Liste des références et résumés des publications de l’équipe de LILLE TOURCOING consacrées à l’infection ostéo-articulaire dans des revues référencées sur PubMed

PUBLICATIONS INTERNATIONALES

1) SENNEVILLE E., YAZDANPANAH Y., CAZAUBIEL M., CORDONNIER M., VALETTE M., et al. Rifampicin-ofloxacin oral regimen for the treatment of mild to moderate diabetic foot osteomyelitis. J Antimicrob Chemother 2001 ; 48 : 927-30.

Seventeen diabetic patients with moderate to mild foot lesions associated with 20 osteomyelitic bones diagnosed by both bone scan and bone biopsy received rifampicin plus ofloxacin for a median duration of 6 months. Cure was defined as disappearance of all signs and symptoms of infection at the end of the treatment and absence of relapse during follow up. At the end of the treatment period, cure was achieved in 15 patients (88.2%) and was maintained in 13 patients (76.5%) at the end of an average post-treatment follow-up of 22 months. No serious drug-related adverse events were recorded.
PMID: 11733482 [PubMed - indexed for MEDLINE]

2) SENNEVILLE E, LEGOUT L, VALETTE M, YAZDANPANAH Y, GIRAUD F, BELTRAND E, ET AL. Risk factors for anaemia in patients on prolonged linezolid therapy for chronic osteomyelitis: a case-control study. J Antimicrob Chemother. 2004 Oct;54 (4): 798-802.

OBJECTIVES: The intrinsic properties of the new antibiotic linezolid make it an attractive candidate for the treatment of chronic osteomyelitis. However, data regarding the tolerance of long-term linezolid administration are still lacking. METHODS: The medical charts of patients given linezolid for >4 weeks were retrospectively analysed, especially their haematology. In a case-control study, we compared the respective characteristics of patients who developed anaemia during linezolid therapy and those who did not. RESULTS: Forty-five adults with chronic osteomyelitis received 600 mg linezolid intravenously twice daily for 7 days, and then orally, for a mean total duration of 15.9 weeks (range, 6-36). Anaemia episodes requiring blood transfusion occurred in 13/45 patients (28.9%). Median time from treatment initiation to anaemia onset was 7.4 weeks (range, 4-16). Anaemia was significantly associated with premature linezolid therapy cessation (P = 0.0012). No linezolid-related thrombocytopenia was observed. By univariate analysis, four variables were associated with the occurrence of anaemia: age >58 years, alcohol abuse, diabetes mellitus and low haemoglobin before linezolid treatment. Logistic regression analysis revealed two independent risk factors for anaemia: age >58 years (OR = 20.5, 95% CI 0.69-599; P = 0.0001) and pre-treatment haemoglobin <10.5 g/dL (OR = 16.49, 95% CI 1.06-255; P = 0.04). CONCLUSIONS: Profound anaemia may occur in adult patients with chronic osteomyelitis on prolonged linezolid therapy, and often necessitates linezolid cessation. These patients are likely to be aged >58 years and to have low pre-treatment haemoglobin. The results for the present series might help physicians to identify patients who should not be given long-term linezolid treatment for chronic osteomyelitis.
PMID: 15329363 [PubMed - indexed for MEDLINE]

3) SENNEVILLE E. Antimicrobial interventions for the management of diabetic foot infections. Expert Opin. Pharmacother. 2005; 6 (2): 263-273.

Foot infections are the most common cause of hospitalisations and amputations in diabetic patients. They occur after skin ulcers or trauma in patients with peripheral neuropathy, sometimes together with vascular disease. Narrow-spectrum antibiotic agents should be prescribed for minor recent infections, and broader-spectrum agents for severe or chronic infections. When indicated, antibiotic therapy should be started early and be tailored to the individual patient. Diabetic foot osteomyelitis is a particularly controversial condition, especially regarding the need for reliable cultures, the type and duration of treatment, and the role of surgery. Recent data indicates that a medical approach might be effective and could reduce foot amputations among diabetic patients. Interdisciplinary cooperation with infectious disease specialists and orthopaedic surgeons should be considered in such situations.
PMID: 15757422 [PubMed - indexed for MEDLINE]

4) CHANTELOT C., CHANTELOT-LAHOUDE S., MASMEJEAN E., EDDINE TA., MIGAUD H., FONTAINE C. Reconstruction of the distal humeral metaphysis by a free vascularized fibular autograft. A case report. J Shoulder Elbow Surg, 2005, 14, 450-453.

PMID: 16015249 [PubMed – indexed for MEDLINE]

5) SENNEVILLE E, MELLIEZ H, BELTRAND E, LEGOUT L, VALETTE M, CAZAUBIEL M, CORDONNIER M, CAILLAUX M, YAZDANPANAH Y, MOUTON Y. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis. 2006 Jan 1;42(1):57-62.

BACKGROUND: We assessed the diagnostic value of swab cultures by comparing them with corresponding cultures of percutaneous bone biopsy specimens for patients with diabetic foot osteomyelitis. METHODS: The medical charts of patients with foot osteomyelitis who underwent a surgical percutaneous bone biopsy between January 1996 and June 2004 in a single diabetic foot clinic were reviewed. Seventy-six patients with 81 episodes of foot osteomyelitis who had positive results of culture of bone biopsy specimens and who had received no antibiotic therapy for at least 4 weeks before biopsy constituted the study population. RESULTS: Pathogens isolated from bone samples were predominantly staphylococci (52%) and gram-negative bacilli (18.4%). The distributions of microorganisms in bone and swab cultures were similar, except for coagulase-negative staphylococci, which were more prevalent in bone samples (P < .001). The results for cultures of concomitant foot ulcer swabs were available for 69 of 76 patients. The results of bone and swab cultures were identical for 12 (17.4%) of 69 patients, and bone bacteria were isolated from the corresponding swab culture in 21 (30.4%) of 69 patients. The concordance between the results of cultures of swab and of bone biopsy specimens was 42.8% for Staphylococcus aureus, 28.5% for gram-negative bacilli, and 25.8% for streptococci. The overall concordance for all isolates was 22.5%. No adverse events--such as worsening peripheral vascular disease, fracture, or biopsy-induced bone infection--were observed, but 1 patient experienced an episode of acute Charcot osteoarthropathy 4 weeks after bone biopsy was performed. CONCLUSIONS: These results suggest that superficial swab cultures do not reliably identify bone bacteria. Percutaneous bone biopsy seems to be safe for patients with diabetic foot osteomyelitis.
PMID: 16323092 [PubMed - indexed for MEDLINE]

6) SENNEVILLE E, SAVAGE C, NALLET I, YAZDANPANAH Y, GIRAUD F, MIGAUD H, DUBREUIL L, COURCOL R, MOUTON Y. Improved aero-anaerobe recovery from infected prosthetic joint samples taken from 72 patients and collected intraoperatively in Rosenow's broth. Acta Orthop. 2006 Feb ;77(1):120-4.

INTRODUCTION: Recovery of the bacteria responsible for prosthetic joint infections is a major problem, which is due in part to the alteration of their ability to grow by storage during transportation to the laboratory. METHODS: In this prospective study, we assessed the benefit of inoculating an enriched liquid medium (Rosenow's broth) with intraoperative samples from 72 patients with prosthetic joint revision due to infection. We compared the results of culture of specimens collected in a standard receptacle with the results for specimens collected in Rosenow's broth. RESULTS AND INTERPRETATION: 144 samples were taken by each of the 2 collection methods for subsequent culture. Concordance between standard and Rosenow samples was observed for 52 of the 58 strains cultured on agar and for 42 of the 97 strains (p < 0.001) which grew only in liquid medium. Infection would not have been diagnosed in 26 patients (almost one-third of all patients) without combining sample collection in Rosenow's broth with standard collection. The bacteria that were not recovered from standard samples but which were recovered from those collected in Rosenow's broth included not only strict anaerobes, in particular Propionibacterium acnes, but also coagulase-negative staphylococci and streptococci.
PMID: 16534711 [PubMed - indexed for MEDLINE]

7) SENNEVILLE E, LEGOUT L, VALETTE M, YAZDANPANAH Y, BELTRAND E, CAILLAUX M, MIGAUD H, MOUTON Y. Effectiveness and tolerability of prolonged linezolid treatment for chronic osteomyelitis: a retrospective study. Clin Ther. 2006; 28:1155-63.

BACKGROUND: Linezolid is an oxazolidinone agent which is apparently well designed for treating chronic osteomyelitis, but data on effectiveness and tolerability as prolonged therapy is currently lacking. OBJECTIVE: The purpose of this study was to assess the effectiveness and tolerability of linezolid in the treatment of chronic osteomyelitis. METHODS: The charts of hospitalized patients who had been treated with linezolid for >4 weeks because of chronic osteomyelitis and were followed up for > or =12 months after the end of treatment were retrospectively reviewed for clinical outcome and tolerability. Cure was defined as the absence of clinical, biological, or radiological evidence of infection throughout the posttreatment follow-up. Linezolid tolerability was assessed on the basis of hematologic properties during treatment. RESULTS: Of the 66 patients included, all were white (mean [SD] age, 67.7 [18.1] years; 41 men and 25 women; mean [SD] weight, 80.7 [18.6] kg). Thirty-seven (56.1%) patients had infection due to implants including 27 prosthetic joints. Pathogens were predominantly methicillin-resistant staphylococci (49/72 strains, 68.1 %). Every patient was administered N linezolid (600 mg BID) treatment for 6 to 8 days as inpatients, and then, as outpatients, they were switched to PO treatment. Fifty (75.8%) patients received a combination of linezolid and other antimicrobial agents, including rifampin (32 [48.5%]). Surgery was performed in 52 (78.8%) patients. The median hospital stay was 14 days (mean [SD], 19 [11.4] days [range, 7-70 days] ). The median duration of treatment was 13 weeks (mean [SD], 14.3 [8.2] weeks [range, 5-36 weeks]). At the end of treatment, 56 (84.8%) patients were cured, and during the post-treatment follow-up (median duration, 15 months [range, 12-36 months]), 4 relapses occurred, resulting in an overall successful cure for 52 (78.8%) patients. Reversible anemia was reported in 21 patients (31.8%), of whom 16 (24.2%) required blood transfusions. Median time from treatment initiation to anemia onset was 7.3 weeks (range, 4-12 weeks). Peripheral neuropathy was reported in 6 (9.1%) patients, of whom 4 remained symptomatic for up to 24 months after linezolid discontinuation. Other reported adverse events included nausea (6 [9.1%]), diarrhea (1 [1.5%]), and headache (2 [3.0%]), although none of these patients discontinued treatment. CONCLUSIONS: In this retrospective chart review, treatment with linezolid as monotherapy or in combination with antimicrobials and/or surgery was associated with cure of chronic osteomyelitis in 84.8% of subjects at 12 weeks after the end of treatment and 78.8% at follow-up. Adverse events were reported in 51.5% of subjects, and 34.8% of subjects discontinued the study because of adverse events.
The potential for severe complications justifies close monitoring of these patients.
PMID: 16982292 [PubMed - indexed for MEDLINE]

8) CARLIER JP, MANICH M, LOIEZ C, MIGAUD H, COURCOL RJ : First Isolation of Clostridium amygdalinum from a Patient with Chronic Osteitis. J Clin Microbiol, 2006, 44, 3842-3844.

We describe a case of osteitis caused by a new and unusual Clostridium species, Clostridium amygdalinum, an environmental, moderately thermophilic bacterium. This is the first documented report of human infection caused by this organism.
PMID: 17021125 [PubMed - indexed for MEDLINE]
PMCID: PMC1594748

9) LEGOUT L, SENNEVILLE E, STERN R, YAZDANPANAH Y, SAVAGE C, ROUSSEL-DELVALEZ M, ROSELE B, MIGAUD H, MOUTON Y : Treatment of bone and joint infections caused by Gram-negative bacilli with a cefepime-fluoroquinolone combination. Clin Microbiol Infect. 2006, 12(10), 1030-1033.

A 3-year retrospective study evaluated the effectiveness and safety of cefepime plus a fluoroquinolone for treating bone and joint infections caused by Gram-negative bacilli (GNB) in 28 patients. Intra-operative cultures yielded primarily Pseudomonas spp. and Enterobacter cloacae. Full recovery (cure) was observed in 79% of patients. There were no serious adverse effects and no resistant organisms were isolated. The results of the study confirmed the safety and effectiveness of cefepime combined with a fluoroquinolone for the treatment of bone and joint infections caused by Gram-negative bacilli.
PMID: 16961643 [PubMed - indexed for MEDLINE]

10) SENNEVILLE E, LEGOUT L, VALETTE M, YAZDANPANAH Y, BELTRAND E, CAILLAUX M, MIGAUD H, MOUTON Y : Effectiveness and tolerability of prolonged linezolid treatment for chronic osteomyelitis: a retrospective study. Clin Ther, 2006, 28(8), 1155-163.

