Piseth Seng1,2,3, Madou Traore4, Jean-Philippe Lavigne5, Laurence Maulin6, Jean-Christophe Lagier7, Jean-François Thiery8, Pierre-Yves Levy9, Pierre-Marie Roger10, Eric Bonnet11, Albert Sotto12, Andreas Stein13,4,7. 1. , 19-21 Boulevard Jean Moulin, Marseille, 13005, France. sengpiseth@yahoo.fr. 2. Service de Maladies Infectieuses Tropicales et Infections Chroniques (MITIC), IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France. sengpiseth@yahoo.fr. 3. Aix-Marseille Université, Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, France. sengpiseth@yahoo.fr. 4. Service de Maladies Infectieuses Tropicales et Infections Chroniques (MITIC), IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France. 5. Service de Microbiologie - Centre Hospitalo-Universitaire de Nîmes, Nîmes, France. 6. Unité d'infectiologie transversale, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France. 7. Aix-Marseille Université, Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, France. 8. Chirurgie Orthopédique et Traumatologique Adulte, Hôpital Privé Résidence du Parc, Marseille, France. 9. Laboratoire de biologie médicale, Hôpital Privé La Casamance, Aubagne, France. 10. Service des Maladies infectieuses et Tropicales - Centre Hospitalo-Universitaire de Nice, Nice, France. 11. Equipe Mobile d'Infectiologie, Hopital Joseph Ducuing, Toulouse, France. 12. Service des Maladies infectieuses et Tropicales - Centre Hospitalo-Universitaire de Nîmes, Nîmes, France. 13. , 19-21 Boulevard Jean Moulin, Marseille, 13005, France.
Abstract
PURPOSE: Cases of fracture-fixation device infection involving Staphylococcus lugdunensis are not frequent. The clinical characteristics and the choice of treatment strategies of these infections are not obviously known to date. METHODS: We performed a review of fracture-fixation device infection involving S. lugdunensis managed by our centres. RESULTS: Among the 38 cases of fracture-fixation device infection involving S. lugdunensis, 53% were located in the tibia. Most of our cases (87%) were chronic infections. Purulent discharge, which occurred in 79% of cases, was the most frequent clinical symptom, followed by pain in 63%, local inflammation in 55%, and fever in 37%. Bacteremia and severe sepsis occurred in 10% and 18% of cases, respectively. Four cases (10%) were treated exclusively with antimicrobial treatment alone. Thirty-four cases (89%) were treated with a combination of surgery with antimicrobial therapy including surgical debridement, antibiotics and osteosynthesis device retention in six cases (16%), and osteosynthesis device removal in 27 cases (71%). The mean length of antibiotic treatment was 119 days. The relapse rate was high that was not related to selection of resistant strains. Polymicrobial infection had no impact on clinical outcome. A combination of surgery with antimicrobial therapy was identified as a significant prognostic factor associated with remission (p = 0.042). CONCLUSIONS: S. lugdunensis is probably involved in more infections than has been reported. Using appropriate microbiological methods laboratories should routinely identify the species of all coagulase-negative Staphylococci isolates involved in fracture-fixation device infection to better achieve the treatment strategies of fracture-fixation device infection involving S. lugdunensis.
PURPOSE: Cases of fracture-fixation device infection involving Staphylococcus lugdunensis are not frequent. The clinical characteristics and the choice of treatment strategies of these infections are not obviously known to date. METHODS: We performed a review of fracture-fixation device infection involving S. lugdunensis managed by our centres. RESULTS: Among the 38 cases of fracture-fixation device infection involving S. lugdunensis, 53% were located in the tibia. Most of our cases (87%) were chronic infections. Purulent discharge, which occurred in 79% of cases, was the most frequent clinical symptom, followed by pain in 63%, local inflammation in 55%, and fever in 37%. Bacteremia and severe sepsis occurred in 10% and 18% of cases, respectively. Four cases (10%) were treated exclusively with antimicrobial treatment alone. Thirty-four cases (89%) were treated with a combination of surgery with antimicrobial therapy including surgical debridement, antibiotics and osteosynthesis device retention in six cases (16%), and osteosynthesis device removal in 27 cases (71%). The mean length of antibiotic treatment was 119 days. The relapse rate was high that was not related to selection of resistant strains. Polymicrobial infection had no impact on clinical outcome. A combination of surgery with antimicrobial therapy was identified as a significant prognostic factor associated with remission (p = 0.042). CONCLUSIONS:S. lugdunensis is probably involved in more infections than has been reported. Using appropriate microbiological methods laboratories should routinely identify the species of all coagulase-negative Staphylococci isolates involved in fracture-fixation device infection to better achieve the treatment strategies of fracture-fixation device infection involving S. lugdunensis.
Entities:
Keywords:
Bacteria; Bone and joint infection; Fracture-fixation devices; Human; Infection; Internal fixation; Osteomyelitis; Osteosynthesis; Staphylococcus lugdunensis
Authors: Ian H McHardy; Jennifer Veltman; Janet Hindler; Katia Bruxvoort; Marissa M Carvalho; Romney M Humphries Journal: J Clin Microbiol Date: 2016-12-07 Impact factor: 5.948
Authors: N Douiri; Y Hansmann; N Lefebvre; P Riegel; M Martin; M Baldeyrou; D Christmann; G Prevost; X Argemi Journal: Clin Microbiol Infect Date: 2016-06-11 Impact factor: 8.067
Authors: Cyril Mauffrey; David J Hak; Peter Giannoudis; Volker Alt; Christoph Nau; Ingo Marzi; Peter Augat; J K Oh; Johannes Frank; Andreas Mavrogenis; Xavier Flecher; Jean-Noel Argenson; Ashok Gavaskar; David Rojas; Yehia H Bedeir Journal: Int Orthop Date: 2018-05-03 Impact factor: 3.075