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.

Aim

Bone and joint infections (BJI) need frequently prolonged antibiotic treatment at high dosage for a total of 6 or 12 weeks depending the type of infection. Impact of such prolonged antibiotic exposure on the gut microbiota has never been assessed.

Aims

The French registry for complex bone and joint infections (C-BJIs) was created in 2012 in order to facilitate a homogeneous management of patients presented for multidisciplinary advice in referral centres for C-BJI, to monitor their activity and to produce epidemiological data. We aimed here to present the genesis and characteristics of this national registry and provide the analysis of its data quality.

Aim

Gram negative bacteria (GNB) are emerging pathogens in chronic post-traumatic osteomyelitis. However, data on multi-drug (MDR) and extensively drug resistant (XDR) GNB are sparse.

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Late acute prosthetic joint infections (PJI) treated with surgical debridement and implant retention (DAIR) have a high failure rate. The aim of our study was to evaluate treatment outcome in late acute PJIs treated with DAIR versus implant removal.

Aim

Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI). However, the efficacy of DAIR and identification of risk factors for failure in patients with late acute PJI, is not well described.

Aim

Data on Prosthetic joint infection (PJI) caused by multi-drug resistant (MDR) or XDR (extensively drug resistant) Gram negative bacteria (GNB) are limited. Treatment options are also restricted. We conducted a multi-national, multi-center assessment of clinical data and factors of outcome for these infections.

Aim

Bone and joint infections (BJI) are associated with a heavy morbidity and high health costs. Comorbidities, device associated infections and complicated journeys are associated with increased mortality, treatment failures and costs. For this reason, 24 referral centers (RC) have been created in 2009 in order to advise about management of “complex” BJI in weekly multidisciplinary meetings (MM). Since end of 2012, data from these meetings are gathered in a national database. We aimed to describe the data from this French registry of BJI and determine factors associated with the definition of “complex” BJI.

Aim

Pubic osteomyelitis (PO) is one of less frequent Bone and Joint Infections forms (BJI). Its management is still poorly codified as far as nosological framework is still unclear in medical literature. We aim to describe PO epidemiology and to look for factors associated with management failure.

Aim

Prosthetic joint infection (PJI) concerns up to 20% of all prosthesis revision procedures. The IDSA recommends at least 2 weeks of intravenous antimicrobial therapy while most of the appropriate antibiotics in these settings have very high oral bioavailability (e.g., rifampicin, cotrimoxazole, fluoroquinolone, clindamycin, fusidic acid, linezolid and doxycycline).

Aim

To assess the spread of foot infection and its impact on the outcomes of major amputations of lower extremities in diabetic patients.

Aim

The treatment of a chronic prosthetic joint infection (PJI) is a combination of the bacteria's identification, a «carcinological» surgery and an appropriate antibiotherapy. In case of gram positive cocci infection, rifampicin is often used.

The aim of this study is to determine which factors are responsible for the development of resistance to rifampicine.

Aim

Propionibacterium acnes (PA) is an important cause of shoulder prosthetic joint infections (SPJIs) for which the optimal treatment has not yet been determined. Rifampicin and Levofloxacin both showed not benefit in recent experimental models of PA-SPJIs. We describe herein the experience of five different medical French centers in order to assess factors associated with patient's outcome with special emphasize on antibiotic regimens.

There is currently no consensus on the use of suppressive antibiotic therapy (SAT) in prosthetic joint infections (PJI) (1). We describe herein the experience of a French Reference Centre for Complex Osteo-Articular Infections on use of oral cyclines (doxycline and minocycline) for SAT.

A retrospective analysis was performed on consecutive patients with PJI who received oral cyclines (doxycycline or minocycline) for SAT between January 2006 and June 2014. All patients had surgical management, followed by systemic antibiotic treatment and SAT instauration thereafter. Remission was defined as an asymptomatic patient with a functioning prosthesis.

Seventy-nine patients with a mean age of 63.8 ± 16.8 years were included. Sixteen patients (20%) had neoplasia, 9 (11%) diabetes mellitus, 10 (13%) rheumatoid arthritis, and 6 patients (8%) were receiving corticosteroids or chemotherapy.

There were 37 knee (47%), 36 hip (46%), 4 elbow (5%), and 2 shoulder (3%) infections, with a mean delay from implantation of 7.37 ± 6.94 months (range 1–27). Surgical management consisted in debridement and implant retention for 60 patients (76%), or in implant exchange for 19 patients (24%).

Main pathogens were coagulase-negative staphylococci (37%) and Staphylococcus aureus (41%); 23 patients had polymicrobial infection (29%).

The most frequent initial antibiotic regimens debuted before SAT were rifampicin combinations (70%). Mean duration of curative antibiotic therapy was 103 ± 75 days.

Indications of SAT were (i) patients unsuitable for or refusing further surgery (n=23), suboptimal (ii) surgery (n=26) or (iii) curative antibiotic therapy (n=11), (iv) complex orthopaedic surgery (n=11), and (v) immunosuppressive status (n=8). Seventy-three patients received doxycycline and 6 patients received minocycline as SAT (n=48). Mean SAT duration was 625± 536 days (range 30–2900), with a mean follow-up of 765 ± 572 days.