BACKGROUND: Linezolid is an oxazolidinone agent which is apparently well designed for treating chronic osteomyelitis, but data on effectiveness and tolerability as prolonged therapy is currently lacking. OBJECTIVE: The purpose of this study was to assess the effectiveness and tolerability of linezolid in the treatment of chronic osteomyelitis. METHODS: The charts of hospitalized patients who had been treated with linezolid for >4 weeks because of chronic osteomyelitis and were followed up for > or =12 months after the end of treatment were retrospectively reviewed for clinical outcome and tolerability. Cure was defined as the absence of clinical, biological, or radiological evidence of infection throughout the posttreatment follow-up. Linezolid tolerability was assessed on the basis of hematologic properties during treatment. RESULTS: Of the 66 patients included, all were white (mean [SD] age, 67.7 [18.1] years; 41 men and 25 women; mean [SD] weight, 80.7 [18.6] kg). Thirty-seven (56.1%) patients had infection due to implants including 27 prosthetic joints. Pathogens were predominantly methicillin-resistant staphylococci (49/72 strains, 68.1 %). Every patient was administered N linezolid (600 mg BID) treatment for 6 to 8 days as inpatients, and then, as outpatients, they were switched to PO treatment. Fifty (75.8%) patients received a combination of linezolid and other antimicrobial agents, including rifampin (32 [48.5%]). Surgery was performed in 52 (78.8%) patients. The median hospital stay was 14 days (mean [SD], 19 [11.4] days [range, 7-70 days] ). The median duration of treatment was 13 weeks (mean [SD], 14.3 [8.2] weeks [range, 5-36 weeks]). At the end of treatment, 56 (84.8%) patients were cured, and during the post-treatment follow-up (median duration, 15 months [range, 12-36 months]), 4 relapses occurred, resulting in an overall successful cure for 52 (78.8%) patients. Reversible anemia was reported in 21 patients (31.8%), of whom 16 (24.2%) required blood transfusions. Median time from treatment initiation to anemia onset was 7.3 weeks (range, 4-12 weeks). Peripheral neuropathy was reported in 6 (9.1%) patients, of whom 4 remained symptomatic for up to 24 months after linezolid discontinuation. Other reported adverse events included nausea (6 [9.1%]), diarrhea (1 [1.5%]), and headache (2 [3.0%]), although none of these patients discontinued treatment. CONCLUSIONS: In this retrospective chart review, treatment with linezolid as monotherapy or in combination with antimicrobials and/or surgery was associated with cure of chronic osteomyelitis in 84.8% of subjects at 12 weeks after the end of treatment and 78.8% at follow-up. Adverse events were reported in 51.5% of subjects, and 34.8% of subjects discontinued the study because of adverse events. The potential for severe complications justifies close monitoring of these patients.
PMID: 16982292 [PubMed - indexed for MEDLINE]

11) SADOVSKAYA I, FAURE S, WATIER D, LETERME D, CHOKR A, GIRARD J, MIGAUD H, JABBOURI S. Immunological investigations of a potential use of poly-N-acetyl-{beta}-(1,6)-glucosamine as an antigen for the detection of staphylococcal orthopedic prosthesis-related infections. Clin Vaccine Immunol. 2007, 14(12), 1609-1615.

Staphylococcus aureus and coagulase-negative staphylococci are microorganisms most frequently isolated from orthopedic-implant-associated infections. Their capacity to maintain these infections is thought to be related to their ability to form adherent biofilms.
Poly-N-acetyl-beta-(1,6)-glucosamine (PNAG) is an important constituent of the extracellular biofilm matrix of staphylococci.
In the present study, we explored the possibility of using PNAG as an antigen for detecting antibodies in the blood sera of patients with staphylococcal orthopedic-prosthesis-associated infections. First, we tested the presence of anti-PNAG antibodies in an animal model, in the blood sera of guinea pigs that developed an implant-associated infection caused by biofilm-forming, PNAG-producing strains of Staphylococcus epidermidis. Animals infected with S. epidermidis RP62A showed levels of anti-PNAG immunoglobulin G (IgG) significantly higher than those of the control group. The comparative study of healthy individuals and patients with staphylococcal prosthesis-related infections showed that (i) relatively high levels of anti-PNAG IgG were present in the blood sera of the healthy control group, (ii) the corresponding levels in the infected patients were slightly but not significantly higher, and (iii) only 1 of 10 patients had a level of anti-PNAG IgM significantly higher than that of the control group. In conclusion, the encouraging results obtained in the animal study could not be readily applied for the diagnosis of staphylococcal orthopedic-prosthesis-related infections in humans, and PNAG does not seem to be an appropriate antigen for this purpose. Further studies are necessary to determine whether the developed enzyme-linked immunosorbent assay method could serve as a complementary test in the individual follow-up treatment of such infections caused by PNAG-producing staphylococci.
PMID: 17942607 [PubMed - indexed for MEDLINE]

12) SENNEVILLE E, POISSY J, LEGOUT L, DEHECQ C, LOÏEZ C, VALETTE M, BELTRAND E, CAILLAUX M, MOUTON Y, MIGAUD H, YAZDANPANAH Y. Safety of prolonged high-dose levofloxacin therapy for bone infections. J Chemother. 2007 Dec;19(6):688-93.

The records of 84 patients with bone infections treated with high-dose levofloxacin (i.e. 0.75-1g daily) for more than 4 weeks were reviewed. Patients were given either 500 mg b.i.d. throughout the treatment period [Group 1 (n=41)], 500 mg b.i.d. for 3 weeks and then 750 mg q.d. [Group 2 (n=21)] or 750 mg q.d. for the whole treatment period [Group 3 (n=22)]. All patients had combined therapy, including levofloxacin-rifampin in 62 cases (73.8%), for an average duration of 13.7 weeks. Muscular pain and/or tendonitis were reported in 19 patients (22.6%) which affected more patients in Groups 1 and 2 than in Group 3 (14/41 and 5/21 vs. 0/22; p=0.01 and 0.001, respectively). A dosage of 750 mg q.d. may be warranted for prolonged high-dose levofloxacin treatment in patients with bone infections rather than 500 mg b.i.d. for the entire duration of treatment, or for the first 3 weeks.
PMID: 18230552 [PubMed - in process]

13) SENNEVILLE E, LOMBART A, BELTRAND E, VALETTE M, LEGOUT L, CAZAUBIEL M, YAZDANPANAH Y, FONTAINE P. Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study. Diabetes Care. 2008 Apr;31(4):637-42.s

OBJECTIVE: The purpose of this article was to identify criteria predictive of remission in nonsurgical treatment of diabetic foot osteomyelitis. RESEARCH DESIGN AND METHODS: Diabetic patients who were initially treated without orthopedic surgery for osteomyelitis of the toe or metatarsal head of a nonischemic foot between June 2002 and June 2003 in nine French diabetic foot centers were identified, and their medical records were reviewed. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least 1 year after the end of treatment. A total of 24 demographic, clinical, and therapeutic variables including bone versus swab culture-based antibiotic therapy were analyzed. RESULTS: Fifty consecutive patients aged 62.2 +/- 11.1 years (mean +/- SD) with diabetes duration of 16 +/- 10.9 years were included. The mean duration of antibiotic treatment was 11.5 +/- 4.21 weeks. Bone biopsy was routinely available in four of the nine centers. Overall patient management was similar in the different centers except for the use of rifampin, which was recorded more frequently in patients from centers in which a bone biopsy was available. At the end of a 12.8-month posttreatment mean follow-up, 32 patients (64%) were in remission. Bone culture-based antibiotic therapy was the only variable associated with remission, as determined by both univariate (18 of 32 [56.3%] vs. 4 of 18 [22.2%], P = 0.02) and multivariate analyses (odds ratio 4.78 [95% CI 1.0-22.7], P = 0.04). CONCLUSIONS: Bone culture-based antibiotic therapy is a factor predictive of success in diabetic patients treated nonsurgically for osteomyelitis of the foot.
PMID: 18184898 [PubMed - in process]

 

14) HARTEMANN-HEURTIER A, SENNEVILLE E Diabetic foot osteomyelitis. Diabetes Metab. 2008 Apr;34(2):87-95.

Bone infection in the diabetic foot is always a complication of a preexisting infected foot wound. Prevalence can be as high as 66%. Diagnosis can be suspected in two mains conditions: no healing (or no depth decrease) in spite of appropriate care and off-loading, and/or a visible or palpated bone with a metal probe. The first recommended diagnostic step is to perform (and if necessary to repeat) plain radiographs. After a four-week treatment period, if plain radiographs are still normal, suspicion for bone infection will persist in case of bad evolution despite optimized management of off-loading and arterial disease. It is only in such cases that other diagnosis methods than plain radiographs must be used. Staphylococcus aureus is the most common pathogen cultured from bone samples, followed by Staphylococcus epidermidis. Among enterobacteriaceae, Escherichia coli, Klebsiella pneumonia and Proteus sp. are the most common, followed by Pseudomonas aeruginosa. Surprisingly, bacteria usually considered contaminant (as coagulase negative staphylococci (CNS) and Corynebacterium sp.) have been documented to be pathogens in the osteomyelitis of diabetic foot. Traditional approach to treatment of chronic osteomyelitis was by surgical resection of infected and necrotic bone. But new classes of antibiotics have both the required spectrum of activity and the capacity to penetrate and concentrate in the infected bone. Recently, several observations of osteomyelitis remission following non-surgical management with a prolonged course of antibiotics have been published. Lastly, combined approach with local bone excision and antibiotics has been proposed. Prospective trials should be undertaken to determine the relative roles of surgery and antibiotics in managing diabetic foot osteomyelitis.
PMID: 18242114 [PubMed - in process]

15) NGUYEN S, PASQUET A, LEGOUT L, BELTRAND E, DUBREUIL L, MIGAUD H, YAZDANPANAH Y, SENNEVILLE E Efficacy and tolerance of rifampicin-linezolid compared with rifampicin-cotrimoxazole combinations in prolonged oral therapy for bone and joint infections. Clin Microbiol Infect. 2009 May 4.

Both linezolid and cotrimoxazole are antibiotics that are well suited for oral therapy of bone and joint infections (BJI) caused by otherwise resistant Gram-positive cocci (GPC) (resistance to fluoroquinolones, maccolides, betalactamines). However, in this context, no data are currently available regarding the safety and tolerance of these antibiotics in combination with rifampicin. The objective of this study was to compare the efficacy and safety of a combination of rifampicin and linezolid (RLC) with those of a combination of rifampicin and cotrimoxazole (RCC) in the treatment of BJI. Between February 2002 and December 2006, 56 adult patients (RLC, n = 28; RCC, n = 28), including 36 with infected orthopaedic devices (RLC, n = 18; RCC, n = 18) and 20 with chronic osteomyelitis (RLC, n = 10; RCC, n = 10), were found to be eligible for inclusion in this study. Patients who discontinued antibiotic therapy within 4 weeks of commencing treatment were considered to represent cases of treatment failure and were excluded. Rates of occurrence of adverse effects were similar in the two groups, at 42.9% in the RLC group and 46.4% in the RCC group (p = 1.00), and led to treatment discontinuation in four (14.3%) RLC and six (21.4%) RCC patients. Cure rates were found to be similar in the two groups (RLC, 89.3%, RCC, 78.6%; p = 0.47). Prolonged oral RLC and RCC therapy were found to be equally effective in treating patients with BJI caused by resistant GPC, including patients with infected orthopaedic devices. However, the lower cost of cotrimoxazole compared with linezolid renders RCC an attractive treatment alternative to RLC. Further larger clinical studies are warranted to confirm these preliminary results.
PMID: 19438638 [PubMed - as supplied by publisher]

16) LANGLAIS F, JUDET H, VIELPEAU C, BERNARD L, CHAUVEAUX D, BEAUFILS P, BERNARD L, DUJARDIN F, HAMADOUCHE M, MAMOUDY P, MIGAUD H, MINET J, PEGOIX M, SENNEVILLE E, TABUTIN J, BONNOMET F, CAILLON J, POTEL G, ROSENCHER N, SAMAMA CM. Use of acrylic cement with antibiotic in primary arthroplasty. Rev Chir Orthop Reparatrice Appar Mot. 2008 Oct;94 Suppl(6):S215-8.

