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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 49 - 49
1 Dec 2017
Becker A Valour F Perpoint T Boussel L Ruffion A Laurent F Senneville E Chidiac C Ferry T
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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.

Method

We performed a retrospective cohort study, carried out in two Reference Centres, including patients with PO in 2010–2016. Treatment failure was defined by: (i) persistence of clinical signs despite treatment; (ii) clinical relapse with same microorganisms; (iii) infection recurrence with one or more different microorganism(s);

(iv) new signs of infection (abscess, sinus tract) in same area, without recourse to get microbiological documentation. Factors associated with management failure were determined by univariate Cox analysis (hazard ratio [HR] and 95% confidence interval calculation). Kaplan-Meier curve were compared between groups by log-rank test.