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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 4 - 4
1 Oct 2022
Dupieux C Dubois A Loiez C Marchandin H Lavigne JP Munier C Chanard E Gazzano V Courboulès C Roux A Tessier E Corvec S Bemer P Laurent F Roussel-Gaillard T
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Aim

Bone and joint infections (BJIs) are serious infections requiring early optimized antimicrobial therapy. BJIs can be polymicrobial or caused by fastidious bacteria, and the patient may have received antibiotics prior to sampling, which may decrease the sensitivity of culture-based diagnosis. Furthermore, culture-based diagnosis can take up to 14 days. Molecular approaches can be useful to overcome these concerns. The BioFire® system performs syndromic multiplex PCR in 1 hour, with only a few minutes of sample preparation. The BioFire® Joint Infection (JI) panel (BF-JI), recently FDA-cleared, detects both Gram-positive (n=15) and Gram-negative bacteria (n=14), Candida, and eight antibiotic resistance genes directly from synovial fluids. The aim of this study was to evaluate its performance in acute JIs in real-life conditions.

Method

BF-JI was performed on synovial fluid from patients with clinical suspicion of acute JI, either septic arthritis or periprosthetic JI, in 6 French centers. The results of BF-JI were compared with the results of culture of synovial fluid and other concomitantly collected osteoarticular samples obtained in routine testing in the clinical microbiology laboratory.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 9 - 9
1 Dec 2021
Ferry T Conrad A Senneville E Roux S Dupieux-Chabert C Dinh A Lustig S Goutelle S Briot T Pham T Valour F
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Aim

Tedizolid is an oxazolidinone antibiotic that: (i) is recommended at the dose of 200 once daily in patients with skin and soft tissue infection; (ii) seems to have a better long-term hematological and neurological safety profile in comparison with linezolid; (iii) remains active on multidrug-resistant (MDR) Gram-positive pathogens. Consequently, it might represent an option as suppressive antimicrobial treatment (SAT) in patients with complex implant-associated bone and joint infection (BJI) due to MDR Gram-positive pathogens.

Method

We performed a cohort study (2017–2020) to evaluate the long-term safety of tedizolid (200mg qd) as SAT in patients with implant-associated BJI. In all cases, the use of tedizolid was validated as the last oral treatment option during multidisciplinar meetings in a reference center for the management of BJI. Serious adverse events, any reason for discontinuation, and standard biological data, were prospectively collected.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 49 - 49
1 Dec 2021
Trecourt A Brevet M Champagnac A Conrad A Josse J Dupieux-Chabert C Valour F Ferry T
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Aim

The aim of this study was to confirm that Mirra's criterion (≥ 5 Polymorphonuclears (PMNs) per field in 5 high power fields (HPFs)) is not adequate for diagnosis of chronic bone and joint infections (BJIs) due to Cutibacterium acnes (C. acnes). The second objective was to determine if plasma-cell infiltration, that is a classical marker of chronic inflammation, could be useful for the diagnosis of chronic BJIs due to C. acnes.

Methods

We retrospectively selected 25 patients from 2009 to 2013 with chronic BJIs due to C. acnes. In addition of Mirra's criterion, the number of plasma-cells (≥5 plasma-cells/5 HPFs, defined as “CRIOAc Lyon's criterion”) was implemented in the histopathological analysis. Patients were defined as infected, if at least one of the two criteria were present.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 23 - 23
1 Dec 2021
Kokenda C Legendre T Abad L Graue C Jay C Ferry T Dupieux-Chabert C kensinger B Laurent F
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Aim

Bone and Joint Infections (BJIs) present with non-specific symptoms and can be caused by a wide variety of bacteria and fungi, including many anaerobes and microorganisms that can be challenging to culture or identify by traditional microbiological methods. Clinicians currently rely primarily on culture to identify the pathogen(s) responsible for infection. The BioFire® FilmArray® Bone and Joint Infection (BJI) Panel (BioFire Diagnostics, Salt Lake City, UT) was designed to detect 15 gram-positive (seven anaerobes), 14 gram-negative bacteria (one anaerobe), two yeast, and eight antimicrobial resistance (AMR) genes from synovial fluid specimens in an hour. The objective of this study was to evaluate the performance of an Investigational Use Only (IUO) version of the BioFire BJI Panel (BBJIP) compared to conventional used as reference methods.

