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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 4 - 4
1 Dec 2018
STAPHYLOCOCCAL ACUTE POSTOPERATIVE PROSTHETIC JOINT INFECTION TREATED WITH ‘DAIR’ (DEBRIDEMENT AND IMPLANT RETENTION) AND IMPACT OF RIFAMPIN: A RETROSPECTIVE COHORT STUDY IN FRANCE
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. 100-B, Issue SUPP_17 | Pages 37 - 37
1 Dec 2018
OPTIMIZED DECISION ALGORITHM FOR THE MICROBIOLOGICAL DIAGNOSIS OF OSTEOARTICULAR INFECTIONS IN ADULTS USING JOINT FLUIDS SAMPLES: A PROSPECTIVE STUDY IN TWO FRENCH HOSPITALS INCLUDING 423 SYNOVIAL FLUIDS
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.