Infections à Staphylococcus aureus résistants à la méticilline communautaires

Surgery's role in contemporary osteoarticular infection management

The treatment paradigm for osteoarticular infections (OAIs) has changed drastically over the past 80 years, from the advent of penicillin to the use of broad-spectrum antibiotics. Before these drugs, surgery was the only available treatment for OAIs; today, antibiotic therapy is considered the primary response to them. As a result, surgical treatment of OAIs is thus far more rarely indicated, sometimes even considered outdated and obsolete. However, long experience has taught us that many OAI contexts can still benefit from surgical management, constituting an essential complement to medical treatment. The present article seeks to contextualize this discussion by providing a chronological review of the surgical treatments used in cases of OAI and describing the quality of evidence supporting their rehabilitation in well-established situations.

Late sequelae of osteoarticular infections in pediatric patients: A single-center study

To review the orthopedic sequelae of pediatric patients diagnosed with osteoarticular infections (OAIs) and identify significant differences between those with and without sequelae. Medical charts between 2010 and 2016 from a tertiary-care pediatric hospital were reviewed to collect demographic and clinical data for this retrospective case series. The main inclusion criteria were: 1. age (≤10 years old); 2. absence of sickle cell anemia and immunocompromising disease or medication; 3. a minimum follow-up of 12 months with radiographs; and 4. diagnosis of osteomyelitis of long bones and/or septic arthritis. The following late sequelae were observed and aggregated: osteal deformations that led to limb-length discrepancies (LLD) superior to 5 mm, abnormal articular angulations of more than 5°, and symptomatic chondropathies visible on imaging studies after 1 year. The patients were divided into 2 subgroups: with and without sequelae. Chi-Squared tests were used for categorical variables and Mann–Whitney U tests for continuous data to identify statistically significant differences between the 2 subgroups. Among 401 patients with osteomyelitis and/or septic arthritis, 50 (12.5%) were included (24 girls and 26 boys). There were 36 (72%) cases of osteomyelitis, 8 (16%) cases of septic arthritis, and 6 (12%) cases of combined infection (3 acute/subacute and 3 chronic cases). Five (10%) patients had orthopedic sequelae at the latest follow-up. The total duration of antibiotic treatment (P = .002), infectious disease follow-up (P = .002), and the presence of sequestra (P = .005) were significantly different between subgroups. There were no statistically significant differences between the 2 subgroups for the other variables, but some trends could be discerned. Only 4/50 patients developed a sequestrum, 2 of which were in the orthopedic sequelae subgroup. Furthermore, initial C-reactive protein (CRP) values were higher in the sequelae subgroup, as were the CRP values at hospital discharge. The orthopedic follow-up was also longer in the sequelae subgroup. Finally, the delay between the onset of symptoms and the beginning of antibiotic treatment was longer in the sequelae group. Patients with orthopedic sequelae had a longer antibiotic treatment and infectious disease follow-up, and were more likely to have presented with a sequestrum. Level of evidence: IV – case series.

Amoxicillin-Clavulanic Acid Empirical Oral Therapy for the Management of Children with Acute Haematogenous Osteomyelitis

According to the Guidelines of the European Society of Pediatric Infectious Diseases (ESPID), in low methicillin-resistant Staphylococcus aureus (MRSA) prevalence settings, short intravenous therapy is recommended in uncomplicated cases of acute haematogenous osteomyelitis (AHOM), followed by empirical oral therapy, preferentially with first/second-generation cephalosporin or dicloxacillin or flucloxacillin. However, several practical issues may arise using some of the first-line antibiotics such as poor palatability or adherence problems. Clinical, laboratory and therapeutic data from children with AHOM hospitalized in one Italian Paediatric Hospital between 2010 and 2019 were retrospectively collected and analyzed. The aim of the study was to highlight the extent of the use and the possible role of amoxicillin-clavulanic acid in the oral treatment of children with AHOM. Two hundred and ten children were included. S.aureus was identified in 42/58 children (72.4% of identified bacteria); 2/42 S.aureus isolates were MRSA (4.8%). No Kingella kingae was identified. Amoxicillin-clavulanic acid was the most commonly used oral drug (60.1%; n = 107/178) and it was associated with clinical cure in all treated children. Overall, four children developed sequelae. One (0.9%) sequela occurred among the 107 children treated with amoxicillin-clavulanic acid. Our results suggest that amoxicillin-clavulanic acid might be an option for oral antibiotic therapy in children with AHOM.

