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Bone & Joint Research
Vol. 9, Issue 10 | Pages 635 - 644
1 Oct 2020
Lemaignen A Grammatico-Guillon L Astagneau P Marmor S Ferry T Jolivet-Gougeon A Senneville E Bernard L

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.

Methods

A centralized online secured database gathering the electronic case report forms (eCRFs) was filled for every patient presented in multidisciplinary meetings (MM) among the 24 French referral centres. Metrics of this registry were described between 2012 and 2016. Data quality was assessed by comparing essential items from the registry with a controlled dataset extracted from medical charts of a random sample of patients from each centre. Internal completeness and consistency were calculated.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 83 - 83
1 Dec 2018
Lemaignen A Astagneau P Marmor S Ferry T Seng P Mainard D Jenny J Laurent F Grare M Jolivet-Gougeon A Senneville E Bernard L
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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.

Method

Demographic, clinical, microbiologic and therapeutic characteristics of patients are systematically recorded in the database. Data from the first presentation in RC for each adult patients are presented. Complexity of BJI is recorded after each meeting according to 4 criteria (first failure, complex antibiotic therapy, precarious underlying conditions or complex surgical procedure). Part of unavailable data have been completed by pattern extraction from text-encoded commentaries. Factors associated with complexity were determined by multivariate logistic regression.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 25 - 25
1 Dec 2017
Mahieu R Dubee V Ansart S Bernard L Gwenael LM Asseray N Arvieux C Ramanantsoa C Legrand E Abgueguen P
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Aim

The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear. Poorer outcome has been associated with Streptococcus agalactiae species, comorbidities and polyethylene exchange for conservative approach. Rifampicin use may be associated with higher remission rate but results are sparse.

Method

A cohort of streptococcal PJI (including total hip arthroplasty –THA- or total knee arthroplasty –TKA-) was prospectively created and retrospectively reviewed in 7 reference centers for management of complex PJI between January 1, 2010 and December 31, 2012.


The Bone & Joint Journal
Vol. 95-B, Issue 6 | Pages 831 - 837
1 Jun 2013
Dunkel N Pittet D Tovmirzaeva L Suvà D Bernard L Lew D Hoffmeyer P Uçkay I

We undertook a retrospective case-control study to assess the clinical variables associated with infections in open fractures. A total of 1492 open fractures were retrieved; these were Gustilo and Anderson grade I in 663 (44.4%), grade II in 370 (24.8%), grade III in 310 (20.8%) and unclassifiable in 149 (10.0%). The median duration of prophylaxis was three days (interquartile range (IQR) 1 to 3), and the median number of surgical interventions was two (1 to 9). We identified 54 infections (3.6%) occurring at a median of ten days (IQR 5 to 20) after trauma. Pathogens intrinsically resistant to the empirical antibiotic regimen used (enterococci, Enterobacter spp, Pseudomonas spp) were documented in 35 of 49 cases (71%). In multivariable regression analyses, grade III fractures and vascular injury or compartment syndrome were significantly associated with infection. Overall, compared with one day of antibiotic treatment, two to three days (odds ratio (OR) 0.6 (95% confidence interval (CI) 0.2 to 2.0)), four to five days (OR 1.2 (95% CI 0.3 to 4.9)), or > five days (OR 1.4 (95% CI 0.4 to 4.4)) did not show any significant differences in the infection risk. These results were similar when multivariable analysis was performed for grade III fractures only (OR 0.3 (95% CI 0.1 to 3.4); OR 0.6 (95% CI 0.2 to 2.1); and OR 1.7 (95% CI 0.5 to 6.2), respectively).

Infection in open fractures is related to the extent of tissue damage but not to the duration of prophylactic antibiotic therapy. Even for grade III fractures, a one-day course of prophylactic antibiotics might be as effective as prolonged prophylaxis.

Cite this article: Bone Joint J 2013;95-B:831–7.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 7 | Pages 833 - 838
1 Jul 2008
Uçkay I Pittet D Bernard L Lew D Perrier A Peter R

More than a million hip replacements are carried out each year worldwide, and the number of other artificial joints inserted is also rising, so that infections associated with arthroplasties have become more common. However, there is a paucity of literature on infections due to haematogenous seeding following dental procedures. We reviewed the published literature to establish the current knowledge on this problem and to determine the evidence for routine antibiotic prophylaxis prior to a dental procedure.

