), but its cost has decreased since this molecule was genericized in 2018; the same trend was observed for linezolid. Thus, costs for old ETs decreased overall, from EUR 1 033 610 in 2014 to EUR 604 997 in 2019, but global costs remained stable due to new ET utilization accounting for 46.5 % of overall costs in 2019. Tedizolid, used as suppressive antimicrobial therapy, represented 77.5 % of total new ET costs. In our centre, dalbavancin was never used. The cost paid by RCs for ETs and the duration of ET remained stable overall between 2016 and 2019. Conclusions:
A high consumption of off-label ET is required to treat patients with BJIs in a CRIOAc, and the consequence is a high cost of antimicrobial therapy for these patients, estimated to be almost EUR 10 million in France annually. Costs associated with ET utilization remained stable over the years. On the one hand, the introduction of the generic drugs of daptomycin and linezolid has significantly decreased the share of old ETs, but, on the other hand, the need for new ETs to treat infections associated with more resistant pathogens has not led to decrease in the overall costs. A drastic price reduction of generic drugs is essential to limit the costs associated with more complex BJIs.
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Affiliation(s)
- Truong-Thanh Pham
- Infectious Diseases Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 69004 Lyon, France.,French Referral Centre for complex Bone and Joint Infections, CRIOAc Lyon, 69000 Lyon, France.,Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Eugénie Mabrut
- French Referral Centre for complex Bone and Joint Infections, CRIOAc Lyon, 69000 Lyon, France
| | - Philippe Cochard
- Hauteville Public Hospital Centre, 01110 Hauteville-Lompnes, France
| | - Paul Chardon
- Val Rosay Rehabilitation Centre, 69370 Saint-Didier-Au-Mont-d'Or, France
| | - Hassan Serrier
- Pôle de Santé publique, Hospices Civils de Lyon, 69003 Lyon, France.,Cellule Innovation, Département de la Recherche Clinique et de l'innovation, Hospices Civils de Lyon, 69003 Lyon, France
| | - Florent Valour
- Infectious Diseases Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 69004 Lyon, France.,French Referral Centre for complex Bone and Joint Infections, CRIOAc Lyon, 69000 Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 69007 Lyon, France
| | - Laure Huot
- Pôle de Santé publique, Hospices Civils de Lyon, 69003 Lyon, France.,Cellule Innovation, Département de la Recherche Clinique et de l'innovation, Hospices Civils de Lyon, 69003 Lyon, France
| | - Michel Tod
- Service de Pharmacie, Hospices Civils de Lyon, Lyon, France
| | | | - Christian Chidiac
- Infectious Diseases Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 69004 Lyon, France.,French Referral Centre for complex Bone and Joint Infections, CRIOAc Lyon, 69000 Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 69007 Lyon, France
| | - Tristan Ferry
- Infectious Diseases Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 69004 Lyon, France.,French Referral Centre for complex Bone and Joint Infections, CRIOAc Lyon, 69000 Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 69007 Lyon, France
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19
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Sousa R, Carvalho A, Santos AC, Abreu MA. Optimal microbiological sampling for the diagnosis of osteoarticular infection. EFORT Open Rev 2021; 6:390-398. [PMID: 34267930 PMCID: PMC8246105 DOI: 10.1302/2058-5241.6.210011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Infection is a dire complication afflicting every field of orthopaedics and traumatology. If specific clinical, laboratory and imaging parameters are present, infection is often assumed even in the absence of microbiological confirmation. However, apart from confirming infection, knowing the exact infecting pathogen(s) and their antimicrobial susceptibility patterns is paramount to help guide treatment. Every effort should therefore be undertaken with that goal in mind.Not all microbiological findings carry the same relevance, and knowing exactly how and where a sample was collected is key. Several different sampling techniques are available, and one must be aware of both advantages and limitations. Microbiological sampling alternatives in some of the most common clinical scenarios such as native and prosthetic joint infections, osteomyelitis and fracture-related infections, spinal and diabetic foot infections will be discussed.Orthopaedic surgeons should also be aware of basic laboratory sample processing techniques as they have a direct impact on the way specimens should be dealt with and transported to the laboratory. Only by knowing these basic principles will surgeons be able to participate in the multidisciplinary discussion and decision making around how to interpret microbiological findings in each specific patient. Cite this article: EFORT Open Rev 2021;6:390-398. DOI: 10.1302/2058-5241.6.210011.
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Affiliation(s)
- Ricardo Sousa
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude, Portugal
| | - André Carvalho
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Cláudia Santos
- Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude, Portugal.,Department of Microbiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Araújo Abreu
- Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude, Portugal.,Department of Microbiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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20
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Intra-Articular Injections Prior to Total Knee Arthroplasty Do Not Increase the Risk of Periprosthetic Joint Infection: A Prospective Cohort Study. Antibiotics (Basel) 2021; 10:antibiotics10030330. [PMID: 33801092 PMCID: PMC8004162 DOI: 10.3390/antibiotics10030330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 01/28/2023] Open
Abstract
Periprosthetic joint infections (PJI) occur in 0.5 to 2.8% of total knee arthroplasties (TKA) and expose them to an increase of morbidity and mortality. TKA are mainly performed after failure of non-surgical management of knee osteoarthritis, which frequently includes intra-articular injections of corticosteroids or hyaluronic acid. Concerning the potential impact of intra-articular injections on TKA infection, literature provides a low level of evidence because of the retrospective design of the studies and their contradictory results. In this prospective cohort study, we included patients after a total knee arthroplasty, at the time of their admission in a rehabilitation center, and we excluded patients with any prior knee surgery. 304 patients were included. Mean follow-up was 24.9 months, and incidence proportion of PJI was 2.6%. After multivariate logistic regression, male was the only significant risk factor of PJI (OR = 19.6; p = 0.006). The incidence of PJI did not differ between patients who received prior intra-articular injections and others, especially regarding injections in the last 6 months before surgery. The use of intra-articular injection remains a valid therapeutic option in the management of knee osteoarthritis, and a TKA could still be discussed.
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