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Salvage procedure for chronic periprosthetic knee infection: the application of DAIR results in better remission rates and infection-free survivorship when used with topical degradable calcium-based antibiotics. Knee Surg Sports Traumatol Arthrosc 2020; 28:2823-2834. [PMID: 31321457 DOI: 10.1007/s00167-019-05627-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Debridement, systemic antibiotics and implant retention (DAIR) is very successful for early periprosthetic joint infection (PJI), but can fail in late-onset cases. We selected patients with PJI who were unsuitable for two-stage exchange total knee arthroplasty (TKA) and compared the outcomes of DAIR with or without degradable calcium-based antibiotics. METHODS All patients fulfilled the criteria for late-onset PJI of TKA, as defined by an International Consensus Meeting in 2013, but were unsuitable for multistage procedures and TKA exchange due to operative risk. Fifty-six patients (mean age: 70.6 years, SD ± 10.8), in two historical collectives, were treated using a single-stage algorithm consisting of DAIR without antibiotics (control group, n = 33, 2012-2014), or by DAIR following the implantation of degradable antibiotics as indicated by an antibiogram (intervention group, n = 23, 2014-2017). OSTEOSET® (admixed vancomycin/tobramycin), and HERAFILL-gentamicin® were used as carrier systems. The primary endpoint was re-infection or surgical intervention after DAIR. RESULTS There were no significant differences between the two groups in terms of mean age, Charlson comorbidity index or the rate of mixed infections. Overall, 65.2% of patients achieved remission in the intervention group compared with only 18.2% in the control group (p < 0.001); 50% of re-infections in the intervention group even occurred after 36 months. Kaplan-Meier analysis showed that, compared with controls, the intervention group experienced significantly longer 3-year infection-free survival. CONCLUSION DAIR shows poor efficacy in difficult-to-treat cases, as demonstrated in our control group, which had a re-infection rate of 81.8%. In contrast, a DAIR group receiving topical calcium-based antibiotics showed significantly higher 3-year infection-free survival. Therefore, the combination of DAIR and degradable antibiogram-based local antibiotics is a reasonable salvage procedure for this body of patients. This is important as the number of severely sick patients who are too old for appropriate PJI treatment is estimated to increase significantly due to demographic change.
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Souhail B, Charlot P, Deroudilhe G, Coblentz Y, Pierquet G, Gimel P, Challut N, Levent T, Cusumano S, Dautezac V, Roger PM. Urinary tract infection and antibiotic use around ureteral stent insertion for urolithiasis. Eur J Clin Microbiol Infect Dis 2020; 39:2077-2083. [PMID: 32591897 DOI: 10.1007/s10096-020-03953-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/15/2020] [Indexed: 12/23/2022]
Abstract
Urolithiasis is the main indication for a ureteral JJ stent. Our aim was to determine the incidence of urinary tract infections (UTIs) after a JJ stent for urolithiasis, with an emphasis on antibiotic use. Prospective, multicenter, cohort study over a 4-month period including all of the patients with urolithiasis requiring JJ stent insertion. The clinical and microbiological data and therapeutic information were recorded until removal of the JJ stent. Two hundred twenty-three patients at five French private hospitals were included. A urine culture was performed for 187 patients (84%) prior to insertion of a JJ stent, 36 (19%) of which were positive. One hundred thirty patients (58%) received an antibiotic therapy during surgery: 74 (33%) prophylaxis and 56 (25%) empirical antibiotic therapy, comprising 17 different regimens. The rate of prophylaxis varied according to the center, from 0 to 70%. A total of 208 patients were followed-up until removal of the first stent. The rate of UTIs was 6.3% (13/208); 8.1% of the patients who did not receive a prophylaxis had a UTI versus 1.4% of those who did receive a prophylaxis (p = 0.057). Seven empirical antibiotic regimens were used to treat these 13 patients. Another large panel of antibiotic prescriptions was observed at the time of JJ stent removal. The incidence of a UTI after JJ stent insertion for urolithiasis was 6.3%, in part due to a lack of prophylaxis. An unwarranted diversity of antibiotic use was observed at each step of care.