Method

In a monocentric study, leftover synovial fluid specimens were collected in a single institution including 4 hospitals and tested using conventional bacterial culture (Standard of Care (SoC)) according to routine procedures following French national recommendations. Specimen has been placed in a refrigerator (4°C) as soon as possible after collection and stored for less than or equal to 7 days before enrollment. Performance of the IUO version of the BBJIP was determined by comparison to SoC for species identification.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 27 - 27
1 Dec 2019
Triffault-Fillit C Eugenie M Karine C Becker A Evelyne B Michel T Goutelle S Fessy M Dupieux C Laurent F Lustig S Chidiac C Ferry T Valour F
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Aim

The use of piperacillin/tazobactam with vancomycin as empirical antimicrobial therapy (EAT) for prosthetic joint infection (PJI) has been associated with an increased risk of acute kidney injury (AKI), leading to propose cefepim as an alternative since 2017 in our reference center. The present study compared microbiological efficacy and tolerance of these two EAT strategies.

Method

All patients with PJI empirically treated by vancomycin-cefepim (n=90) were prospectively enrolled in an observational study, and compared with vancomycin-piperacillin/tazobactam-treated historical controls (n=117), regarding: i) the proportion efficacious empirical regimen (i.e., at least one of the two molecules active against the identified organism(s) based on in vitro susceptibility testing); and ii) the incidence of empirical therapy-related adverse events (AE), classified according to the Common terminology criteria for AE (CTCAE).


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 37 - 37
1 Dec 2018
Dupieux C Verhoeven P Descours G Grattard F Benito Y Vandenesch F Cazorla C Ferry T Lustig S Boyer B Boisset S Laurent F Carricajo A
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Aims

Microbiological diagnosis of bone and joint infections (BJIs) is pivotal. However, no consensus exists about the best choice for techniques to be used and the best indications for molecular methods. Our objectives were: (i) to compare the performance of various microbiological diagnostic methods (cultural and molecular) on synovial fluid specimens and (ii) to select an algorithm for optimizing the diagnosis of BJIs in adults.

Methods

This prospective multicentric study (in Lyon and Saint-Etienne, France) included 423 joint fluid samples, collected from 333 adult patients (median age 69 years) suspected for BJI on the basis of medical history and clinical symptoms. For each inclusion, joint fluid and blood culture were collected concomitantly. The synovial fluid was also inoculated into blood culture bottles. Cytology, culture (using 5 solid media and an enrichment broth, incubated for 15 days), universal 16S rRNA PCR and PCR targeting Staphylococcus spp, S.aureus, Streptococcus spp, S.pneumoniae, Kingella kingae, Borrelia burgdorferi and Propionibacterium acnes were systematically performed on synovial fluid.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_23 | Pages 48 - 48
1 Dec 2016
Sophie T Dupieux C Camus C Chidiac C Lustig S Ferry T Laurent F Valour F
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Aim

Intracellular persistence of S. aureus is believed to be one of the major mechanisms leading to bone and joint infection (BJI) chronicity and relapses. Despite its poor intracellular activity, daptomycin (DAP) is increasingly used in the treatment of staphylococcal BJI. The well-known in vitro synergy of daptomycin with various betalactam antibiotics consequently led us to investigate whether these combinations enhance the activity of daptomycin against the intracellular reservoir of methicillin-susceptible (MSSA) and -resistant (MRSA) S. aureus in an ex-vivo model of human osteoblast infection.

Method

Osteoblastic MG63 cells were infected for 2h with MSSA strain or its isogenic MRSA. After killing the remaining extracellular bacteria with lysostaphin, infected cells were then incubated for 24h with DAP, oxacillin (OXA) or ceftaroline (CPT) alone or in combination, at the intraosseous concentrations reached with standard human therapeutic doses. Intracellular bacteria were then quantified by plating cell lysates. Minimum inhibitory concentrations (MICs) of these molecules alone and in combination were determined using the checkerboard method at pH7, but also at pH5 to mimic intracellular conditions.