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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 4 - 4
1 Dec 2018
Becker A Triffault-Fillit C Forestier E Lesens O Cazorla C Descamps S Chidiac C Lustig S Montbarbon E Batailler C Boyer B Ferry T
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Aim

S. aureus and coagulase-negative staphylococci are the most frequent bacteria responsible for PJI. In patients with acute PJI (i.e. <1 month following the implantation), DAIR with exchange of removal components followed by a combination of antibiotics that includes rifampin (particularly rifampin+fluoroquinolone) are recommended. Unfortunately, some patients could not receive rifampin due to drug-drug interaction or stopped it due to an adverse event. Finally, it was unclear if the dose and the duration of rifampin influenced the prognosis.

Method

We performed a retrospective cohort study in 4 hospitals and included patients with staphylococcal acute post-operative (< 1 month) PJI treated with DAIR in 2011–2016 period. Univariate and multivariate Cox analysis and Kaplan Meier curves were used to determine the risk factors for treatment failure (persistence of clinical signs, new surgery w/o persistence or superinfection, infection-related death).


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 75 - 75
1 Dec 2017
Chauvelot P Ferry T Triffault-Fillit C Braun E Perpoint T Laurent F Michel-Henry F Lustig S Chidiac C Valour F
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Aim

Corynebacterium is a rare etiologic agent of BJI. We aimed to describe this rare clinical condition and to assess treatment failure determinants.

Method

All adult patients with proven Corynebacterium BJI (i.e. consistent clinical/radiological signs, AND ≥2 reliable positive bacteriological samples, AND treated as such) were included in a retrospective cohort study. After cohort description, determinants of treatment failure (i.e, infection persistence, relapse, requirement of additional surgical procedure, and BJI-related death) were determined using stepwise logistic regression and Kaplan Meier curve analysis.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 72 - 72
1 Dec 2017
Triffault-Fillit C Valour F Michel T Goutelle S Guillo R Lustig S Fessy M Laurent F Eugenie M Chidiac C Ferry T
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Aim

Current guidelines recommend the combination of vancomycin with either piperacillin-tazobactam (PT) or a third generation cephalosporin (3GC) as empirical antimicrobial therapy of PJI, immediately after surgery. However, clinical and biological safeties of such high dose-combinations are poorly known.

Method

All patients managed in a reference center in France between 2011 and 2016 receiving an empirical antimicrobial therapy for PJI were included in a prospective cohort study. Antimicrobial-related AE upcoming during the empirical treatment phase were describe according to the Common Terminology Criteria for Adverse Events (CTCEA), and severe ones (grade ≥ 3) were reported to pharmacovigilance. AE determinants were assessed using univariate logistic regression.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 24 - 24
1 Dec 2017
Ferry T Johan A Boucher F Chateau J Hristo S Daoud F Braun E Triffault-Fillit C Perpoint T Laurent F Alain-Ali M Chidiac C Valour F
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Aim

A two-stage surgical strategy (debridement-negative pressure therapy (NPT) and flap coverage) with prolonged antimicrobial therapy is usually proposed in pressure ulcer-related pelvic osteomyelitis but has not been widely evaluated.

Method

Adult patients with pressure ulcer-related pelvic osteomyelitis treated by a two-stage surgical strategy were included in a retrospective cohort study. Determinants of superinfection (i.e., additional microbiological findings at reconstruction) and treatment failure were assessed using binary logistic regression and Kaplan-Meier curve analysis.