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Affiliation(s)
| | - Patrick Charlot
- Elsan, Clinique Inkermann, 84 Rte d'Aiffres, 79000, Niort, France
| | - Gilles Deroudilhe
- Elsan, Clinique Saint Augustin, 114 Ave d'Arès, 33000, Bordeaux, France
| | - Yves Coblentz
- Elsan, Clinique Inkermann, 84 Rte d'Aiffres, 79000, Niort, France
| | - Gregory Pierquet
- Elsan, Clinique Saint Augustin, 114 Ave d'Arès, 33000, Bordeaux, France
| | - Pierre Gimel
- Elsan, Clinique Saint-Roch 5 Rue Ambroise Croizat, 66330, Cabestany, France
| | - Nathalie Challut
- Elsan, Clinique Saint-Roch 5 Rue Ambroise Croizat, 66330, Cabestany, France
| | - Thierry Levent
- Elsan, Clinique Vauban, 10 Avenue Vauban, 59300, Valenciennes, France
| | - Stéphane Cusumano
- Elsan, Clinique du Sidobre, Chemin de St Hyppolyte, 81100, Castres, France
| | - Véronique Dautezac
- Elsan, Clinique du Sidobre, Chemin de St Hyppolyte, 81100, Castres, France
| | - Pierre-Marie Roger
- Réso-Infectio-PACA-Est, Nice, France.,Elsan, Clinique Les Fleurs,, Avenue Frédéric Mistral, 83190, Ollioules, France.,Faculté de Médecine, Université Côte d'Azur, 28 Avenue de Valombrose, 06107, Nice, France
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Roger PM, Peyraud I, Vitris M, Romain V, Bestman L, Blondel L, Gras H, Hauchart C, Morandi V, Rancezot A, Borredon G, Dautezac V. Impact of simplified therapeutic guidelines on antibiotic prescriptions: a prospective multicentre comparative study. J Antimicrob Chemother 2020; 75:747-755. [PMID: 31851314 DOI: 10.1093/jac/dkz490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We studied the impact of simplified therapeutic guidelines (STGs) associated with accompanied self-antibiotic reassessment (ASAR) on antibiotic use. METHODS Prospective antibiotic audits and feedback took place at 15 hospitals for 12 months, allowing STGs with ≤15 drugs to be devised. STGs were explained to prescribers through sessions referred to as ASAR. Optimal therapy was defined by the conjunction of a diagnosis and the drug specified in the STGs. Analysis of consumption focused on critical drugs: amoxicillin/clavulanic acid, third-generation cephalosporins and fluoroquinolones. RESULTS We compared prescriptions in five hospitals before (n = 179) and after (n = 168) the implementation of STGs + ASAR. These tools were associated with optimal therapies and amoxicillin/clavulanic acid prescriptions [adjusted odds ratio (AOR) 3.28, 95% CI 1.82-5.92 and 2.18, 95% CI 1.38-3.44, respectively] and fewer prescriptions for urine colonization [AOR 0.20 (95% CI 0.06-0.61)]. Comparison of prescriptions (n = 1221) from 10 departments of three clinics with STGs + ASAR for the first quarters of 2018 and 2019 revealed that the prescriptions by 23 ASAR participants more often complied with STGs than those by 28 other doctors (71% versus 60%, P = 0.003). STGs alone were adopted by 10 clinics; comparing the prescriptions (n = 311) with the 5 clinics with both tools, we observed fewer unnecessary therapies in the latter [AOR 0.52 (95% CI 0.34-0.80)]. The variation in critical antibiotic consumption between 2017 and 2018 was -16% for the 5 clinics with both tools and +20% for the other 10 (P = 0.020). CONCLUSIONS STGs + ASAR promote optimal antibiotic therapy and reduce antibiotic use.
