Treatment of bone and joint infections caused by Gram-negative bacilli with a cefepime–fluoroquinolone combination

Abstract

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.

Remission after treatment of osteoarticular infections due to Pseudomonas aeruginosa versus Staphylococcus aureus: a case-controlled study

“…Although this result was formally statistically insignificant, we detected this tendency in all analyses performed. Our failure risk of 24% is congruent with the 20% [12], 21% [13], 25% [27], 27% [14] or 30% [9] failure rates reported for pseudomonal osteoarticular infections, although lower (5% [11]; 7% [21]) or higher failure rates ranging from 33% [23], 35% [24], 38% [22] to 39% [15] also exist in small case series from the 1980s. Development of resistance among failure cases to the antimicrobial agents used during therapy occurred in 15%, which is congruent with the 13-24% risk after a prolonged antibiotic monotherapy during three-four months [9,24].…”

“…Although a more favourable outcome of combined regimens is still under debate for severe pseudomonal infections such as bacteraemia [7] or pneumonia [7], so far no study could really provide convincing evidence for the benefits of a targeted combined regimen for these infections once the results of the susceptibility testing became available, let alone for osteoarticular infections. Indeed, orthopaedic and infectious diseases studies reporting a dual therapy for P. aeruginosa [13,14] seem to have similar remission incidences than reports with single-agent treatment [15,26]. In one randomised comparative trial, seven cases of biopsy-proven P. aeruginosa osteomyelitis were treated with oral ciprofloxacin, and six patients received a standard parenteral therapy including an aminoglycoside plus an antipseudomonal beta-lactam during six-eight months.…”

“…for more than three months [9,14,20,33] Statistically significant results are displayed in boldface CI confidence interval, n.a. not included in the final model or not analysed due to small sample size a Diabetes mellitus, dialysis, cancer, Child class C cirrhosis, steroid medication b Peri-prosthetic joint infections c All implants without prosthetic joints [13], did not enhance remission when compared in the literature. Dan et al treated 22 cases of pseudomonal osteomyelitis with oral ciprofloxacin with various durations ranging from four to 12 weeks.…”

“…In one randomised comparative trial, seven cases of biopsy-proven P. aeruginosa osteomyelitis were treated with oral ciprofloxacin, and six patients received a standard parenteral therapy including an aminoglycoside plus an antipseudomonal beta-lactam during six-eight months. Although it appeared that patients on standard therapy did better (two vs four failures), the difference was statistically insignificant and numbers were too small to permit a valid evaluation [13,25]. In another randomised study comparing oral ciprofloxacin to parenteral ceftazidime and amikacin, Gentry and Rodriguez reported equal efficacy of the regimens (77% remission vs 79%) [27].…”

“…P. aeruginosa accounts for an absolute minority of all osteoarticular pathogens [1], and most reports are either case series involving around 20-30 cases [9][10][11][12][13] or even less [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Moreover, these reports subsume P. aeruginosa under other Gram-negative pathogens [9,12,13,19], including anaerobes [10,28], and lack adjustment for case mix [9,10,19,21]. Often, outcome comparisons of osteoarticular infections due to P. aeruginosa with Gram-positive pathogens are almost non-existent [10,28].…”