We found that antimicrobial prophylaxis before dental interventions in patients with artificial joints lacks evidence-based information and thus cannot be universally recommended.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 304 - 305
1 Mar 2004
Bernard L LŸbbeke A Feron J Peyramond D Denormandie P Arvieux C Chirouze C Hoffmeyer P
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Aims: The diagnosis of a prosthetic joint infection is difþcult, but crucial for appropriate treatment. Scintigraphy with speciþc markers for infection (labeled white cells or immunoglobulin-G) has been reported as a more reliable diagnostic tool than clinical assessment (fever, þstula), laboratory studies [polynuclear neutrophils blood count (PNC), erythrocyte rate sedimentation (ESR), and C-reactive protein (CRP)], and preoperative aspiration. Methods: In the þrst part of this study, we retrospectively reviewed 230 patients admitted with a suspected prosthetic joint infection and compared the validity of these different diagnostic tools. 209 patients had an infection. Results: Pain, fever, ESR, and PNC are unreliable for identifying occult infection. The presence of a þstula is inconstant, but when present is very reliable to detect infection. Our study revealed sensitivity, speciþcity, positive and negative predictive value as follows: CRP: 97%, 81%, 98%, 71% respectively; aspiration: 82%, 94%, 99%, 43% respectively, and labelled scintigraphy 74%, 76%, 91%, 44% respectively. In the second part, we reviewed 23 articles which included 1,722 prosthetic joints with preoperative evaluation of infection. Conclusions: Both our study and the literature review indicate that CRP and joint aspiration are the best tools to diagnose prosthetic joint infection.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_I | Pages - 63
1 Mar 2002
Gleizes Y Bernard L Pron B Signoret F Feron J Gaillard J
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Purpose: The purpose of this study was to determine the usefulness of systematic bacteriological culture of drainage fluid after aseptic orthopaedic surgery in identifying infection early. There is much controversy over this point in the literature. In addition, the public health cost (approximately 30 euros per culture) must be considered in terms of effectivenes.

Material and methods: A prospective study was conducted in a single orthopaedic surgery department over a one-year period (1999) including all patients undergoing class I surgery (aseptic orthopaedic and traumatologic surgery). The population included 843 patients (52% men, 48% women, mean age 49 years, age range 15–98 years) who underwent 880 aseptic orthopaedic surgery procedures (osteosynthesis 60%, arthroplasty 30%, others 10%). One or several bacteriological cultures on early drainage fluid were performed (n=2434). The results of these cultures were analysed to determine their contribution to early detection of infection and rapid institution of adapted treatment (medical treatment with antibiotics or medical and surgical (revision) treatment).

Results: The bacteriological cultures were negative in 830 patients (98.5%) and positive in 13 (1.5%). A deep infection developed in 21 patients including 3 patients who had a positive drainage fluid culture and 18 who had a negative culture. In addition, ten patients had false positive cultures subsequent to extraneous contamination. The sensitivity, specificity and positive and negative predictive values were 14%, 98%, 23% and 98% respectively.

Discussion, conclusion: Drainage is a common procedure after orthopaedic surgery. The objective is to limit the risk of haematoma formation, but paradoxically with an increased risk of infection by retrograde contamination. The observed sensitivity and predictive values of drainage fluid cultures would suggest this is not a reliable method for detecting infection early, especially since the presence of a drain increases the risk of infection. In the final analysis, we do not recommend systematic culture of drainage fluid after aseptic orthopaedic surgery.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_I | Pages 56 - 56
1 Mar 2002
Bernard L Gleizes V Haj JE Pron B Lotthéa A Signoret F Denormandie P Feron J Perronnec C Gaillard L
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Purpose: Patients hospitalized for osteomyelitis due to multi-resistant strains are often given prolonged parenteral antibiotics. Ambulatory parenteral antibiotic therapy is an alternative allowing outpatient care. The purpose of this study is to assess tolerance, cost and efficacy of this type of treatment.

Material and methods: Thirty-nine patients followed for osteomyelitis were included in this study. These patients were given antibiotics in a continuous infusion using a portable diffuser connected to an implanted chamber. Mean duration of treatment was four months, range 1.5–12 months. The follow-up team included the primary care physician, an infectious diseases specialist, and a nurse with special training in prolonged ambulatory antibiotic treatments. Results of weekly blood tests were transmitted to the referral hospital physician. Adverse effects and cost of prolonged ambulatory antibiotic therapy were recorded. Cost included costs for nurses, physical therapists, and physicians as well as drugs, supplies and laboratory tests. The cost of hospitalisation was determined on the basis of the standard cost for one day of hospitalisation in France.

Results: There were three cases of thrombophlebitis and one case of allergic reaction, both required re-hospitalisation. Cure was achieved in 93% of the patients. Mean follow-up since cure with discontinuation of the antibiotics was 18 months (14–22). Home care was possible in 100% of the patients and 23% of the patients were able to resume their occupational activity; 25% resumed their schooling. Self-administered schemes were possible in 23% of the patients. Compared with conventional hospitalisation, ambulatory parenteral antibiotic therapy enabled a cost savings of 1352 euros per patient.

Discussion: These results demonstrate that ambulatory antibiotic therapy is a very good alternative to classical hospitalisation enabling low morbidity, early resumption of social activities without loss of efficacy.