Adverse events were reported in 13 patients (16%), leading to SAT discontinuation in 5 (6%).

During follow-up, 59 patients were considered in remission (75%), and 20 failed including 13 relapses (16%) and 7 reinfections (9%). Among failure patients, 10 pathogens resistant to doxy/minocycline were identified, including 5 with acquisition of cycline resistance.

In our study, SAT with cyclines is associated to a 75% remission rate, with an acceptable tolerability.

Further studies are warranted to determine ideal regimens and optimal duration of SAT.

We would like to thank Dron Hospital and Lille University Hospital medical teams.

The authors declare that there are no conflicts of interest.

In France, 5% of men and 7% of women aged more than 60 years have a joint prosthesis (JP). The incidence of H-PJI following BSI remains unknown (1–2). The aim of this study was to determine prospectively the clinical characteristics of patients with JP and the incidence of H-PJI following a BSI.

A prospective observational multicentric study was performed in two French General Hospitals, from December 2012 to April 2015. Each patient with JP, in whom a BSI was diagnosed, was evaluated prospectively by an ID specialist. Data regarding clinical and microbiological characteristics were collected. A follow-up by phone call was performed monthly during 6 months to determine the incidence of H-PJI following BSI.

During the study period, 97 patients of mean age ± SD of 82.1 ± 10.4 years were identified, with a predominance of women (n=61). Nineteen patients (20%) had neoplasia, and 32 diabetes mellitus (33%). Most patients had one (n=61; 63%) or two JP (n=29; 30%); with a predominance of hip arthroplasty (n=77; 79%). Predominant pathogens were E. coli (n=41; 42%), S. aureus (n=23; 23%) and S. pneumoniae (n=8; 8%).

At the onset of BSI, the JP was concomitantly infected in 10 (10.3%) patients (including 8 S. aureus, 1 E. coli and 1 P. mirabilis), thus 87 were studied for the incidence of H-PJI following BSI of another source. Among these 87 patients, no H-PJI was detected, with a complete 6-month follow-up available for 29 patients (34%), incomplete follow-up for 26 patients (30%), loss of follow-up for 3 patients (3%), and death occurring in 29 patients (34%). The comparison between the patients with no H-PJI detected (« No Event Group ») and the deceased patients (« Death Group ») showed that patients of the « No Event Group » had a lower rate of neoplasia (14% vs 34%; P=0.025).

Our preliminary results show that patients with JP in whom a BSI occurred were old, and had a high mortality rate. In our study, the incidence of secondary H-PJI appears to be low, since no event was detected during the follow-up. The incidence of H-PJI may have been underestimated due to the high mortality rate.

We would like to thank Dron Hospital and Bethune Hospital medical teams.

The authors declare that there are no conflicts of interest.

Purpose of the study: Factors affecting the course of Staphylococcus aureus (SA) infected total hip arthroplasty (THA) and total knee arthroplasty (TKA) are poorly understood.

Material and methods: The microbiology laboratory database on patients hospitalised from June 2001 to June 2006 for medical and surgical treatment of an SA infected THA or TKA were reviewed. Data collected were: clinical, radiological, and biological (CRP) status known at least two years after the end of the antibiotic treatment. Success was defined as normal findings in all three domains at last follow-up and failure for any other situation.

Results: The series included 87 patients (43 male and 54 female, mean age 66.5 years, 62 THA, 35 TKA). Material was removed in 51 patients (52.6%). The infection was related to met-R SA in 14 patients (14.4%) and polymicrobial infection in 24 patients (24.7%). Mean duration of intravenous treatment was 7.3±9.4 days and total duration of antibiotic treatment was 115.472.2 d. At mean follow-up of 54.1±19.4 d, the overall success was 62/97 (63.9%). The only parameters significantly associated with failure were delay to management after first signs revealing longer infection (67.9 days vs 144.8 days) and an antibiotic therapy not adapted bacteriological results to immediately after surgery. (28.6% vs 3/28; 4.8%). In this series, met-R SA was not a risk factor of failure.

Conclusion: This work suggests that delayed surgical management and quality of antibiotic treatment for the first revision are factors affecting the prognosis of SA infected THA and TKA. These results are in favour of a multidisciplinary approach to care for these patients.

Purpose of the study: Because of its specific properties, linezolid (LZD) is an alternative to glycopeptides for the treatment of BJI causes by resistant Gram-positive cocci. The efficacy and tolerance of long-term (> 28d) administration remain to be determined with precision.

Material and methods: This was a retrospective analysis of the files of patients who received long-term LZD for BJI with a post-treatment follow-up of at least twelve months.