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Affiliation(s)
- Pierre-Marie Roger
- Infectiologie, Clinique Les Fleurs, 332 ave Frédéric Mistral, 83110 Ollioules, France.,Faculté de Médecine, Université Côte d'Azur, Nice, France
| | - Ingrid Peyraud
- Pharmacie, Clinique Inkermann, 84 Rte d'Aiffres, 79000 Niort, France
| | - Michel Vitris
- Hygiène, Clinique du Pont de Chaume, 330 ave Marcel Unal, 82000, Montauban, France
| | - Valérie Romain
- Anesthésie-Réanimation et Hygiène, Pôle Santé Atlantique, Ave Claude Bernard, 44819 St Herblain, France
| | - Laura Bestman
- Service Qualité, Clinique St Louis, 1 rue Basset, 78300 Poissy, France
| | - Lionel Blondel
- Hygiène, Clinique l'Orangerie, 29 allée de la Robertsau, 67000 Strasbourg, France
| | - Hélène Gras
- Pharmacie, Clinique Les Lauriers, 147 rue Jean Giono, 83600 Fréjus, France
| | - Christine Hauchart
- Pharmacie, Clinique St Claude, 1, Bd du Dr Schweitzer, 02100 Saint Quentin, France
| | - Véronique Morandi
- Pharmacie et Hygiène, Clinique St Roch, rue Ambroise Croizat, 66330 Cabestany, France
| | - Agnès Rancezot
- Pharmacie, Clinique Médicale et Cardiologique d'Aressy, rue de Lourdes, 64320 Aressy, France
| | - Gaelle Borredon
- Pharmacie, Clinique Ormeau, 12 chemin de l'Ormeau, 65000 Tarbes, France
| | - Véronique Dautezac
- Pharmacie, Clinique du Sidobre, chemin de St Hyppolyte, 81100 Castres, France
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Souhail B, Le Maréchal M, Manuello R, Chrétien R, Charlot P, Déroudilhes G, Della Guardia M, Blanc V, Fribourg A, Degand N, Roger PM. Antibiotic therapy for Enterococcus bacteraemia: warning for the antimicrobial stewardship team. Eur J Clin Microbiol Infect Dis 2019; 38:2087-2095. [DOI: 10.1007/s10096-019-03645-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/15/2019] [Indexed: 01/23/2023]
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Roger PM, Michélangeli C, Girard D, Etienne P, Borredon G, Dautezac V, Keita-Perse O, Del Giudice P. Streamlined guidelines for antibiotic therapies are required for greater efficacy. Med Mal Infect 2019; 49:363-366. [PMID: 30826173 DOI: 10.1016/j.medmal.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/04/2019] [Indexed: 01/26/2023]
Affiliation(s)
- P M Roger
- Infectiologie, groupe Elsan, 75008 Paris, France; Faculté de médecine, université Côte-d'Azur, 06000 Nice, France; Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France.
| | - C Michélangeli
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Infectiologie, centre hospitalier universitaire de Nice, 06000 Nice, France
| | - D Girard
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Laboratoire Cerballiance, 83190 Ollioules, France
| | - P Etienne
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Centre de lutte contre la tuberculose, centre hospitalier universitaire de Nice, 06000 Nice, France
| | - G Borredon
- Pharmacie, clinique Ormeau, 65000 Tarbes, France
| | - V Dautezac
- Pharmacie, clinique du Sidobre, 81100 Castres, France
| | - O Keita-Perse
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Service d'hygiène hospitalière, hôpital Princesse-Grâce, 98000 Monaco
| | - P Del Giudice
- Reso-Infectio-PACA-Est (reso-infectio.fr), 06000 Nice, France; Dermatologie et infectiologie, hôpital de Fréjus-St-Raphael, 83608 Fréjus, France
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Besnard M, Babusiaux D, Garaud P, Rosset P, Bernard L, Le Nail LR, Berhouet J. Impact of setting up a bone and joint infection referral center on arthroscopic treatment of septic arthritis of the knee and shoulder: Retrospective study. Orthop Traumatol Surg Res 2018; 104:1265-1269. [PMID: 30341032 DOI: 10.1016/j.otsr.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/02/2018] [Accepted: 08/23/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Referral Centers for Bone and Joint Infection (BJI) were set up to optimize BJI management thanks to multidisciplinary teamwork. The main aim of the present study was to assess the impact of setting up the Western France Bone and Joint Infection Referral Center on arthroscopic treatment of septic arthritis of the shoulder and knee. The secondary aim was to identify other risk factors for failure of this treatment. The null hypothesis was that there was no difference between the "success group" and the "failure group". MATERIAL AND METHODS This single-center retrospective study included 52 patients treated for septic arthritis between