Recommandations pour la pratique clinique : A l’issue des réunions du jury, il a été établi les recommandations suivantes, qui ont été exposées lors la séance publique du 5 novembre pendant le congrès de l’Académie d’orthopédie—traumatologie dans le cadre de la Sofcot.
Grade A Compte tenu de l’efficacité avérée sur le plan infectieux, et de l’absence de risque supplémentaire sur le plan mécanique, il est recommandé d’utiliser un ciment contenant un aminoside (gentamicine, tobramycine), dans le cadre d’une prophylaxie anti-infectieuse, lors d’une arthroplastie primaire cimentée
Grade B Lorsqu’un ciment contenant un antibiotique est utilisé, à titre prophylactique, il est recommandé d’utiliser un mélange industriel plutôt qu’un mélange extemporané.
Grade D Préalablement à l’utilisation d’un ciment contenant un antibiotique il est recommandé de rechercher, par l’interrogatoire, une allergie à l’antibiotique utilisé.
Grade D Lorsqu’une arthroplastie primaire, scellée avec un ciment-antibiotique, doit être reprise pour infection, il est recommandé de tenir compte d’un risque accru de germes résistants à l’antibiotique utilisé initialement
Grade D Compte tenu du risque théorique de toxicité rénale, il est recommandé de ne pas utiliser un ciment-aminoside chez l’insuffisant rénal sévère ou en association avec d’autres médicaments néphrotoxiques par voie générale.
PMID: 18928818 [PubMed - indexed for MEDLINE]

 

17) CARLIER JP, MANICH M, LOÏEZ C, MIGAUD H, COURCOL RJ. First isolation of Clostridium amygdalinum from a patient with chronic osteitis. J Clin Microbiol. 2006 Oct;44(10):3842-4.

We describe a case of osteitis caused by a new and unusual Clostridium species, Clostridium amygdalinum, an environmental, moderately thermophilic bacterium. This is the first documented report of human infection caused by this organism.
PMID: 17021125 [PubMed - indexed for MEDLINE]

18) GASIUNAS V, PLENIER I, HERENT S, MAY O, SENNEVILLE E, MIGAUD H. Transabdominal removal of femoral and acetabular components of a severely protruded and infected hip arthroplasty with urinary tract complications. Rev Chir Orthop Reparatrice Appar Mot. 2005 Jun;91(4):346-50.

We present the first report of transabdominal removal of femoral and acetabular components of a severely loosened hip prosthesis protruding into the pelvis. In a 73-year-old woman post-operative development of urinary tract complications emphasize importance of careful assessment of the prosthetic relations with the vascular and nervous structures as well as pelvic organs before removal of the hip prosthesis. Angio-computed tomography is the most contributive exploration to assess vascular relations. In patients with particular clinical presentations or with threatened structures in the vicinity of the prosthesis, this examination must be completed by complementary opacifications (urinary and gastrointestinal tracts, joints). Ureteral catheterization may be needed if the structures are close or if there is a suspected modification of the urinary tract (retraction, mass effect). In present case, we did not opacify the urinary tract before laparatomy despite the presence of urinary signs preoperatively. A suspected ureterovaginal fistula was discovered. But they where also a ureteral lesions which can result from difficult dissection in contact with infected tissues. In this patient, urinary complications led to nephrectomy after temporary pyelostomy for urine bypass. At last follow-up, the urinary tract infection was controlled but reimplantation was not attempted because of insulin dependent diabetes mellitus and poor general condition. The spontaneous course of this infection with prosthesis loosening recalls the importance of regular surveillance of total hip replacements.
PMID: 16158550 [PubMed - indexed for MEDLINE]

19) SENNEVILLE E, MIGAUD H, PINOIT Y, SAVAGE C, LAFFARGUE P, DESPLACES N. Modalités et facteurs de guérison de l’antibiothérapie systémique. Rev Chir Orthop Reparatrice Appar Mot. 2002;88 Suppl5, 184-186.

Les résultats de cette étude rétrospective comprenant plus de 500 patients recrutés sur une période de temps restreinte et bénéficiant d’un recul d’au moins deux ans pour l’évaluation clinique de la guérison ne peuvent cependant pas conduire à des conclusions définitives mais permettent de définir quelques axes de recherche dans le domaine de l’antibiothérapie tels que l’intérêt de la rifampicine dans les schémas thérapeutiques de patients bénéficiant d’un changement de matériel (et le retentissement écologique de ce type d’antibiothérapie à « haut risque »), le bénéfice des associations glycopeptides-rifampicine par rapport aux associations « traditionnelles » rifampicinefluoroquinolones et les durées minimales efficaces des traitements antibiotiques. Cette étude démontre, s’il en était besoin, le potentiel des centres français d’orthopédie pour colliger les données relatives aux patients porteurs d’une infection sur matériel.

20) LOÏEZ C, TAVANI F, WALLET F, FLAHAUT B, SENNEVILLE E, GIRARD J, COURCOL RJ. An unusual case of prosthetic joint infection due to Arcanobacterium bernardiae. J Med Microbiol 2009; 58:842-3.

PMID: 19429766 [PubMed - indexed for MEDLINE]

21) SENNEVILLE E, MORANT H, DESCAMPS D, DEKEYSER S, BELTRAND E, SINGER B, CAILLAUX M, BOULOGNE A, LEGOUT L, LEMAIRE X, LEMAIRE C, YAZDANPANAH Y. Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot. Clin Infect Dis. 2009; 48: 888-93.

BACKGROUND: Needle puncture has been suggested as a method for identifying bacteria in the bones in patients with diabetes with osteomyelitis of the foot. However, no studies have compared needle puncture with concomitant transcutaneous bone biopsy, which is the current standard recommended in international guidelines. METHODS: We conducted a prospective study in 2 French diabetes foot clinics. Transcutaneous bone biopsy specimens, needle puncture specimens, and swab samples were collected on the same day for each patient. RESULTS: Overall, 31 patients were included in the study from July 2006 through February 2008. Twenty-one bone biopsy specimens (67.7%), 18 needle puncture specimens (58%), and 30 swab samples (96.7%) had positive culture results. Staphylococcus aureus was the most common type of bacteria that grew from bone samples, followed by Proteus mirabilis and Morganella morganii. The mean number of bacteria types per positive sample were 1.35, 1.32, and 2.51 for bone biopsy specimens, needle puncture specimens, and swab samples, respectively. Among the 20 patients with positive bone biopsy specimens (69%), 13 had positive needle puncture samples. Overall, the correlation between microbiological results was 23.9%, with S. aureus showing the strongest correlation (46.7%). Results of cultures of bone biopsy and needle puncture specimens were identical for 10 (32.3%) of 31 patients. Bone bacteria were isolated from the needle punctures in 7 (33.3%) of the 21 patients who had positive bone biopsy specimen culture results. If the results of cultures of needle puncture specimens alone had been considered, 5 patients (16.1%) would have received unnecessary treatment, and 8 patients (38.1%) who had positive bone culture results would not have been treated at all. CONCLUSIONS:Our results suggest that needle punctures, compared with transcutaneous bone biopsies, do not identify bone bacteria reliably in patients with diabetes who have low-grade infection of the foot and suspected osteomyelitis.
PMID: 19228109 [PubMed - indexed for MEDLINE]

22) BERENDT AR, PETERS EJ, BAKKER K, EMBIL JM, ENEROTH M, HINCHLIFFE RJ, JEFFCOATE WJ, LIPSKY BA, SENNEVILLE E, TEH J, VALK GD. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev. 2008; 24 Suppl 1:S145-61.

The International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006.The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations.The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae.We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited, and further research is urgently needed.
PMID: 18442163 [PubMed - indexed for MEDLINE]

23) BERENDT AR, PETERS EJ, BAKKER K, EMBIL JM, ENEROTH M, HINCHLIFFE RJ, JEFFCOATE WJ, LIPSKY BA, SENNEVILLE E, TEH J, VALK GD. Specific guidelines for treatment of diabetic foot osteomyelitis. Diabetes Metab Res Rev. 2008; 24 Suppl 1:S190-1.

PMID: 18442187 [PubMed - indexed for MEDLINE

24) MAYNOU C, MÉNAGER S, SENNEVILLE E, BOCQUET D, MESTDAGH H. Clinical results of resection arthroplasty for infected shoulder arthroplasty. Rev Chir Orthop Reparatrice Appar Mot. 2006; 92:567-74.

PURPOSE OF THE STUDY: Infection is a rare complication of shoulder arthroplasty. Various therapeutic solutions have been proposed: antibiotics alone, one-stage or two-stage reimplantation, surgical or arthroscopic cleaning without prosthesis removal, scapulohumeral arthrodesis or simple arthroscopic resection. We evaluated the mid-term clinical outcome after resection arthroplasty for the treatment of infected shoulder arthroplasty. MATERIAL AND METHODS: The series included ten infected arthroplasties in ten patients. Mean duration of implantation was two years seven months (range nine months to five years). Bacteriological diagnosis was established from intraoperative articular samples or systematic samples taken during surgical revision procedures: meti-S Staphylococcus aureus strains (n=4), coagulase-negative Staphylococcus (n=5 including three S. epidermidis) Streptococcus mitis (n=1) and Citrobacter koseri (n=1). The mean Constant score before revision was 58 (range 23-77). Subjective patient satisfaction before surgical revision was rated good in six cases, fair in one and poor in three. Surgery associated removal of the implant, complete resection of the cement, resection of the fistular tracts, wide debridement of infected tissues and total synovectomy. RESULTS: Patients were seen at an average follow-up of three years eight months. The objective functional outcome measured with the Constant score was only fair, 28 points (range 20.6-36), and corresponded to a loss of 29 points compared with the preoperative score. This was explained mainly by lower scores for joint motion, function and muscle force but with persistently satisfactory scores for pain. All patients remained pain-free (daytime and nighttime). Patient satisfaction was rated good for two, fair for five and mediocre for three. Clinical and biological proof of eradicated infection was obtained in all patients. DISCUSSION: Infection remains a serious devastating problem for shoulder arthroplasty with an important functional impact. Resection only has a modest clinical effect. Precise identification of the causal germ with institution of adapted antibiotic therapy is required for eradication of the infection. Early diagnosis is probably the most important parameter affecting clinical outcome and surgical options. Functional results after resection arthroplasty are modest. This procedure should be reserved for patients with reduced functional demands. Improved management of the infectious load and reduction of diagnostic delay should help improve functional outcome and favor use of stow-stage procedures for reinsertion.
PMID: 17088753 [PubMed - indexed for MEDLINE]

2009
Société de Pathologie Infectieuse de Langue Française (SPILF); Collège des Universitaires de Maladies Infectieuses et Tropicales (CMIT); Groupe de Pathologie Infectieuse Pédiatrique (GPIP); Société Française d'Anesthésie et de Réanimation (SFAR); Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT); Société Française d'Hygiène Hospitalière (SFHH); Société Française de Médecine Nucléaire (SFMN); Société Française de Médecine Physique et de Réadaptation (SOFMER); Société Française de Microbiologie (SFM); Société Française de Radiologie (SFR-Rad); Société Française de Rhumatologie (SFR-Rhu). [Recommendations for clinical practice. Osteo-articular infection therapy according to materials used (prosthesis, implants, osteosynthesis)]. Med Mal Infect. 2009 Oct;39(10):745-74.

Nguyen S, Pasquet A, Legout L, Beltrand E, Dubreuil L, Migaud H, Yazdanpanah Y, Senneville EEfficacy and tolerance of rifampicin-linezolid compared with rifampicin-cotrimoxazole combinations in prolonged oral therapy for bone and joint infections. Clin Microbiol Infect. 2009 Dec;15(12):1163-9
Abstract
Both linezolid and cotrimoxazole are antibiotics that are well suited for oral therapy of bone and joint infections (BJI) caused by otherwise resistant Gram-positive cocci (GPC) (resistance to fluoroquinolones, maccolides, betalactamines). However, in this context, no data are currently available regarding the safety and tolerance of these antibiotics in combination with rifampicin. The objective of this study was to compare the efficacy and safety of a combination of rifampicin and linezolid (RLC) with those of a combination of rifampicin and cotrimoxazole (RCC) in the treatment of BJI. Between February 2002 and December 2006, 56 adult patients (RLC, n = 28; RCC, n = 28), including 36 with infected orthopaedic devices (RLC, n = 18; RCC, n = 18) and 20 with chronic osteomyelitis (RLC, n = 10; RCC, n = 10), were found to be eligible for inclusion in this study. Patients who discontinued antibiotic therapy within 4 weeks of commencing treatment were considered to represent cases of treatment failure and were excluded. Rates of occurrence of adverse effects were similar in the two groups, at 42.9% in the RLC group and 46.4% in the RCC group (p = 1.00), and led to treatment discontinuation in four (14.3%) RLC and six (21.4%) RCC patients. Cure rates were found to be similar in the two groups (RLC, 89.3%, RCC, 78.6%; p = 0.47). Prolonged oral RLC and RCC therapy were found to be equally effective in treating patients with BJI caused by resistant GPC, including patients with infected orthopaedic devices. However, the lower cost of cotrimoxazole compared with linezolid renders RCC an attractive treatment alternative to RLC. Further larger clinical studies are warranted to confirm these preliminary results.

