Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study

Triffault-Fillit, Claire; Ferry, Tristan; Laurent, François; Pradat, Pierre; Dupieux, Céline; Conrad, Anne; Becker, Agathe; Lustig, Sébastien; Fessy, Michel-Henry; Chidiac, Christian; Valour, Florent

doi:10.1016/j.cmi.2018.04.035

Cited by 101 publications

(97 citation statements)

References 23 publications

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“…Benito and colleagues focused on the influence of route of acquisition and time after surgery on the microbiology of PJI [22]. In their prospective study, Triffault-Fillit and colleagues described the microbiology of PJI depending on time to occurrence [23]. These two studies suggest that few or no Gram-negative bacilli are isolated from late PJI.…”

Section: Discussionmentioning

confidence: 99%

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Deroche

Bémer

Valentin

et al. 2019

JCM

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Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

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Section: Discussionmentioning

confidence: 99%

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Deroche

Bémer

Valentin

et al. 2019

JCM

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“…4). [10]. вне зависимости от чувствительности штаммов стафилококков к метициллину изоляты S. epidermidis значимо чаще были устойчивы к большинству изученных антибиотиков.…”

Section: материал и методыunclassified

“…несмотря на то, что наиболее частыми в России возбудителями нозокомиальных инфекций являются представители сем. enterobacteriaceae, P. aeruginosa и Acinetobacter sp., на долю которых приходится 43,1, 19,6 и 14,4% всех выделенных бактериальных возбудителей госпитальных инфекций [18-20], их участие в этиологии ортопедических имплантат-ассоциированных инфекций не столь велико и, по данным различных авторов, не превышает в совокупности 10-35% [9,10,21,22]. в нашей работе в общем спектре возбудителей ИаИ выявлено снижение частоты выделения Acinetobacter sp.…”

Section: материал и методыunclassified

“…золотистый стафилококк и коагулазонегативные стафилококки (кнс) более чем в половине случаев являются причинами ИаИ, грамотрицательные бактерии (Грам(-)) ответственны за 5-23% случаев ортопедической инфекции, особенно среди пожилых людей [8][9][10]. патогенез инфекции, обусловленный грамотрицательными и грамположительными (Грам(+)) патогенами, связан с формированием биопленок на компонентах эндопротеза, которые защищают бактерии от противомикробных агентов и иммунной системы хозяина [11].…”

Section: Introductionunclassified

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Adverse Trends in the Etiology of Orthopedic Infection: Results of 6-Year Monitoring of the Structure and Resistance of Leading Pathogens

Божкова

Касимова

Тихилов

et al. 2018

Traumatology and Orthopedics of Russia

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Osteomyelitis remains one of the most intractable diseases. The nature of the pathogen and its resistance to antibiotics significantly affect the outcome and cost of treatment.The aim of the study: to analyze the dynamics of the spectrum and antibiotic resistance of the leading pathogens of orthopedic infection for the period 2012– 2017.Material and methods. The structure of pathogens isolated from the focus of infection from 2774 patients with periprosthetic infection and chronic osteomyelitis was retrospectively analyzed. Antibiotic resistance of the leading pathogens that occupied more than 4% in the species structure was studied. Comparative analysis of changes in the spectrum of pathogens and antibiotic resistance was carried out for the periods 2012-2013, 2014–2015 and 2016-2017. Epidemiological analysis was performed in the program „microbiological monitoring system” Microbe-2. Statistical processing of the obtained data was carried out using the Z-criterion.Results.From 2774 patients with orthopedic infection have been isolated 4359 strains, in the structure of which about 73.5% were occupied by S. aureus, S. epidermidis, E. faecalis, E. faecium, P. aeruginosa, Acinetobacter sp. representatives of the family Enterobacteriacea. In 27% of the cases, microorganisms of other species were identified. Microbial associations were identified in 19.4% of cases. In the structure of the leading Gram(+) pathogens, a significant decrease in the incidence of S. aureus was detected, while the share of S. epidermidis increased significantly. Among the leading Gram(-) microorganisms, a significant increase in the proportion of representatives of the fam. Enterobacteriacea was found, against the background of a decrease in the share of Acinetobacter sp. and P. aeruginosa. The level of resistance of MSSA to the studied antibiotics ranged from 0.1 to 8.8%, for MSSE the spread was from 1.9 to 16.7%. Negative dynamics of growth of resistance of non-fermenting bacteria is established. The strains of Acinetobacter sp. demonstrated greater resistance to tested antibiotics in comparison with P. aeruginosa.Conclusion.An increase in the role of S. epidermidis and K. pneumoniae in the etiology of orthopedic infection was established. The revealed increase in the resistance of microbial pathogens to most tested and used antibiotics should be taken into account in the appointment of empirical antibiotic therapy. The extremely high frequency of resistance of gram-negative bacteria to cephalosporins and fluoroquinolones excludes the possibility of their empirical use, which requires the management of carbapenems in the starting treatment regimens. High resistance to fluoroquinolones limits the ability of oral antibiotic therapy in patients with periprosthetic infection.

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“…Empirical antibiotic treatment of early PJIs include coverage of vancomycin was recommended until de nitive culture results become available [20]. In a prospective cohort study of microbiologic epidemiology of PJI, the results revealed 28.9% of S. aureus, 28.6% of CNS, 14.1% of Enterobacteriaceae and 13.1% of streptococci [21].…”

Section: Discussionmentioning

confidence: 99%

The treatment and prophylaxis usage profile of intravenous vancomycin medication in orthopedics

Wang

Jiang

2020

Preprint

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Background Despite vancomycin has been widely used in orthopedics, the details of vancomycin usage in orthopedics remains unknown. The purpose of the study was to evaluate the usage profile of intravenous vancomycin medication in orthopedics. Methods The medical records of inpatients receiving intravenous vancomycin medication from January 2015 to December 2019 in a single center of orthopedics department were retrospectively reviewed. The gender, age, diagnosis, surgical information, microbiological data, duration of vancomycin medication were collected. The related data were analyzed and compared between subgroups. Results A total of 258 cases receiving intravenous vancomycin medication (≥ 3 days) were enrolled. The mean age was 57.3 years. There were 141 cases in treatment and 117 in Prophylaxis group. The mean duration of vancomycin medication was 11.2 days. The duration was longer in Treatment than Prophylaxis group (14.8 versus 6.9 days, P < 0.05). The main reasons for treatment were PJI after TKA (46.7%) and THA (18.2%) in Joint subgroup and SSI after spine surgery (51.5%) for Spine subgroup. For prophylaxis usage, the main reasons were postoperative clinical suspicious infection. The bacteria responsible for infections in Treatment group were S. epidermidis (34.6%), S. aureus (31.8%), other Staphylococcus (12.1%), MRSA (7.5%), Streptococcus (7.5%), Enterococcus faecalis (3.7%) and Bacillus (2.8%). Conclusion Taken together, our research firstly revealed the treatment and prophylaxis usage profile of intravenous vancomycin medication in orthopedics. It provides the different purposes, main causes, bacteriological data and medication duration for treatment and prophylaxis vancomycin usage in orthopedics.

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Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study

Abstract: Considering the minority amount of GNB in late postoperative PJI, the empirical use of a broad-spectrum β-lactam should be reconsidered, especially when a two-stage exchange is planned.

Cited by 101 publications

References 23 publications

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Adverse Trends in the Etiology of Orthopedic Infection: Results of 6-Year Monitoring of the Structure and Resistance of Leading Pathogens

The treatment and prophylaxis usage profile of intravenous vancomycin medication in orthopedics

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