January 1, 2000 and December 31, 2013 by arthroscopic joint lavage associated to at least 4 weeks' antibiotic therapy. Exclusion criteria comprised: retrospective diagnosis of rheumatoid arthritis after negative bacteriological analysis, early cessation of antibiotic treatment, and follow-up less than 4 weeks. Failure was defined as non-healing after first-line treatment. The primary endpoint was date of treatment compared to the launch date of the Center in the first quarter of 2010. The influence of pre- and intraoperative criteria related to patient, treatment and microorganism was assessed. RESULTS At follow-up, 17 patients (32.9%) showed failure of first-line treatment and 5 (9.6%) were non-healed at end of treatment, whatever the re-intervention. The failure rate significantly decreased after setting up the Center, from 42.9% to 11.8% (p=0.03). In the failure group, 70.6% of patients showed immunosuppression, versus 37.2% in the success group (p=0.01). Neither time to surgery (p=1), type of microorganism, or performance of antiseptic lavage (p=0.25) or synovectomy (p=0.62) influenced outcome. CONCLUSION Multidisciplinary management of septic arthritis improved treatment success. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Marion Besnard
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France.
| | - Damien Babusiaux
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
| | - Pascal Garaud
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Philippe Rosset
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
| | - Louis Bernard
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Service de médecine interne et maladies infectieuses, centre hospitalier universitaire de Tours, boulevard Tonnellé, 37044 Tours cedex 09, France
| | - Louis-Romé Le Nail
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
| | - Julien Berhouet
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
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- Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
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Gramlich Y, Walter G, Klug A, Harbering J, Kemmerer M, Hoffmann R. Procedure for single-stage implant retention for chronic periprosthetic infection using topical degradable calcium-based antibiotics. INTERNATIONAL ORTHOPAEDICS 2018; 43:1559-1566. [PMID: 30112681 DOI: 10.1007/s00264-018-4066-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/17/2018] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Surgical treatment using DAIR (debridement, systemic antibiotics, and implant retention) can lead to high rates of treatment success in cases of early periprosthetic joint infection (PJI) but can fail in late-onset cases. Supplementary local antibiotic therapy is not yet generally established and lacks evidence-based proof of efficacy. The aim of this study was to analyze DAIR outcomes in recurrent PJI cases and patients who are not suitable for a two-stage exchange, using additional degradable calcium-based antibiotics. METHODS All patients fulfilled the Infectious Diseases Society of America (IDSA) guidelines for chronic late-onset PJI but were not suitable for a multistage procedure because of their individual operation risk. A total of 42 patients (mean age, 73 years) were treated using a single-stage algorithm consisting of DAIR, followed by implantation of degradable antibiotics chosen in accordance with an antibiogram. OSTEOSET® (admixed ceftriaxone/vancomycin/tobramycin) and Herafill-Gentamycin® were used as carrier systems. The follow-up period was 23 months (± SD, 10.3). The study is based on institutional review board (IRB) approval. RESULTS The clinical entities were chronic PJI of the hip (45.2%), knee (28.6%), and knee arthrodesis (26.2%). The bacterial spectrum was composed of Staphylococcus epidermidis (29%), Staphylococcus aureus (21%), and Enterococcus faecalis (21%). 21.4% showed a combination of two or more bacteria. In 73.8%, permanent remission was achieved, while 11.9% showed chronic PJI under implant retention. Implant retention could be achieved in 85.7%. CONCLUSION DAIR usually shows low levels of success in difficult-to-treat cases. However, we could demonstrate the successful treatment of patients with recurrent PJI (typically considered DAIR-inappropriate) using degradable antibiogram-based topical calcium-based antibiotics. Over 70% of the cases went to remission and over 85% of the implants could be retained.