2010
Société de Pathologie Infectieuse de Langue Française (SPILF); Collège des Universitaires de Maladies Infectieuses et Tropicales (CMIT); Groupe de Pathologie Infectieuse Pédiatrique (GPIP); Société Française d'Anesthésie et de Réanimation (SFAR); Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT); Société Française d'Hygiène Hospitalière (SFHH); Société Française de Médecine Nucléaire (SFMN); Société Française de Médecine Physique et de Réadaptation (SOFMER); Société Française de Microbiologie (SFM); Société Française de Radiologie (SFR-Rad); Société Française de Rhumatologie (SFR-Rhu). Recommendations for bone and joint prosthetic device infections in clinical practice (prosthesis, implants, osteosynthesis). Société de Pathologie Infectieuse de Langue Française. Med Mal Infect. 2010 Apr;40(4):185-211. doi: 10.1016/j.medmal.2009.12.009

Legout L, Valette M, Dezeque H, Nguyen S, Lemaire X, Loïez C, Caillaux M, Beltrand E, Dubreuil L, Yazdanpanah Y, Migaud H, Senneville E. Tolerability of prolonged linezolid therapy in bone and joint infection: protective effect of rifampicin on the occurrence of anaemia? J Antimicrob Chemother. 2010 Oct;65(10):2224-30.
Abstract
BACKGROUND: Linezolid therapy has shown high rates of clinical success in patients with osteomyelitis and prosthetic joint infections caused by Gram-positive cocci. Recent studies have demonstrated that linezolid/rifampicin combination therapy prevents the emergence of rifampicin-resistant mutations in vitro. However, linezolid/rifampicin combination-related haematological and neurological toxicities have not been evaluated.
OBJECTIVES: To assess the tolerability of prolonged linezolid/rifampicin combination therapy compared with other linezolid-containing regimens in patients with bone and joint infections.
METHODS: We reviewed the medical records of 94 patients who had received linezolid for >4 weeks after bone and joint infections. Anaemia was defined as a ≥2 g/dL reduction in haemoglobin, leucopenia as a total leucocyte count <4 × 10(9)/L, and thrombocytopenia as a reduction in platelet count to <75% of baseline.
RESULTS: Anaemia was less frequent among patients on linezolid/rifampicin combination therapy than among patients on linezolid alone or in combination with other drugs (9.3%, 44% and 52%, respectively; P<0.01). In multivariate analysis, age and treatment group were independently associated with anaemia. Thrombocytopenia was reported in 44% of patients on linezolid/rifampicin combination therapy, in 48% of patients on linezolid alone and in 57.7% of patients on other linezolid-containing regimens. Age was the only variable associated with thrombocytopenia (P=0.019) in univariate analysis.
CONCLUSIONS: Linezolid/rifampicin combination therapy was associated with a significantly reduced incidence of anaemia among patients with bone and joint infections, but it did not have an effect on thrombocytopenia and peripheral neuropathy rates. Linezolid/rifampicin combination therapy was not associated with poor clinical outcomes.

2011
Lemaire X, Loiez C, Valette M, Migaud H, Dubreuil L, Yazdanpanah Y, Senneville E. Comparison of vancomycin and teicoplanin trough serum levels in patients with infected orthopedic devices: new data for old therapies. J Infect Chemother. 2011 Jun;17(3):370-4.
Abstract
We compared retrospectively vancomycin and teicoplanin trough serum levels after loading doses and, subsequently, after high daily doses, in 52 patients (26 in each group) who had developed infections after implantation of an orthopedic device. The target trough serum level was > 25 mg/l. Trough levels were significantly higher at 2 days (±1) and 5 days (±1) in patients who received teicoplanin compared with patients who received a continuous perfusion of vancomycin (26.1 vs. 16 mg/l at day 2 ± 1, P = 0.01; 27.8 vs. 19.9 mg/l at day 5 ± 1, P = 0.01). One of the 26 patients taking vancomycin reached the target trough serum level by day 2 (±1), whereas 10 of the 26 patients taking teicoplanin reached the target by that time (P = 0.002). At day 5 (±1), 6/26 patients taking vancomycin reached the target, versus 13/26 patients taking teicoplanin (P = 0.04). However, physicians should remain cautious when administering teicoplanin empirically because of the higher MIC₉₀ values observed for coagulase-negative staphylococci compared with vancomycin.

Girard J, Blairon A, Wavreille G, Migaud H, Senneville E. Total hip arthroplasty revision in case of intra-pelvic cup migration: designing a surgical strategy. Orthop Traumatol Surg Res. 2011 Apr;97(2):191-200
Abstract
Intrapelvic acetabular cup migration is a rare but serious complication, which can occur after cup loosening following total hip arthroplasty. To make safe intrapelvic implant removal, several principles must be respected: identification of potential risks with a thorough preoperative workup, preoperative planing of a surgical strategy for removing protruding hardware without injuring noble anatomical structures, preserving muscle and bone stock, pelvic anatomy reconstruction (including, as needed, osteosynthesis of the pelvis), and prosthetic components selection correcting any length discrepancy. Preoperative assessment is based on a complete radiological workup, angio-CT, as well as studies searching for signs of inflammation (blood workup and joint aspiration). All cases of intrapelvic migration of an acetabular component do not systematically command a subperitoneal approach. The presence of some residual bone shell, an intrapelvic foreign body, or a path deviation from normal in a vascular bundle or an ureter must be analyzed before deciding on the approach. The potential problems managing this mode of loosening event are a reminder for the need of periodical total hip arthroplasty follow-up. This regular monitoring helps preventing complications sometimes life threatening.

Poissy J, Senneville E. New antibiotics for severe ICU-aquired bacterial infections. Infect Disord Drug Targets. 2011 Aug;11(4):401-12
Abstract
Infection is a major cause of morbidity and mortality in intensive care units (ICU). The impact on prognostic of an inadequate antibiotic therapy is well established. The problem is due to the growing spread of resistant microorganisms, including both Gram-negative and Gram-positive pathogens, especially in the case of ICU-acquired infections. In this context, antibiotics with broad spectrum activity are usually required. Moreover, these antibiotics should reach high concentrations in tissues, especially in lungs, and should exert a bactericidal activity for the most severely ill patients, especially those with bloodstream infections. A frequent problem in clinical practice is the lack of data validating their use in the context of critically ill patients. In the present article, we review the newest antibiotics that could be of interest for severe ICU-acquired infections: tigecycline, moxifloxacine, the newer carbapenems, linezolide and daptomycine. We discuss their approved indications and identify the fields in which they could be used to treat infections acquired in the ICU.

Senneville E, Joulie D, Legout L, Valette M, Dezèque H, Beltrand E, Roselé B, d'Escrivan T, Loïez C, Caillaux M, Yazdanpanah Y, Maynou C, Migaud H. Outcome and predictors of treatment failure in total hip/knee prosthetic joint infections due to Staphylococcus aureus. Clin Infect Dis. 2011 Aug;53(4):334-40.
Abstract
BACKGROUND: Variables associated with the outcome of patients treated for prosthetic joint infections (PJIs) due to Staphylococcus aureus are not well known.
METHODS: The medical records of patients treated surgically for total hip or knee prosthesis infection due to S. aureus were reviewed. Remission was defined by the absence of local or systemic signs of implant-related infection assessed during the most recent contact with the patient.
RESULTS: After a mean posttreatment follow-up period of 43.6 ± 32.1 months, 77 (78.6%) of 98 patients were in remission. Retention of the infected implants was not associated with a worse outcome than was their removal. Methicillin-resistant S. aureus (MRSA)-related PJIs were not associated with worse outcome, compared with methicillin-susceptible S. aureus (MSSA)-related PJIs. Pathogens identified during revision for failure exhibited no acquired resistance to antibiotics used as definitive therapy, in particular rifampin. In univariate analysis, parameters that differed between patients whose treatment did or did not fail were: American Society of Anesthesiologists (ASA) score, prescription of adequate empirical postsurgical antibiotic therapy, and use of rifampin combination therapy upon discharge from hospital. In multivariate analysis, ASA score ≤2 (odds ratio [OR], 6.87 [95% confidence interval {CI}, 1.45-32.45]; P = .04) and rifampin-fluoroquinolone combination therapy (OR, 0.40 [95% CI, 0.17-0.97]; P = .01) were 2 independent variables associated with remission.
CONCLUSIONS: The results of the present study suggest that the ASA score significantly affects the outcome of patients treated for total hip and knee prosthetic infections due to MSSA or MRSA and that rifampin combination therapy is associated with a better outcome for these patients when compared with other antibiotic regimens.

Mallet M, Loiez C, Melliez H, Yazdanpanah Y, Senneville E, Lemaire X. Staphylococcus simulans as an authentic pathogenic agent of osteoarticular infections. Infection. 2011 Oct;39(5):473-6.
Abstract
OBJECTIVES: To evaluate the role of Staphylococcus simulans in bone and joint infections (BJI) and determine their main characteristics.
METHODS: A search of the database of the microbiology laboratories of Lille hospital and Tourcoing hospital was performed. Only results from blood, bone, and orthopedic device cultures were taken into account for hospitalized patients between January 2004 and January 2009. We considered cases in which S. simulans was the only bacteria isolated in all of the patients' biological samples with clinical and laboratory signs of infection. For patients with complete medical records, we recorded the clinical and epidemiological data.
RESULTS: Six cases of BJI due to S. simulans were recorded, with five cases related to orthopedic devices infections. Three patients lived in rural areas. In four out of six patients, S. simulans was isolated in intraoperative biopsy material. In one patient, S. simulans grew in synovial fluid and in another in blood cultures only. The latter patient had a spondylodiscitis, and chronic foot ulcers due to gout disease were suspected to be the origin of the infection. All patients were healed after a mean follow up of 9 ± 3 months. Orthopedic devices were removed in four of the five patients concerned. The combination of rifampicin plus levofloxacin was used in four patients.
CONCLUSION: The present data suggest that, even though S. simulans remains rarely observed in clinical pathology, its role in osteoarticular infections, especially in the case of infected orthopedic devices, is not exceptional. As for the antibiotic treatment, the combination of rifampicin and levofloxacin seems to be an effective strategy according to our clinical results.

Joulie D, Girard J, Mares O, Beltrand E, Legout L, Dezèque H, Migaud H, Senneville E. Factors governing the healing of Staphylococcus aureus infections following hip and knee prosthesis implantation: a retrospective study of 95 patients. Orthop Traumatol Surg Res. 2011 Nov;97(7):685-92.
Abstract
INTRODUCTION: The prognostic factors for total hip arthroplasty (THA) and total knee arthroplasty (TKA) Staphylococcus aureus prosthetic joint infections are poorly known, notably because of the heterogeneous management in terms of both antibiotic administration and adopted surgical strategy. Uniform treatment regimens would make it easier to define the outcome of these S. aureus infections.
PATIENTS AND METHODS: Between 2001 and 2006, 95 patients with a S. aureus joint infection after THA or TKA were treated, strictly following a standardized protocol according to the recommendations of Zimmerli et al. The patients' mean age was 65.7 years, 71 with THA and 28 with TKA (four patients had two infected joints). These 95 patients presented 120 infectious episodes, all of whom had surgical treatment: 53 lavages (44.1%), 17 one-stage prosthesis revisions (14.2%), 29 two-stage prosthesis revisions (24.2%), and 21 prostheses removed (17.5%). On the intraoperative samples taken, methicillin-sensitive S. aureus (MSSA) was isolated in 88 patients (73.3%) and methicillin-resistant S. aureus (MRSA) in 18 patients (15%); finally 14 patients were included because of the positive results of preoperative samples taken. Twenty-seven infections (22.5%) were multibacterial, including at least S. aureus and 93 were single S. aureus bacteria. Success was defined at a minimum 12 months of follow-up by the association of the following parameters: normal erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) results, noninflammatory scar with no fistula, no surgical revision, and no antibiotic treatment.
RESULTS: At a mean follow-up of 38±24.9 months, 81 of the 120 infectious episodes were resolved (67.5%) and 77 of the 95 patients were healed (81%). Six parameters significantly influenced the healing of the infection: initial cementless fixation, THA, preoperative knowledge of the bacterium, immediate postoperative antibiotic therapy adapted to the microbiological data, changing the prosthesis, and monobacterial infection. Only the latter two were independent, with an odds ratio of 5 (1.6-14.9) and 2.9 (1.1-7.7) respectively. However, resistance to methicillin did not appear to be a factor of failure.
DISCUSSION: Management of prosthetic S. aureus infections according to a uniform protocol in a specialized medical center healed the infection in 81% of the patients. Treatment improvement requires knowledge of the bacterium, adaptation of immediate probabilistic antibiotic therapy, and preference for changing the prosthesis over simple lavage.