Results: Between January 2001 and December 2003, 68 patients (mean age 54.6 years) received LZD (600 mg/12h) intravenously then orally for a mean duration of 14.6 weeks on average (range 6–36 weeks). The orthopedic implants were infected in 31 patients (45.6%, 27 prostheses and 4 external fixators). A fistulization was diagnosed in 29 patients (42.6%). Medical and surgical treatment was undertaken in 51 patients (75%). Germs isolated from deep samples were staphylococci (n=57, 51 meti-R), and strepotococci (n=11). A polymicrobial infection was recorded in six patients (8.8%). Clinical success was achieved in 52 patients (76.5%) at the end of treatment, a result which was sustained for 48 of them to mean follow-up of 16.8 months (range 12–48). Sixty-three episodes of side effects were noted: anemia (n=29), peripheral neuropathy (n=9), nausea (n=14), headache (n=2), neutropenia (n=2), and thrombopenia (n=1), leading to discontinuation of LZD in 23 patients (33.8%) on average 11.9 weeks (range 6–36) after onset of treatment. Fifteen patients (22.1%) required transfusion.

Discussion: Among the patients in this series with BJI, most caused by a multiresistant germ, the rate of success was satisfactory (48/68, 70.6%) with LZD. Treatment was associated with a high frequency of serious adverse effects leading to discontinuation in one-third of patients.

Conclusion: Long-term treatment of BJI with LZD appears to be effective, including in patients with infected orthopedic material. Conversely, tolerance problems can limit is use to infections caused by mul-tiresistant Gram-positive cocci unresponsive to other compounds.

Aims: Rosenow’s broth is an enriched liquid medium used at laboratory for culture of anaerobes. It has never been tested for transport and culture of bacteria, particularly those that are frequently involved in chronic prosthetic infections. This prospective study assessed these data. Methods: 154 intraoperative specimens and joint aspirations were harvested between 1998 and 2000 in 80 patients that had infected knee (24) or hip (56) prostheses. For each of the 154 specimens there was a standard and a Rosenow recipient. Culture obtained on agar medium was called “direct culture” (DC) and culture from any liquid medium was called after “enrichment” (AE). The similitude between bacteria isolated from different specimens was assessed. Results: A bacteria was isolated from DC in 59 specimens (38%) and after AE in 95 specimens (62%). Among the 59 positive DC there was agreement between standard and Rosenow in 87%, and no agreement in 13% [ Staphylococcus sp. (6), Pseudomonas sp.(1) Enterobacteriacae (1)]. Among the 95 cultures AE, Rosenow and standard cultures were in agreement in 41 (43,1%), only standard was positive in 13 (13,6%), but only Rosenow’s broth was positive in 41 (43,1%) with negative standard cultures [16 Staphylococcus sp(13 S. epidermidis), 5 Streptococcus sp., 2 Enterococcus sp., 1 Corynebacterium sp, 3 Enterobacteriacaeand 14 anaerobes]. Sensibility and predictive positive value of Rosenow were respectively 0.86 and 0.86. Conclusion: This study suggest the accuracy of the Rosenow’s broth for transport and culture as agreement was observed in 87% with the DC that is considered as the “gold standard”. When only cultures AE were positive, the Rosenow’s broth corrected the diagnosis in 43%, particularly for infections related to S. epidermidis-and anaerobes.

Purpose: The Rosenow enriched medium (RW) enables culture of anaerobic germs as well as slow-growing germs sometimes causing chronic infections on implanted material. The purpose of this work was to determine the usefulness of RW for the bacteriological diagnosis of infections on total hip arthroplasty (THA) and total knee arthroplasty (TKA°.

Material and methods: One hundred fifty-four pre- or intraoperative standard and RW samples were obtained in a prospective study of 80 consecutive patients (mean age 67.6 years) with an infected THA (n=56) or TKA (n=24) between January 1998 and June 2000. A bacteria was considered “infecting” if it grew on direct culture on at least two samples after enrichment. A single positive sample after enrichment was considered a contamination except for strict anaerobes for which direct culture could not be achieved. For these germs, growth after enrichment was thus considered significant.

Results: Among the 154 samples, 59 (38%) gave positive direct cultures and 95 (62%) positive enriched cultures. Among the 59 positive direct cultures, the RW culture was concordant in 87% of the cases. For the 13% of discordant cultures, the germs did not grow on standard medium: Staphylococcus (n=6), Pseudomonas (n=1), and enterobacteria (n=1). For the 95 positive enriched cultures, 41 (43.1%) of the RW cultures were condordant with the standard culture; the standard was positive in 13 (13.6%) and the RW negative (11 Staphylococcus including five aureus, one Pseudomonas, and one Corynebacterium), but in 41 cases, the RW was positive while the standard was negative (16 Staphylococcus, including 13 coagulase negative, five Streptococcus, two Entero-coccus, one Corynebacterium, three enterobacteria, and fourteen anaerobes). The infecting nature of the aerobic bacteria was retained because earlier or later samples were positive. The sensitivity and predictive value of a positive RW culture were 86% and 86% respectively.

Discussion: Using RW medium and standard samples is useful if germs grow after enrichment in order to confirm the infecting nature of the isolated germ (double culture). The reliability of RW medium was confirmed since it was concordant in 87% of the cases with a positive “gold standard” culture. For positive cultures after enrichment with a negative standard culture, RW allows correcting the diagnosis of infection in 43% of the cases. Its usefulness lies basically in the isolation of coagulase negative Staphylococcus and anaerobes (especially Propionibacterium spp. and Peptostreptococcus spp.).