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Affiliation(s)
- Yves Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany.
| | - Gerhard Walter
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Johannes Harbering
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Matthias Kemmerer
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
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Laurent E, Gras G, Druon J, Rosset P, Baron S, Le-Louarn A, Rusch E, Bernard L, Grammatico-Guillon L. Key features of bone and joint infections following the implementation of reference centers in France. Med Mal Infect 2018. [PMID: 29526340 DOI: 10.1016/j.medmal.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES French reference centers for bone and joint infections (BJI) were implemented from 2009 onwards to improve the management of complex BJIs. This study compared BJI burden before and after the implementation of these reference centers. PATIENTS AND METHODS BJI hospital stays were selected from the 2008 and 2013 national hospital discharge database using a validated algorithm, adding the new complex BJI code created in 2011. Epidemiology and economic burden were assessed. RESULTS BJI prevalence increased in 2013 (70 vs. 54/100,000 in 2008). Characteristics of BJI remained similar between 2008 and 2013: septic arthritis (50%), increasing prevalence with age and sex, case fatality 5%, mean length of stay 17.5 days, rehospitalization 20%. However, device-associated BJIs increased (34 vs. 26%) as well as costs (€421 million vs. €259 in 2008). Similar device-associated BJI characteristics between 2008 and 2013 were: septic arthritis (70%), case fatality (3%), but with more hospitalizations in reference centers (34 vs. 30%) and a higher cost per stay. Among the 7% of coded complex BJIs, the mean length of stay was 22.2 days and mean cost was €11,960. CONCLUSIONS BJI prevalence highly increased in France. Complex BJI prevalence assessment is complicated by the absence of clinical consensus and probable undercoding. A validation of clinical case definition of complex BJI is required.
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Affiliation(s)
- E Laurent
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France; Équipe de Recherche EE1 EES, université de Tours, 37000 Tours, France.
| | - G Gras
- Service de maladies infectieuses, CHRU de Tours, 37000 Tours, France
| | - J Druon
- Service de chirurgie orthopédique, CHRU de Tours, 37000 Tours, France
| | - P Rosset
- Service de chirurgie orthopédique, CHRU de Tours, 37000 Tours, France; Faculté de médecine, université de Tours, 37000 Tours, France
| | - S Baron
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France; Équipe de Recherche EE1 EES, université de Tours, 37000 Tours, France
| | - A Le-Louarn
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France
| | - E Rusch
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France; Équipe de Recherche EE1 EES, université de Tours, 37000 Tours, France
| | - L Bernard
- Service de maladies infectieuses, CHRU de Tours, 37000 Tours, France; Faculté de médecine, université de Tours, 37000 Tours, France
| | - L Grammatico-Guillon
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France; Faculté de médecine, université de Tours, 37000 Tours, France
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Aillet C, Jammes D, Fribourg A, Léotard S, Pellat O, Etienne P, Néri D, Lameche D, Pantaloni O, Tournoud S, Roger PM. Bacteraemia in emergency departments: effective antibiotic reassessment is associated with a better outcome. Eur J Clin Microbiol Infect Dis 2017; 37:325-331. [DOI: 10.1007/s10096-017-3136-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022]
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Comparative Analysis of Bacterial Community Composition and Structure in Clinically Symptomatic and Asymptomatic Central Venous Catheters. mSphere 2017; 2:mSphere00146-17. [PMID: 28959736 PMCID: PMC5615130 DOI: 10.1128/msphere.00146-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/17/2017] [Indexed: 01/03/2023] Open
Abstract
Totally implanted venous access ports (TIVAPs) are commonly used catheters for the management of acute or chronic pathologies. Although these devices improve health care, repeated use of this type of device for venous access over long periods of time is also associated with risk of colonization and infection by pathogenic bacteria, often originating from skin. However, although the skin microbiota is composed of both pathogenic and nonpathogenic bacteria, the extent and the consequences of TIVAP colonization by nonpathogenic bacteria have rarely been studied. Here, we used culture-dependent and 16S rRNA gene-based culture-independent approaches to identify differences in bacterial colonization of TIVAPs obtained from two French hospitals. To explore the