2012
Legout L, Beltrand E, Migaud H, Senneville E. Antibiotic prophylaxis to reduce the risk of joint implant contamination during dental surgery seems unnecessary. Orthop Traumatol Surg Res. 2012 Dec;98(8):910-4
Abstract
INTRODUCTION: Joint implant infection rates range between 0.5% and 3%. Contamination may be hematogenous, originating in oro-dental infection and, as in endocarditis, antibiotic prophylaxis has been recommended to cover oro-dental surgery in immunodepressed patients with joint implants less than 2 years old, despite the lack of any formal proof of efficacy. In this context, the cost and side effects of such prophylaxis raise the question of its real utility.
MATERIALS AND METHODS: A search of Pubmed was performed using the following keywords: prosthetic joint infection, dental procedure, antibiotic prophylaxis, hematogenous infection, dental infection, bacteremia, and endocarditis. Six hundred and fifty articles were retrieved, 68 of which were analyzed in terms of orthopedic prosthetic infection and/or endocarditis and oro-dental prophylaxis, as relevant to the following questions: frequency and intensity of bacteremia of oro-dental origin, frequency of prosthetic joint infection secondary to dental surgery, and objective efficacy of antibiotic prophylaxis in dental surgery in patients with joint implants.
RESULTS: Bacteremia of oro-dental origin is more frequently associated with everyday activities such as mastication than with tooth extraction. Isolated cases of prosthetic contamination from dental infection have been reported, but epidemiological studies in joint implant bearers found that absence of antibiotic prophylaxis during oro-dental surgery did not increase the rate of prosthetic infection. The analysis was not able to answer the question of the efficacy of dental antibiotic prophylaxis in immunodepressed patients; however, oro-dental hygiene and regular dental treatment reduce the risk of prosthetic infection by 30%.
DISCUSSION AND CONCLUSION: The present update is in agreement with the conclusions of ANSM expert group, which advised against antibiotic prophylaxis in oro-dental surgery in implant bearers, regardless of implant duration or comorbidity: the associated costs and risks are disproportional to efficacy.

Titécat M, Loïez C, Senneville E, Wallet F, Dezèque H, Legout L, Migaud H, Courcol RJ. Evaluation of rapid mecA gene detection versus standard culture in staphylococcal chronic prosthetic joint infections. Diagn Microbiol Infect Dis. 2012 Aug;73(4):318-21.
Abstract
In case of periprosthetic joint infections, the antibiotic treatment administered intraoperatively entails consequences on bacterial ecology with potential secondary effects. This study evaluates the rapid detection of methicillin-resistant staphylococci (MRS) by Xpert® technology directly on intraoperative samples. Xpert® technology was compared to conventional culture for 104 clinical specimens performed on 30 patients. The performance of the test expressed in terms of sensitivity, specificity, positive predictive value, and negative predictive value was, respectively, 87.1%, 100%, 100%, and 94.5% for the 104 specimens, and 92.3%, 100%, 100%, and 94.4% for the 30 patients. With the rapid detection of MRS, the use of vancomycin was limited for 17 of these 30 patients. In conclusion, this technique would allow the implementation of first-line antibiotic treatment adapted to the presence of MRS or not within approximately 1 h and would strongly reduce the use of broad-spectrum antibiotic.

Miletic B, May O, Krantz N, Girard J, Pasquier G, Migaud H. De-escalation exchange of loosened locked revision stems to a primary stem design: complications, stem fixation and bone reconstruction in 15 cases.
Orthop Traumatol Surg Res. 2012 Apr;98(2):138-43.
Abstract
INTRODUCTION: Femoral stem revision with a locked stem after total hip arthroplasties treats severe bone defects by favoring spontaneous bone reconstruction. Initially, once reconstruction was obtained, the temporary implant was to be replaced by a standard primary component. The use of locked stems has increased, but repeat revision with a short stem which is also called "de-escalation" has not been extensively studied.
HYPOTHESIS: Repeat revision of a locked stem with a short stem is not associated with any specific morbidity and does not affect the quality of reconstruction obtained, or fixation of the subsequent standard length primary design stem.
PATIENTS AND METHODS: Fifteen patients whose locked femoral stem was exchanged due to thigh pain and/or radiographic images showing failed osteointegration were analyzed. These 15 patients were all followed-up and evaluated by the Postel Merle d'Aubigné score. Progression of bone defects was evaluated using the Hofmann cortical index.
RESULTS: There were no difficulties extracting the locked stem and a standard length primary stem was inserted with no associated procedures or bone complications in any of the cases. At a mean follow-up of 55 months (36-84months), thigh pain had disappeared and the Postel Merle d'Aubigné score had increased from 12.6±2.9 (7-16) to 16.5±0.9 (15-18) (P=0.0001). The use of a locked femoral stem resulted in bone reconstruction in all cases, the Hofmann index increased from 30.5%±17.9% (12-71%) before insertion of the locked stem to 43.6%±25.6% (19-90%) at exchange (P<0.05). Bone reconstruction was durable after the exchange with a stable Hofmann index 43.7%±26.2% (17-92%) at the final follow-up (P=0.9). No recurrent loosening occurred.
DISCUSSION: Revision of a loosened locked femoral stem with a standard design primary stem does not result in any specific increased morbidity, or modify bone reconstruction obtained with the locked stem and results in stable fixation of a new standard length stem.

Gros C, Yazdanpanah Y, Vachet A, Roussel-Delvallez M, Senneville E, Lemaire X. Skin and soft tissue infections due to Panton-Valentine leukocidin producing Staphylococcus aureus. Med Mal Infect. 2012 Oct;42(10):488-94
Abstract
OBJECTIVE: The authors had for aim to describe the epidemiological and clinical characteristics, and the treatment of patients presenting with skin and soft tissue infections due to Panton-Valentine leukocidin (PVL) producing Staphylococcus aureus in the Nord-Pas-de-Calais (NPDC) region, North of France.
METHODS: We included patients presenting with PVL producing S. aureus infection from seven hospitals in the NPDC region, between February 2004 and April 2008. We retrospectively collected patient data using a standardized questionnaire. The features of patients presenting with skin and soft tissue were then analyzed.
RESULTS: PVL producing S. aureus was isolated from 64 patients. Fifty-four patients presented with skin and soft tissue infections. The mean age of patients was 23.8 years (63% male patients). The mean number of persons living with the infected patient was 4.5 (vs. 2.5 in NPDC). The lesions were abscesses with inflammatory signs in 64.8% of the cases (20% were necrotic). Among the patients, 70.3% carried a methicillin resistant strain. Antibiotics per os were used for 83.3% of patients; the first-line antibiotics were considered inadequate in 53.3% of the cases. Among the patients, 83.3% underwent surgery. Fourteen out of 38 patients with available data had been exposed to antibiotic therapy during the three months before hospital management.
CONCLUSION: Recent exposure to antibiotics and living with a high number of persons are reasons to suspect a PVL producing S. aureus infection in patients with skin abscess.

Legout L, Ettahar N, Massongo M, Veziris N, Ajana F, Beltrand E, Senneville E. Osteomyelitis of the wrist caused by Mycobacterium arupense in an immunocompetent patient: a unique case. Int J Infect Dis. 2012 Oct;16(10):e761-2.

2013
Legout L, Senneville E. Periprosthetic joint infections: clinical and bench research. ScientificWorldJournal. 2013 Oct 27;2013:549091.
Abstract
Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections.

Senneville E, Brière M, Neut C, Messad N, Lina G, Richard JL, Sotto A, Lavigne JP; French Study Group on the Diabetic Foot. First report of the predominance of clonal complex 398 Staphylococcus aureus strains in osteomyelitis complicating diabetic foot ulcers: a national French study. Clin Microbiol Infect. 2014 Apr;20(4):O274-7
Abstract
Staphylococcus aureus is the most common pathogen cultured from diabetic foot infection including diabetic foot osteomyelitis. This French multicentre study determined the genetic content of S. aureus isolated from 157 consecutive cases admitted to 12 diabetic foot centres between 2008 and 2011. We describe for the first time the emergence of the CC398 methicillin-susceptible S. aureus clone, the main clone in diabetic foot osteomyelitis, and its tropism for bone. This clone spreads to humans from an animal source through its intrinsic virulence. This adaptation of S. aureus isolates looks to be a worrisome problem and should be carefully monitored.

Senneville E, Nguyen S. Current pharmacotherapy options for osteomyelitis: convergences, divergences and lessons to be drawn. Expert Opin Pharmacother. 2013 Apr;14(6):723-34
Abstract
INTRODUCTION: Antibiotic therapy of osteomyelitis is complex and requires a multidisciplinary approach including surgeons and infectious diseases specialists. However, it suffers from a lack of high-quality clinical studies indicating the superiority of one type of therapy over another. Knowing the antibiotics and their main characteristics is important to guide the choice of treatment for patients with osteomyelitis.
AREAS COVERED: The aim of the present article is to review the systemic curative antibiotic therapy of osteomyelitis in adults with a focus on new agents. Diabetic foot osteomyelitis will be briefly discussed separately. A literature search of the PubMed database using the term 'osteomyelitis' alone and in combination with 'hematogenous', 'vertebral', 'biofilm', 'diabetic foot', 'trauma', 'antibiotic' 'daptomycin', 'telavancin', 'tigecycline', 'linezolid', 'ertapenem', 'ceftobiprole' and 'ceftaroline' was carried out.
EXPERT OPINION: Antibiotic treatment of acute and chronic osteomyelitis should be considered as two distinct entities with regard to the choice of the most appropriate antibiotics and the need for surgery. Among the most recently available antibiotics, ertapenem and daptomycin are promising agents for the treatment of osteomyelitis due to resistant bacteria.

 

Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E. 2012 infectious diseases society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections. J Am Podiatr Med Assoc. 2013 Jan-Feb;103(1):2-7.
Abstract
Foot infections are a common and serious problem in persons with diabetes. Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence. Infections are then classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations). This classification system, along with a vascular assessment, helps determine which patients should be hospitalized, which may require special imaging procedures or surgical interventions, and which will require amputation. Most DFIs are polymicrobial, with aerobic gram-positive cocci (GPC), and especially staphylococci, the most common causative organisms. Aerobic gram-negative bacilli are frequently copathogens in infections that are chronic or follow antibiotic treatment, and obligate anaerobes may be copathogens in ischemic or necrotic wounds. Wounds without evidence of soft tissue or bone infection do not require antibiotic therapy. For infected wounds, obtain a post-debridement specimen (preferably of tissue) for aerobic and anaerobic culture. Empiric antibiotic therapy can be narrowly targeted at GPC in many acutely infected patients, but those at risk for infection with antibiotic-resistant organisms or with chronic, previously treated, or severe infections usually require broader spectrum regimens. Imaging is helpful in most DFIs; plain radiographs may be sufficient, but magnetic resonance imaging is far more sensitive and specific. Osteomyelitis occurs in many diabetic patients with a foot wound and can be difficult to diagnose (optimally defined by bone culture and histology) and treat (often requiring surgical debridement or resection, and/or prolonged antibiotic therapy). Most DFIs require some surgical intervention, ranging from minor (debridement) to major (resection, amputation). Wounds must also be properly dressed and off-loaded of pressure, and patients need regular follow-up. An ischemic foot may require revascularization, and some nonresponding patients may benefit from selected adjunctive measures. Employing multidisciplinary foot teams improves outcomes. Clinicians and healthcare organizations should attempt to monitor, and thereby improve, their outcomes and processes in caring for DFIs.

