Probabilistic chemotherapy in knee and hip replacement infection: the place of linezolid

Deroche, Luc; Plouzeau, Chloé; Bémer, Pascale; Tandé, Didier; Valentin, Anne-Sophie; Jolivet‐Gougeon, Anne; Lemarié, Carole; Bret, Laurent; Kempf, Marie; Héry-Arnaud, Geneviève; Corvec, Stéphane; Burucoa, Christophe; Arvieux, Cédric; Bernard, Louis

doi:10.1007/s10096-019-03594-z

Cited by 12 publications

(11 citation statements)

References 28 publications

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“…However, a short course does not seem to be associated with an increased risk of adverse renal outcomes [34]. A shorter probabilistic treatment may also be beneficial in the case of linezolid use, as it limits the development of drug resistance and reduces side-effects, which are associated with the treatment duration [7,8,[35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

“…A combination containing a beta-lactam, such as piperacillin/tazobactam or a third-generation cephalosporin, is recommended, associated to an antibiotic that has been shown to be effective against Gram-positive bacteria, methicillin-resistant staphylococci in particular [2][3][4][5]. Vancomycin, daptomycin or linezolid are suitable options for this application [6][7][8]. Bacterial identification tools allow a faster diagnosis, but no recommendation provides guidelines on the duration of this EAT and the right time to re-evaluate it [2,3,9].…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…The treatment of periprosthetic joint infection (PJI) includes different surgical approaches involving debridement and prosthesis retention as well as one-stage exchange or twostage exchange, and medical systemic treatment can vary greatly regarding length and substances used (Osmon et al, 2013b;Anemuller et al, 2019;de Beaubien et al, 2019) with successful shorter-term courses (Winkler et al, 2019) described as being contrasted by long-time antibiotic suppression treatment in severe, complicated cases (Siqueira et al, 2015;Wouthuyzen-Bakker et al, 2017;Leijtens et al, 2019). Furthermore, microbiological results are changing with increasing prevalence of resistant strains (Drago et al, 2017;De Vecchi et al, 2018), particularly methicillinresistant (MR) coagulase-negative Staphylococcus (CoNS) now being the main pathogen detected (Lourtet-Hascoet et al, 2018;Hipfl et al, 2019;Tevell et al, 2019). In this context, linezolid is a potential antimicrobial treatment option addressing resistant Staphylococcus (Deroche et al, 2019) as well as reducing the need for long-term inpatient treatment given its excellent oral bioavailability (Kutscha-Lissberg et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Clinical use of linezolid in periprosthetic joint infections – a systematic review

Theil

Schmidt-Braekling

Gosheger

et al. 2020

J. Bone Joint Infect.

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Abstract. Introduction: The most common causative organism in periprosthetic joint infections (PJIs) is Gram-positive bacteria that are increasingly drug resistant. In these cases the use of linezolid may be warranted. However, there are conflicting reports regarding its role in antibiotic treatment of PJIs. The aim of this review is to gather and analyze clinical results and treatment details on linezolid in patients with PJIs. Methods: In August 2019, a comprehensive literature search using MEDLINE (Pubmed and Ovid) and Cochrane Library was performed. A total of 504 records were screened, and a total of 16 studies including 372 patients treated with linezolid for a PJI were included in this review based on the PRISMA criteria and after quality analysis using the MINOR score and Newcastle–Ottawa scale, as well as assessing level of evidence. Pooling analysis as well as descriptive analysis was performed. Results: Based on the results from the studies included, infection control was achieved in 80 % (range 30 %–100 %) of patients after a mean follow-up period of 25 (range 2–66) months. The mean duration of treatment was 58 d intravenous and orally at a median dose of 600 mg bis in die (b.i.d.) (range 400–900 b.i.d.). A combination therapy with rifampicin was used in 53 % of patients. MRSA (methicillin-resistant Staphylococcus aureus) infections were present in 29 % and resistant CoNS (coagulase-negative Staphylococcus) in 46 %. Adverse effects occurred in 33 % of cases, mostly anemia, thrombocytopenia and gastrointestinal complaints leading to treatment discontinuation in 9 %. However, great heterogeneity was found with respect to surgical treatment, diagnosis of infection and indication for linezolid. Discussion: Linezolid is an appropriate option for treatment of resistant Gram-positive organisms in PJIs. Most commonly 600 mg b.i.d. is used, and a combination with rifampicin appears feasible although one must consider individual increases in doses in these cases. However, adverse effects are common and there are limited data for long-term use and optimal antibiotic combinations or individual doses.

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“…New cyclic lipopeptides (daptomycin), oxazolidinones (tedizolid), or synthetic glycopeptides (oritavancin) 20,108–110 …”

Section: New Advancements In the Treatment Of Musculoskeletal Infectionmentioning

confidence: 99%

“…Systemic antibiotic therapy is a critical aspect of treating PJI, however, increasing bacterial resistance to conventional antimicrobial agents creates significant treatment challenges 146,147 . Over the past decade, novel antibiotics with broad‐spectrum activity against Gram‐positive organisms such as daptomycin, which is a cyclic lipopeptide, and linezolid, an oxazolidinone, have been developed to expand treatment options for resistant infections 108–110 . For instance, daptomycin had greater than an 80% treatment success rate for a mix of chronic and acute PJIs in the setting of resistant Staphylococcal infection when alternative antibiotics such as vancomycin could not be used due to resistance or patient intolerance 108 .…”

Section: New Advancements In the Treatment Of Musculoskeletal Infectionmentioning

confidence: 99%

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Ricciardi

Muthukrishnan

Masters

et al. 2020

Journal Orthopaedic Research

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Prosthetic joint infection (PJI) is a devastating complication that results in substantial costs to society and patient morbidity. Advancements in our knowledge of this condition have focused on prevention, diagnosis, and treatment, in order to reduce rates of PJI and improve patient outcomes. Preventive measures such as optimization of patient comorbidities, and perioperative antibiotic usage are intensive areas of current clinical research to reduce the rate of PJI. Improved diagnostic tests such as synovial fluid (SF) α‐defensin enzyme‐linked immunosorbent assay, and nucleic acid‐based tests for serum, SF, and tissue cultures, have improved diagnostic accuracy and organism identification. Increasing the diversity of available antibiotic therapy, immunotherapy, and alternative implant coatings remain promising treatments to improve infection eradication in the setting of PJI.

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Probabilistic chemotherapy in knee and hip replacement infection: the place of linezolid

Cited by 12 publications

References 28 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

Clinical use of linezolid in periprosthetic joint infections – a systematic review

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

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