relationships between nonpathogenic organisms colonizing TIVAPs and the potential risk of infection, we analyzed the bacterial community parameters between TIVAPs suspected (symptomatic) or not (asymptomatic) of infection. Although we did not find a particular species assemblage or community marker to distinguish infection risk on an individual sample level, we identified differences in bacterial community composition, diversity, and structure between clinically symptomatic and asymptomatic TIVAPs that could be explored further. This study therefore provides a new view of bacterial communities and colonization patterns in intravascular TIVAPs and suggests that microbial ecology approaches could improve our understanding of device-associated infections and could be a prognostic tool to monitor the evolution of bacterial communities in implants and their potential susceptibility to infections. IMPORTANCE Totally implanted venous access ports (TIVAPs) are commonly used implants for the management of acute or chronic pathologies. Although their use improves the patient's health care and quality of life, they are associated with a risk of infection and subsequent clinical complications, often leading to implant removal. While all TIVAPs appear to be colonized, only a fraction become infected, and the relationship between nonpathogenic organisms colonizing TIVAPs and the potential risk of infection is unknown. We explored bacteria present on TIVAPs implanted in patients with or without signs of TIVAP infection and identified differences in phylum composition and community structure. Our data suggest that the microbial ecology of intravascular devices could be predictive of TIVAP infection status and that ultimately a microbial ecological signature could be identified as a tool to predict TIVAP infection susceptibility and improve clinical management.
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Mothes A, Léotard S, Nicolle I, Smets A, Chirio D, Rotomondo C, Tiger F, Del Giudice P, Perrin C, Néri D, Foucault C, Della Guardia M, Hyvernat H, Roger PM. Community-acquired pneumonia and positive urinary antigen tests: Factors associated with targeted antibiotic therapy. Med Mal Infect 2016; 46:365-371. [DOI: 10.1016/j.medmal.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/28/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
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Bacteraemic urinary tract infections may mimic respiratory infections: a nested case-control study. Eur J Clin Microbiol Infect Dis 2016; 35:1601-5. [PMID: 27272327 DOI: 10.1007/s10096-016-2697-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
Daily practice suggests that respiratory signs may be observed in bacteraemic urinary infections (BUI). Our objective was to search for an association between the presence of respiratory symptoms and the bacteraemic nature of urinary tract infections (UTI). A nested case-control study was carried out based on our computerised dashboard from January 2011 to June 2015. Cases were defined as patients with a BUI due to Enterobacteriaceae species, identified in blood and urine cultures. Controls had fever and a positive urinary sample but sterile blood cultures (NBUI) and a final diagnosis of urinary infection. Patients from the BUI group were 1:1 matched to the NBUI group according to four parameters: age, gender, cardiovascular and pulmonary comorbid conditions. Subjects with cognitive impairment limiting clinical accuracy and those with healthcare-associated infections were excluded. We compared systematically recorded respiratory and urinary symptoms between groups: signs on auscultation, dyspnoea, chest pain, cough and sputum, dysuria with burning, pollakiuria, flank or costovertebral angle tenderness and ischuria. One hundred BUI were compared to 100 NBUI, both groups exhibiting a similar rate for all considered comorbid conditions. In the BUI group, 58 % showed at least one respiratory sign vs. 20 % in the NBUI group, p < 0.001, while urinary signs were less frequent: 54 % vs. 71 %, p = 0.013. In the multivariate analysis, BUI was associated with the presence of abnormal pulmonary auscultation [adjusted odds ratio (AOR), 5.91; p < 0.001] and a trend towards less urinary symptoms (AOR, 1.58; p = 0.058). Patients with BUI presented with significantly more respiratory signs, which overshadowed urinary symptoms, compared to those with non-bacteraemic UTI. Such observations impact clinical decision-making.
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Severe community-acquired pneumonia and positive urinary antigen test for S. pneumoniae: amoxicillin is associated with a favourable outcome. Eur J Clin Microbiol Infect Dis 2015; 34:2455-61. [DOI: 10.1007/s10096-015-2503-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
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