 

Maaloum Y, Meybeck A, Olive D, Boussekey N, Delannoy PY, Chiche A, Georges H, Beltrand E, Senneville E, d'Escrivan T, Leroy O. Clinical spectrum and outcome of critically ill patients suffering from prosthetic joint infections. Infection. 2013 Apr;41(2):493-501.
Abstract
PURPOSE: To report the clinical characteristics and prognosis of prosthetic joint infections (PJIs) in Intensive care units (ICUs).
METHODS: Forty-one patients consecutively admitted to ICUs for PJIs between January 2004 and June 2011 were included in a retrospective case series.
RESULTS: A majority of patients (73 %) had severe underlying disease. Acute infection affected 26 patients (63 %). Blood cultures were positive in 16 patients (39 %). Staphylococcus species were the most commonly implicated causative organisms (n = 36, 88 %). The surgical strategy was two-stage replacement in 25 cases (61 %). The surgical procedure leading to ICU admission was mainly prosthesis removal with spacer implantation (n = 13, 32 %). Initial antibiotherapy was a broad-spectrum beta-lactam antibiotic combined with a glycopeptide, linezolid, or daptomycin in 26 cases (63 %). Mortality in the ICU was 20 %. In nonsurvivors, diabetes, acute infection, and American Society of Anesthesiologists (ASA) score >3 were more frequent. The distribution of surgical strategies and procedures was not statistically different in survivors and nonsurvivors. The proportion of patients treated with antibiotherapy adjusted according to previous microbiological findings was higher in nonsurvivors (50 vs. 12 %, p = 0.02).
CONCLUSIONS: In our case series of critically ill patients suffering from PJI, factors associated with a poor outcome were diabetes mellitus, ASA score >3, and acute infection. Surgical strategies and surgical procedures had no significant impact on the ICU mortality. Adjustment of initial antibiotherapy according to previous microbiological findings should be made with caution.

 

Titécat M, Senneville E, Wallet F, Dezèque H, Migaud H, Courcol RJ, Loïez C. Bacterial epidemiology of osteoarticular infections in a referent center: 10-year study. Orthop Traumatol Surg Res. 2013 Oct;99(6):653-8.
Abstract
INTRODUCTION: Management of osteoarticular infections combines surgical treatment with antibiotic therapy. For some teams the immediate postoperative regimen requires at least partly wide-spectrum probabilistic treatment while waiting for the microbiological results. This protocol exposes the patient to the selection of resistant bacteria and the hospital unit to a modification of its bacterial ecology. The objective of this study was to retrospectively describe the microbial epidemiology of the Traumatology and Orthopaedics Department of the Lille University Hospital over 10 years (2002-2011).
MATERIALS AND METHODS: The bacterial species isolated in culture of osteoarticular samples were listed, after removing any duplicates. The antibiotics retained for follow-up were those used in treatment of these infections as well as those recognized as markers of resistance. For Gram-positive species, the antibiotics considered were methicillin, rifampicin, fluoroquinolones, glycopeptides, and linezolid; for the Gram-negative species, cefotaxime, cefepime, imipenem, and fluoroquinolones were considered.
RESULTS: Of the 5006 strains isolated between 2002 and 2011, Gram-positive cocci accounted for more than 71%; Staphylococcus aureus 27%, and coagulase-negative staphylococci (CoNS) 54%. Contrary to S. aureus, resistance to methicillin, fluoroquinolones, and teicoplanin significantly increased in CoNS, reaching 44%, 34%, and 22%, respectively, of the strains in 2011. The proportion of streptococcal and enterococcal infections remained stable, a mean 7.4% and 5.3%, respectively, per year. Enterobacteria (12.5% of the isolates) were producers of extended-spectrum beta-lactamase in 7.8% of the cases. Pseudomonas aeruginosa was involved in 3.6% of the infections, and 12% of the strains remained resistant to ceftazidime. Propionibacterium acnes accounted for 5.8% of the bacteria isolated and showed few antibiotic resistance problems.
DISCUSSION: Stability in the distribution and the susceptibility of different bacterial species was noted over this 10-year period. Although the evolution of S. aureus resistance was favourable, the resistance of CoNS specially to methicillin and glycopeptides increased.

 

Delaunay C, Hamadouche M, Girard J, Duhamel A; SoFCOT Group What are the causes for failures of primary hip arthroplasties in France? Clin Orthop Relat Res. 2013 Dec;471(12):3863-9.
Abstract
BACKGROUND: There are no large database cohorts describing the causes for failure of primary THAs in France. Because implants and causes for revision vary between national registers, it is important to obtain data from all countries.
QUESTIONS/PURPOSES: We therefore determined (1) the mechanisms of failure of primary THAs, (2) their order of appearance with time, (3) the types of surgical techniques and implant designs used to perform revision THAs, and (4) 90-day complications after revision THA in France.
METHODS: We prospectively collected data on all 2107 first-time revision THAs from 30 tertiary centers from January 1, 2010, to December 31, 2011. A dual-mobility liner had been used in 251 hips. Mean time from primary procedure to revision THA was 11.2 years (range, 1 day to 42 years). Mean age at revision was 70 years (range, 17-104 years).
RESULTS: The causes for revision were mechanical loosening (42%), periprosthetic fracture (12%), infection (11%), wear/osteolysis (11%), dislocation (10%), surgical technique error (6%), and implant fracture (3%). The most common type of revision procedure was all-component revision (49%). A dual-mobility liner was used in 1184 hips (62%). The 90-day dislocation rate was less than 4%, and mortality rate was 1.6%.
CONCLUSIONS: Contrary to other reported data, we found dislocation was not the main cause for failure of primary THAs but was still the more frequent early complication after revision. These findings might be related to the use of dual-mobility sockets in more than 10% of primary THAs and more than 60% of revision THAs.

 

Putman S, Kern G, Senneville E, Beltrand E, Migaud H. Knee arthrodesis using a customised modular intramedullary nail in failed infected total knee arthroplasty. Orthop Traumatol Surg Res. 2013 Jun;99(4):391-8.
Abstract
BACKGROUND: Knee arthrodesis is used to treat patients with failed infected total knee arthroplasty (TKA). Among fixation methods, intramedullary nailing increases the chances of bone union but may carry a risk of infection around the nail. This risk is not well understood, because available case-series studies were not confined to patients with knee infection.
HYPOTHESIS: Infection recurrence rates after knee arthrodesis with intramedullary nailing used to treat failed infected TKA are similar to those seen with other fixation methods.
METHODS: We retrospectively reviewed 31 cases of knee arthrodesis with fixation by a modular intramedullary nail performed at a subspecialized center treating complex osteoarticular infections (CRIOAC). The antibiotic regimen was determined based on multidisciplinary discussions and microbiological studies of preoperative and intraoperative specimens. Mean follow-up was 50 ± 22 months (range, 28-90 months). Arthrodesis was performed in one stage (n=6) or two stages (n=25). Success was defined as presence, after a postoperative follow-up of at least 24 months, based on the following criteria: normal erythrocyte sedimentation rate and/or C-reactive protein, no wound inflammation or sinus tract, no revision surgery, and no antibiotic treatment. Bone union was not a criterion for a successful arthrodesis procedure.
RESULTS:
Removal of the fixation material was required in three patients and long-term palliative antibiotic therapy in three patients (fixation material in place with repeated positive specimens) for a total of six failures due to infection (6/31, 19.4%). None of the patients experienced mechanical failure (no breakage of the material and no fixation failure of the nails designed to allow osteointegration). The mean leg length discrepancy was 10 ± 10 mm (range, 5-34 mm) and the mean Oxford score was 41 ± 11 (range, 23-58). The 50-month rate of arthrodesis survival to revision surgery for nail removal was 77.8 ± 4% and the 50-month rate of arthrodesis survival without revision surgery for persistent infection was 74.6 ± 4.2%.
DISCUSSION: The infection recurrence rate was higher than with other fixation methods but remained acceptable (19.4%). Use of a modular intramedullary nail prevented major leg-length discrepancies, which are often poorly accepted by the patients, and allowed immediate weight bearing despite the often severe bone loss.

Ducharne G, Girard J, Pasquier G, Migaud H, Senneville E. Hip prosthesis infection related to an unchecked intrauterine contraceptive device: a case report. Orthop Traumatol Surg Res. 2013 Feb;99(1):111-4.
Abstract
Intrauterine devices (IUD) used for contraception can be the source of local infections or can migrate, which justifies regular checking recommendations and limitations around the implantation period. To our knowledge, bone and joint infections related to an infected IUD have not been described in the scientific literature. This paper reports on a case of the repeated infection of a total hip prosthesis related to an infected IUD that had been forgotten after being implanted 34years previously. The arthroplasty infection revealed itself through dislocation of a dual mobility cup. Commensal bacteria that colonize the female genital tract (Streptococcus agalactiae) were identified at the site of hip arthroplasty. This led to the discovery of the IUD that was infected by the same bacterium. Despite lavage of the non-loosened arthroplasty, removal of the IUD and 2months of antibiotic treatment, the dislocation recurred and the prosthesis was again infected with the same microorganism 4months later. This recurrence of the infection, with persistence of a uterine abscess containing the same bacterium, was treated with repeated lavage of the joint, total hysterectomy and antibiotics treatment. The infection had resolved when followed-up 3years later. The occurrence of a bone and joint infection with this type of bacterium should trigger the evaluation of a possible IUD infection.

Vaznaisiene D, Beltrand E, Laiskonis AP, Yazdanpanah Y, Migaud H, Senneville E. Major amputation of lower extremity: prognostic value of positive bone biopsy cultures. Orthop Traumatol Surg Res. 2013 Feb;99(1):88-93.
Abstract
BACKGROUND: To assess the correlation between culture results of section's osseous slice biopsy (SOB) and the distal infected site responsible for the amputation performed concomitantly during major amputation of lower extremity. The influence of a positive culture of SOB on the patients' outcome was also evaluated.
MATERIALS AND METHODS: We conducted a retrospective study of medical charts of patients who underwent SOB during major amputation of lower extremity at our institution from 2000 to 2009.
RESULTS: Fifty-seven patients (42 males/15 females, mean age 52.16years) who undergone major limb amputation (47 below knee and ten above knee) were included. The initial medical conditions of the investigated patients were: trauma (n=32), infection (n=13), trophic disorders (n=10) and tumor (n=2). The major cause of amputation was an uncontrolled infection, accouting for 64.9% of the cases (37/57) (foot=5, ankle=8, leg=24), the remaining 20 patients had trophic disorders of lower limb. Twenty-one (36.8%) from 57 biopsies were sterile, 12 (21.1%) doubtful and 24 (42.1%) positive. Thirty-one (54.4%) patients had an antibiotic-free interval before limb amputation. Independently of the bacterial species, 69.6% of the microorganisms identified from SOB were found in the distal infected site. Patients with positive SOB had a significantly longer interval between the decision to amputate the patient and the surgical procedure (200.2 vs. 70.1days; P<0.03) and a shorter total duration of antibiotic therapy before amputation than patients with negative SOB (3.68 vs. 6.08months; P<0.03). The delay for complete healing was significantly higher in patients with a positive SOB compared with those with a negative SOB (3.57 vs. 2.48months; P<0.03).
CONCLUSION: Our results suggest that the infection may extend from the distal site to the level of amputation in a large proportion of cases and that the delay with which the amputation is performed after the decision has been taken may play a role in this event.

2014
O'Toole P, Osmon D, Soriano A, Berdal JE, Bostrum M, Franco-Cendejas R, Huang D, Nelson C, Nishisaka F, Salgado CD, Sawyer R, Segreti J, Senneville E, Zhang XL. Oral antibiotic therapy. J Arthroplasty. 2014 Feb;29(2 Suppl):115-8.

O'Toole P, Osmon D, Soriano A, Berdal JE, Bostrum M, Franco-Cendejas R, Huang D, Nelson C, Nishisaka F, Roslund B, Salgado CD, Sawyer R, Segreti J, Senneville E, Zhang XL. Oral antibiotic therapy. J Orthop Res. 2014 Jan;32 Suppl 1:S152-7.