Sequelae of pediatric osteoarticular infection

The epidemiology and diagnosis of osteoarticular infections (OAI) have changed considerably in recent years, partly due to the development of molecular biology. Kingella kingae is now recognized as the most frequent pathogen in children under 4 years of age, while methicillin-resistant Staphylococcus aureus (SA) has been increasingly reported. Although the clinical course of OAI is mostly benign, with shorter antibiotic regimens and simplified treatments, serious functional impairments and life-threatening complications can still occur, especially in case of delayed diagnosis or infection caused by Panton-Valentine leukocidin-producing strains of SA. Newborns and patients with sickle cell disease have greater risk of orthopaedic sequelae, which need to be detected and managed early. The main sequelae of osteomyelitis are angular limb deformity, due to partial growth arrest, and lower limb discrepancy. Therapeutic options are guided by the patient's age and predictions at maturity. The main complications of septic arthritis are joint stiffness and osteonecrosis. The procedures to consider are arthrodesis, joint reconstruction in immature children, and arthroplasty at the end of growth.

[Treatment of superficial bacterial cutaneous infections: a survey among general practitioners in France]

BACKGROUND

Superficial bacterial skin infection and superinfection of skin diseases are usually treated by general practitioners using antiseptics or antibiotics. However, acquired resistance to biocidal agents, both systemic and topical, is growing.

OBJECTIVES OF THE STUDY

Our aim was to assess the skill of GPs in clinical situations involving common skin infections.

MATERIAL AND METHODS

On 16 June 2010, we sent a questionnaire to all GPs in a rural region of France (the Cher department) together with a stamped addressed envelope for the reply. The questionnaire contained seven pages of multiple-choice questions and five clinical cases, each one illustrated with a photograph (sty, furuncle, whitlow, colonized chronic wounds and impetigo). Anonymity of responses was guaranteed. Data was analysed using the Clinsight(®) software package.

RESULTS

The response rate was 51% (102 responses). GPs reported little difficulty in treating these patients (median 3, range 1 to 8 on a scale of increasing difficulty from 0 to 10). The main results of the study are firstly the frequency of combination of at least one antiseptic with one antibiotic (46%); secondly, the frequency of combination of two antibiotics (20% of cases); thirdly, the frequent prescription of systemic antibiotics for chronic wounds colonized by Pseudomonas aeruginosa (61%).

DISCUSSION

Our study shows the high frequency of prescriptions for combined therapy to treat superficial skin infections despite the fact that monotherapy with either an antiseptic or an antibiotic would probably suffice. It also shows the unnecessary prescription of antibiotics for colonization of a chronic wound. The study was limited in terms of size and design: it was a questionnaire rather than an analysis of prescriptions actually made in "real life", and the response rate was 51%. In addition, aside from impetigo, for which randomised studies and recommendations were given, the other surface infections (sty, folliculitis, whitlow) tend to be treated more empirically.

CONCLUSION

Dissemination of recommendations regarding the respective role of antiseptics and antibiotics (and their route of administration, topical or systemic) in superficial skin infections would doubtless be useful for prescribers, and more rational use of these agents would help limit bacterial resistance.

Development of a multicomponent Staphylococcus aureus vaccine designed to counter multiple bacterial virulence factors

Staphylococcus aureus is a major cause of healthcare-associated infections and is responsible for a substantial burden of disease in hospitalized patients. Despite increasingly rigorous infection control guidelines, the prevalence and corresponding negative impact of S. aureus infections remain considerable. Difficulties in controlling S. aureus infections as well as the associated treatment costs are exacerbated by increasing rates of resistance to available antibiotics. Despite ongoing efforts over the past 20 years, no licensed S. aureus vaccine is currently available. However, learnings from past clinical failures of vaccine candidates and a better understanding of the immunopathology of S. aureus colonization and infection have aided in the design of new vaccine candidates based on multiple important bacterial pathogenesis mechanisms. This review outlines important considerations in designing a vaccine for the prevention of S. aureus disease in healthcare settings.