 

34) Tornero E, Senneville E, Euba G, Petersdorf S, Rodriguez-Pardo D, Lakatos B, Ferrari MC, Pilares M, Bahamonde A, Trebse R, Benito N, Sorli L, del Toro MD, Baraiaetxaburu JM, Ramos A, Riera M, Jover-Sáenz A, Palomino J, Ariza J, Soriano A; European Society Group of Infections on Artificial Implants (ESGIAI). Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study.
Clin Microbiol Infect. 2014 Nov;20(11):1219-24.
Abstract
The objective of this study was to review the characteristics and outcome of prosthetic joint infections (PJI) due to Enterococcus sp. collected in 18 hospitals from six European countries. Patients with a PJI due to Enterococcus sp. diagnosed between January 1999 and July 2012 were retrospectively reviewed. Relevant information about demographics, comorbidity, clinical characteristics, microbiological data, surgical treatment and outcome was registered. Univariable and multivariable analyses were performed. A total of 203 patients met the inclusion criteria. The mean (SD) was 70.4 (13.6) years. In 59 patients the infection was diagnosed within the first 30 days (29.1%) from arthroplasty, in 44 (21.7%) between 31 and 90 days, in 54 (26.6%) between 91 days and 2 years and in 43 (21%) after 2 years. Enterococcus faecalis was isolated in 176 cases (89%). In 107 (54%) patients the infection was polymicrobial. Any comorbidity (OR 2.53, 95% CI 1.18-5.40, p 0.01), and fever (OR 2.65, 95% CI 1.23-5.69, p 0.01) were independently associated with failure. The only factor associated with remission was infections diagnosed later than 2 years (OR 0.25, 95% CI 0.09-0.71, p 0.009). In conclusion, prosthetic joint infections due to Enterococcus sp. were diagnosed within the first 2 years from arthroplasty in >70% of the patients, almost 50% had at least one comorbidity and infections were frequently polymicrobial (54%). The global failure rate was 44% and patients with comorbidities, fever, and diagnosed within the first 2 years from arthroplasty had a poor prognosis.

 

35) Ollivier M, Senneville E, Drancourt M, Argenson JN, Migaud HPotential changes to French recommendations about peri-prosthetic infections based on the international consensus meeting (ICMPJI). Orthop Traumatol Surg Res. 2014 Oct;100(6):583-7.
Abstract
BACKGROUND:
Despite the large volume of studies on the prevention, diagnosis, and treatment of peri-prosthetic infections, surgical practice often rests on limited scientific evidence in this field. The vast International Consensus Meeting on Peri-prosthetic Joint Infection (ICMPJI) held in 2013 produced robust recommendations.
HYPOTHESIS:
French consensus conference recommendations show no major differences with ICMPJI recommendations.
MATERIALS AND METHODS:
The 207 recommendations developed by 300 experts at the ICMPJI were translated, and the translation was then examined by four reviewers, including 2 having participated in the consensus conference. The reviewers looked for any differences with French practices and recommendations.
RESULTS:
Twenty-three major differences or innovations were identified compared to French recommendations and standard practice. Among them, pre-operative screening for nasal or urinary micro-organisms is performed routinely in France but should be reserved according to the ICMPJI for symptomatic patients and/or patients at high risk for infection. The ICMPJI emphasizes the role for the operating room environment as a vector for infection; more specifically, the operating lamp handle and suction cannula deserve close attention. A wound discharge persisting longer than 5-7 days requires irrigation and debridement. This procedure is effective only within the first 3 post-operative months and/or the first 3 weeks after symptom onset and must include exchange of all modular implants. The ICMPJI warns against both irrigation-debridement in fungal infections (suggesting two-stage prosthesis replacement) and one-stage replacement in patients with sinus tracts. The use of spacers (articulating at the knee) is recommended in the event of two-stage prosthesis replacement.
DISCUSSION:
The ICMPJI recommendations differed in many ways with French recommendations and standard practice. They can be expected to impact practices in France, although a point worth noting is that only 1 of the 207 recommendations received unanimous agreement by the conference experts (keeping operating room traffic to a minimum).

2015

36) Titécat M, Senneville E, Wallet F, Dezèque H, Migaud H, Courcol RJ, Loïez C. Microbiologic profile of Staphylococci isolated from osteoarticular infections: evolution over ten years. Surg Infect (Larchmt). 2015 Feb;16(1):77-83
Abstract
BACKGROUND:
Staphylococci, especially coagulase-negative staphylococci (CoNS) represent the most frequent micro-organism associated with osteoarticular infections (OAIs), especially those involving orthopedic devices. The antibiotic susceptibility profile of the bacteria mostly responsible for OAIs is therefore crucial information for choosing the appropriate antibiotic regimen administered during the removal procedure until the first results of the conventional culture.
METHODS:
The antibiotic susceptibility profile of staphylococci isolated from OAIs in a referent center for osteoarticular infection was studied over a 10-y period to adapt antibiotic protocols to the ecology.
RESULTS:
From 2002 to 2011, the resistance of Staphylococcus aureus to methicillin and rifampicin decreased (27.9% versus 20.6% and 13% versus 1%, respectively); the resistance to fluoroquinolones (FQ) was stable (24% on average), and all the isolates were susceptible to glycopeptides. For CoNS, the resistance to methicillin, rifampicin, and FQ increased (30.4% versus 43.9%, 13% versus 18.5%, and 20.3% versus 34.1%, respectively) over the same period. Resistance of the CoNS to vancomycin was observed in 2011 for the first time (2.3%), and 3.8% were resistant to teicoplanin in 2002 compared with 22% in 2011, with 3.5% resistant to linezolid in 2011.
CONCLUSION:
The sensibility of bacteria over 10 y remained stable, except for CoNS. The increase of the resistances for CoNS led us to exclude teicoplanin from the first-line empiric antibiotic treatment, to avoid linezolid, and to prefer vancomycin or daptomycin

37) Nguyen S, Robineau O, Titecat M, Blondiaux N, Valette M, Loiez C, Beltrand E, Migaud H, Senneville E. Influence of daily dosage and frequency of administration of rifampicin-levofloxacin therapy on tolerance and effectiveness in 154 patients treated for prosthetic joint infections. Eur J Clin Microbiol Infect Dis. 2015 Aug;34(8):1675-82.

Abstract
Data on the tolerance and effectiveness of rifampicin-levofloxacin combination therapy (RLCT) in patients treated for prosthetic joint infections (PJIs) according to daily dosage are lacking. A review of the clinical data from patients treated with RLCT for PJIs in a French referent center for PJIs was conducted. A total of 154 patients (75 F/79 M), with a median age of 64.1 years and median body weight of 83.1 kg, were included. The median daily dosages of rifampicin and levofloxacin were, respectively, 1,200 mg (range 300-2,100) and 750 mg (range 500-1,500), corresponding to a mean daily dose per kg of, respectively, 16.2 ± 4.3 mg/kg and 10.1 ± 3.0 mg/kg. After a mean follow-up period of 55.6 ± 27.1 months (range 24-236), 127 patients (82.5 %) were in remission. Adverse events attributable to rifampicin and levofloxacin were reported in 48 (31.2 %) and 13 (8.4 %) patients (p < 0.001), respectively. Patients who experienced rifampicin-related adverse events had been given higher rifampicin daily doses than the other patients (p = 0.04). The rifampicin daily dosage did not influence patient outcome and nor did the levofloxacin daily dosage on both tolerance and patient outcome. Our results suggest that adjusting rifampicin daily doses to the patient total body weight when combined with levofloxacin for the treatment of PJIs is associated with a poor tolerance. High daily doses of rifampicin (>600 mg) and levofloxacin (750 mg) do not improve patient outcome when compared to lower daily doses in this setting.

2016

38) Pommepuy T, Lons A, Benad K, Beltrand E, Senneville E, Migaud H. Bilateral One-Stage Revision of Infected Total Hip Arthroplasties: Report of Two Cases and Management of Antibiotic Therapy. Case Rep Orthop. 2016;2016:3621749.
Abstract
Recommendations for the management of chronic and bilateral total hip arthroplasty (THA) infection are lacking. However, this type of infection involves medical problems concerning the management of the antibiotic therapy. We report two cases of such infections operated as one-stage revision. For each case, both hips were infected with the same bacteria (Staphylococcus caprae for one patient and methicillin-sensitive Staphylococcus aureus for the other). The probabilistic antibiotic treatment started during the first side (after harvesting intraoperative samples) did not prevent the culture of the bacteriologic harvested during the intervention of the second side. Cultures were positive for the same bacteria for both sides in the two cases presented herein. After results of intraoperative cultures, patients received culture-guided antibiotic therapy for three months and were considered cured at the end of a two-year follow-up. Our results suggest one-stage bilateral change of infected THA is a viable option and that early intraoperative antibiotic, started during the first-side exchange, does not jeopardize microbiological documentation of the second side. This work brings indirect arguments, in favor of the use of prophylactic antibiotics during revision of infected THA.

39) Titécat M, Nguyen S, Dezeque H, Valette M, Beltrand E, Blondiaux N, LoÏez C, Migaud H, Senneville E.  COL 6-02 - Détection rapide des staphylocoques résistants à la méticilline (SRM) au cours des reprises pour infections de prothèses ostéo-articulaires (IPOAS) : étude rétrospective à partir de 215 patients consécutifs. Med Mal Infect. 2016 Jun;46(4 Suppl 1):13.

40) Joseph C, Nguyen S, Dezeque H, Titecat M, Valette M, Blondiaux N, Beltrand E, Migaud H, Senneville E.  IOA-08 - Comparaison de la daptomycine (DAP) et de la vancomycine (VAN) en traitement probabiliste d'attente au cours des reprises pour infections de prothèses ostéo-articulaires (IPOAS). Med Mal Infect. 2016 Jun;46(4 Suppl 1):65

41) Cornu M, Guérin M, Boulo M, Mullie-Léger J, Loridant S, Fréalle E, Senneville E, Migaud H, Mathieu D, Sendid B.  IPF-08 - Mucormycoses post-traumatiques, à propos de deux cas à Mucor circinelloides. Med Mal Infect. 2016 Jun;46(4 Suppl 1):69.
42) Fiaux E, Titecat M, Robineau O, Lora-Tamayo J, El Samad Y, Etienne M, Frebourg N, Blondiaux N, Brunschweiler B, Dujardin F, Beltrand E, Loiez C, Cattoir V, Canarelli JP, Hulet C, Valette M, Nguyen S, Caron F, Migaud H, Senneville E; G4 bone and joint infection study group (G4BJIS). Outcome of patients with streptococcal prosthetic joint infections with special reference to rifampicin combinations. BMC Infect Dis. 2016 Oct 13;16(1):568.
Abstract
BACKGROUND:
Outcome of patients with streptococcal prosthetic joint infections (PJIs) is not well known.
METHODS:
We performed a retrospective multicenter cohort study that involved patients with total hip/knee prosthetic joint (THP/TKP) infections due to Streptococcus spp. from 2001 through 2009.
RESULTS:
Ninety-five streptococcal PJI episodes (50 THP and 45 TKP) in 87 patients of mean age 69.1 ± 13.7 years met the inclusion criteria. In all, 55 out of 95 cases (57.9 %) were treated with debridement and retention of the infected implants with antibiotic therapy (DAIR). Rifampicin-combinations, including with levofloxacin, were used in 52 (54.7 %) and 28 (29.5 %) cases, respectively. After a mean follow-up period of 895 days (IQR: 395-1649), the remission rate was 70.5 % (67/95). Patients with PJIs due to S. agalactiae failed in the same proportion as in the other patients (10/37 (27.1 %) versus 19/58 (32.7 %); p = .55). In the univariate analysis, antibiotic monotherapy, DAIR, antibiotic treatments other than rifampicin-combinations, and TKP were all associated with a worse outcome. The only independent variable significantly associated with the patients' outcomes was the location of the prosthesis (i.e., hip versus knee) (OR = 0.19; 95 % CI 0.04-0.93; p value 0.04).
CONCLUSIONS:
The prognosis of streptococcal PJIs may not be as good as previously reported, especially for patients with an infected total knee arthroplasty. Rifampicin combinations, especially with levofloxacin, appear to be suitable antibiotic regimens for these patients.

43) Deny A, Loiez C, Deken V, Putman S, Duhamel A, Girard J, Pasquier G, Chantelot C, Senneville E, Migaud H. Epidemiology of patients with MSSA versus MRSA infections of orthopedic implants: Retrospective study of 115 patients. Orthop Traumatol Surg Res. 2016 Nov;102(7):919-923.
Abstract
Factors that predict the occurrence of a surgical site infection due to methicillin-resistant Staphylococcus aureus (MRSA) are not well known; however this information could be used to modify the recommended antimicrobial prophylaxis. We carried out a retrospective study of S. aureus infections on orthopedic implants to determine: (1) whether epidemiological factors can be identified that predict a MRSA infection, (2) the impact of these factors as evidenced by the odds ratio (OR).
HYPOTHESIS:
Risk factors for a MRSA infection can be identified from a cohort of patients with S. aureus infections.
MATERIALS AND METHODS:
We identified 244 patients who experienced a S. aureus surgical site infection (SSI) in 2011-2012 documented by intraoperative sample collection. Of these 244 patients, those who had a previous SSI (n=44), those with a SSI but no orthopedic implant (n=80) or those who had the infection more than 1-year after the initial surgery (n=5) were excluded. This resulted in 115 patients (53 arthroplasty, 62 bone fixation) being analyzed for this study. There were 24 MRSA infections and 91 MSSA infections. The following factors were evaluated in bivariate and multifactorial analysis: age, sex, type of device (prosthesis/bone fixation), predisposition (diabetes, obesity, kidney failure), and environmental factors (hospitalization in intensive care unit within past 5 years, nursing home stay).
RESULTS:
Two factors were correlated with the occurrence of MRSA infections. (1) Nursing home patients had a higher rate of MRSA infections (67% vs. 18%, P=0.017) with an OR of 8.42 (95% CI: 1.06-66.43). (2) Patients who had undergone bone fixation had a lower rate of MRSA infections than patients who had undergone arthroplasty (13% vs. 30%, P=0.023), OR 0.11 (95% CI: 0.02-0.56). Although the sample size was too small to be statistically significant, all of the patients with kidney failure (n=4) had a MRSA infection.
DISCUSSION:
Since these MRSA infection risk factors are easy to identify, the antimicrobial prophylaxis could be adapted in these specific patient groups.

 

 

 

 

 

PUBLICATIONS NATIONALES

25) SENNEVILLE E, LEGOUT L, CORROYER B, YAZDANPANAH Y, MOUTON Y. Adequate use of teicoplanin in bone and joint infections. Med Mal Infect. 2004 Jun; 34 (Suppl 1): S99-S102

PMID: 15676260 [PubMed - as supplied by publisher]

26) SENNEVILLE E. Diabetic foot osteomyelitis Rev Prat. 2007 May 15;57(9):991-4.

Bone and joint infections associated with chronic wound of the diabetic foot are frequent and severe complications that should be considered in most cases. Early diagnosis and aggressive treatment are likely to limit bad outcome. Clinical studies with acceptable methodology addressing the relative role of medical and surgical approaches are needed. Bone biopsy available in routine in a diabetic foot clinic represents a marker of good quality of management of such patients. Given the global burden and potential severity of osteomyelitis of the diabetic foot, every measure that can prevent the occurrence and persistence of a foot wound in a diabetic patient remain major objectives.
PMID: 17695679 [PubMed - indexed for MEDLINE]

27) SENNEVILLE E. Infection and diabetic foot. Rev Med Interne. 2008; 29 Suppl 2: S243-8.

The large number of factors that influence the outcome of patients with diabetic foot infections calls for a multidisciplinary management of such patients. Infection is always the consequence of a preexisting foot wound whose chronicity is facilitated by the diabetic peripheral neuropathy, whereas peripheral vascular disease is a factor of poor outcome, especially regarding the risk for leg amputation. Primary and secondary prevention of IPD depends both on the efficacy of wound off-loading. Antibiotic treatment should only be considered for clinically infected foot wounds for which diagnostic criteria have recently been proposed by international consensus. The choice of the antibiotic regimen should take into account the risk for selecting bacterial resistance, and as a consequence, agents with a narrow spectrum of activity should be preferred. Respect of the measures for preventing the spread of bacterial resistance in diabetic foot centers is particularly important.
PMID: 18822250 [PubMed - indexed for MEDLINE]

28) PINOIT Y, SENNEVILLE E, MIGAUD H. Acute soft tissue infections. Rev Prat. 2006 Jun 30;56(12):1363-8. Review.

PMID: 16948228 [PubMed - indexed for MEDLINE]

29) GRADOS F, LESCURE FX, SENNEVILLE E, FLIPO RM, SCHMIT JL, FARDELLONE P. Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Joint Bone Spine. 2007; 4:133-9.

OBJECTIVES: To develop recommendations about identifying the causative organism, obtaining imaging studies, and selecting pharmacological and non-pharmacological treatments in adults with pyogenic discitis and vertebral osteomyelitis (PDVO). METHODS: A rheumatologist and an infectiologist drafted recommendations based on their personal experience and a review of studies in English or French retrieved on Medline using the following search terms: "infectious spondylodiscitis", "infectious spondylitis", "spondylodiscitis", "discitis", "vertebral osteomyelitis", "spine infection", and "bone and joint infections". The recommendations were submitted to four experts for validation. RESULTS: 85 articles were selected for detailed review. No prospective randomized controlled trials were identified. Antimicrobial therapy should be initiated only after recovery of the causative organism in blood cultures or percutaneous disk biopsy specimens, except in patients with neutropenia or severe sepsis. The initial treatment rests on a combination of two bactericidal and synergistic antimicrobials in high dosages. The total duration of antimicrobial therapy should be 12 weeks at least. Radiographs of the spine and chest and magnetic resonance imaging (MRI) of the spine should be performed routinely during the initial evaluation. In PDVO due to hematogenous dissemination of a streptococcus or staphylococcus, routine echocardiography may be in order. Radiographs centered on the affected disk should be obtained 1 and 3 months into antimicrobial therapy and 3 months after treatment discontinuation. Follow-up MRI is usually unnecessary when the clinical and laboratory abnormalities respond to treatment. If not, or if the initial investigations show a collected abscess, a repeat MRI after 1 month of antimicrobial treatment may be useful. Clinical and laboratory follow-up is mandatory throughout antimicrobial therapy and during the first 6 months after treatment discontinuation. CONCLUSIONS: Recommendations based on descriptive studies and expert opinion were developed. They can be expected to improve the quality and uniformity of PDVO management. Further studies are needed to improve the level of evidence that is available for developing recommendations. In particular, prospective randomized multicenter studies should be performed to compare the intravenous to the oral route for initial antimicrobials administration and to compare different treatment durations.
PMID: 17337352 [PubMed - indexed for MEDLINE].

30) LOÏEZ C, WALLET F, PISCHEDDA P, RENAUX E, SENNEVILLE E, MEHDI N, COURCOL RJ. First case of osteomyelitis caused by "Staphylococcus pettenkoferi". J Clin Microbiol. 2007; 45:1069-71.

"Staphylococcus pettenkoferi" (proposed name) was identified as an unusual agent of osteomyelitis in a diabetic foot infection. The phenotypical tests used failed to give a good identification. Molecular 16S rRNA gene and rpoB sequencing allowed us to correctly identify this new species of coagulase-negative staphylococcus responsible for this chronic infection.
PMID: 17202276 [PubMed - indexed for MEDLINE]

31) MULLEMAN D, PHILIPPE P, SENNEVILLE E, COSTES C, FAGES L, DEPREZ X, FLIPO RM, DUQUESNOY B. Streptococcal and enterococcal spondylodiscitis (vertebral osteomyelitis). High incidence of infective endocarditis in 50 cases. J Rheumatol. 2006; 33: 91-7

OBJECTIVE: To characterize the clinical, biological, and imaging features and outcomes of patients with streptococcal and enterococcal spondylodiscitis (SESD). METHODS: This retrospective study of patients with SESD was carried out in 2 departments of rheumatology from 1990 through 2002. Comparison was made with cases of staphylococcal spondylodiscitis (SSD) seen during the same period, excluding postoperative cases. RESULTS: Fifty cases of SESD were reviewed and compared with 86 cases of SSD. The main finding was a higher frequency of concomitant infective endocarditis in patients with SESD (11/42 vs 1/37; p = 0.009). Evidence of inflammation, imaging features, and neurological impairment at admission appeared to be less severe in SESD, but the difference did not reach statistical significance. Duration of treatment was shorter in SESD than in SSD (105 +/- 26 days vs 130 +/- 49 days; p = 0.003). CONCLUSION: Our study confirms the high incidence of infective endocarditis (26%) during SESD. Clinicians must look for predisposing factors and clinical abnormalities in patients with spondylodiscitis whenever a streptococcal or enterococcal agent is identified. Echocardiography should be performed as routine in such situations.
PMID: 16395756 [PubMed - indexed for MEDLINE]

32) YAZDANPANAH Y, LEMAIRE X, SENNEVILLE E, DELCEY V, VIGET N, MOUTON Y, AJANA F, DUBREUIL L. Melioidotic osteomyelitis of the femur occurring in a traveler. J Travel Med. 2002 Jan-Feb;9(1):53-4.

PMID: 11953265 [PubMed - indexed for MEDLINE]

33) SENNEVILLE E, YAZDANPANAH Y, CORDONNIER M, CAZAUBIEL M, LEPEUT M, BACLET V, BELTRAND E, KHAZARJIAN A, CAILLAUX M, DUBREUIL L, MOUTON Y. Are the principles of treatment of chronic osteitis applicable to the diabetic foot? Presse Med. 2002; 31:393-9.

OBJECTIVE: The interest of the management of bone infections in the diabetic foot, inspired by the recommendations for the treatment of chronic osteitis, was assessed in this study. METHODS: Twenty bone infections in 17 diabetic patients with moderate to mild infections of the feet were confirmed by the results of X-ray and/or scintigraphic studies and bone surgery biopsy cultures revealing one or more bacteria sensitive to standard osteitis treatment (rifampicine + fluoroquinolone). The patients had received this treatment per os for a median duration of 6 months (3 to 10 months). Clinical follow-up was carried out during a consultation at 1, 3 and 6 months during treatment and then by telephone every six months after the end of treatment. Clinical success was defined as the disappearance of any local sign of infection and by the absence of relapse during the post-treatment follow-up period. The evolution of the bone infection was also assessed by the results of a control conducted 3 to 6 months after initiation of the antibiotic treatment. RESULTS: At the end of the treatment, all signs of infection had disappeared in 15/17 patients (88.2%) and no relapse had occurred in 14 (82.3%) patients at the end of a median post-treatment period of 22 months (12 to 41 months). Resection of necrotic bone was performed at the same time as the bone biopsy in 2 patients. The median duration of hospitalisation was of 14 days (3 to 53 days). During the study, a multi-resistant germ was isolated in 4 patients (1 Pseudomonas aeruginosa, 3 Staphylococcus aureus). During the post-treatment follow-up, 3 patients dies from causes unrelated to the infection treated. No serious adverse event was reported during the study. DISCUSSION: The results of this pilot study support the rationale of applying the treatment regimens of chronic osteitis to diabetic lesions of the feet, but are only applicable to comparable patients presenting with non-severe lesions of the feet. Moreover, the use of antibiotics with potent selection of resistance such as rifampicine and fluoroquinolone, requires that bone biopsies be taken, which is not easy in all the diabetic foot care centres. We are presently conducting a study to identify the sub-populations of diabetic patients who could benefit from such treatment.
PMID: 11933734 [PubMed - indexed for MEDLINE]

34) Ducharne G, Girard J, Pasquier G, Migaud H, Senneville E.

Hip prosthesis infection related to an unchecked intrauterine contraceptive device: A case report.

Orthop Traumatol Surg Res. 2012 Dec 10. doi:pii: S1877-0568(12)00277-0. 10.1016/j.otsr.2012.09.015.

Abstract

Intrauterine devices (IUD) used for contraception can be the source of local infections or can migrate, which justifies regular checking recommendations and limitations around the implantation period. To our knowledge, bone and joint infections related to an infected IUD have not been described in the scientific literature. This paper reports on a case of the repeated infection of a total hip prosthesis related to an infected IUD that had been forgotten after being implanted 34years previously. The arthroplasty infection revealed itself through dislocation of a dual mobility cup. Commensal bacteria that colonize the female genital tract (Streptococcus agalactiae) were identified at the site of hip arthroplasty. This led to the discovery of the IUD that was infected by the same bacterium. Despite lavage of the non-loosened arthroplasty, removal of the IUD and 2months of antibiotic treatment, the dislocation recurred and the prosthesis was again infected with the same microorganism 4months later. This recurrence of the infection, with persistence of a uterine abscess containing the same bacterium, was treated with repeated lavage of the joint, total hysterectomy and antibiotics treatment. The infection had resolved when followed-up 3years later. The occurrence of a bone and joint infection with this type of bacterium should trigger the evaluation of a possible IUD infection.