C Triffault-Fillit1, T Ferry2, F Laurent3, P Pradat4, C Dupieux3, A Conrad2, A Becker5, S Lustig6, M H Fessy7, C Chidiac2, F Valour2. 1. Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France. Electronic address: claire.triffault-fillit@chu-lyon.fr. 2. Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France. 3. Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de microbiologie, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France. 4. INSERM U1052, Center for Clinical Research, Croix-Rousse Hospital, Lyon, France. 5. Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France. 6. Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de chirurgie orthopédique, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France. 7. Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de chirurgie orthopédique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France.
Abstract
OBJECTIVES: The high microbiologic diversity encountered in prosthetic joint infection (PJI) makes the choice of empirical antimicrobial therapies challenging, especially in cases of implant retention or one-stage exchange. Despite the risk of dysbiosis and toxicity, the combination of vancomycin with a broad-spectrum β-lactam is currently recommended in all cases, even if Gram-negative bacilli (GNB) might be less represented in late PJI. In this context, this study aimed to describe the microbiologic epidemiology of PJI according to the chronology of infection. METHODS: This prospective cohort study (2011-2016) evaluated the microbiologic aetiology of 567 PJI according to time of occurrence from prosthesis implantation-early (<3 months), delayed (3-12 months) and late (>12 months)-as well as mechanism of acquisition. RESULTS: Initial microbiologic documentation (n = 511; 90.1%) disclosed 164 (28.9%) Staphylococcus aureus (including 26 (16.1%) methicillin-resistant S. aureus), 162 (28.6%) coagulase-negative staphylococci (including 81 (59.1%) methicillin-resistant coagulase-negative staphylococci), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) streptococci and 60 (10.6%) Cutibacterium acnes. Considering nonhaematogenous late PJI (n = 182), Enterobacteriaceae (n = 7; 3.8%) were less represented than in the first year after implantation (n = 56; 17.2%; p <0.001), without difference regarding nonfermenting GNB (4.6% and 2.7%, respectively). The prevalence of anaerobes (n = 40; 21.9%; including 32 (80.0%) C. acnes) was higher in late PJI (p <0.001). Consequently, a broad-spectrum β-lactam might be useful in 12 patients (6.6%) with late PJI only compared to 66 patients (20.3%) with early/delayed PJI (p <0.001). CONCLUSIONS: 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.
OBJECTIVES: The high microbiologic diversity encountered in prosthetic joint infection (PJI) makes the choice of empirical antimicrobial therapies challenging, especially in cases of implant retention or one-stage exchange. Despite the risk of dysbiosis and toxicity, the combination of vancomycin with a broad-spectrum β-lactam is currently recommended in all cases, even if Gram-negative bacilli (GNB) might be less represented in late PJI. In this context, this study aimed to describe the microbiologic epidemiology of PJI according to the chronology of infection. METHODS: This prospective cohort study (2011-2016) evaluated the microbiologic aetiology of 567 PJI according to time of occurrence from prosthesis implantation-early (<3 months), delayed (3-12 months) and late (>12 months)-as well as mechanism of acquisition. RESULTS: Initial microbiologic documentation (n = 511; 90.1%) disclosed 164 (28.9%) Staphylococcus aureus (including 26 (16.1%) methicillin-resistant S. aureus), 162 (28.6%) coagulase-negative staphylococci (including 81 (59.1%) methicillin-resistant coagulase-negative staphylococci), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) streptococci and 60 (10.6%) Cutibacterium acnes. Considering nonhaematogenous late PJI (n = 182), Enterobacteriaceae (n = 7; 3.8%) were less represented than in the first year after implantation (n = 56; 17.2%; p <0.001), without difference regarding nonfermenting GNB (4.6% and 2.7%, respectively). The prevalence of anaerobes (n = 40; 21.9%; including 32 (80.0%) C. acnes) was higher in late PJI (p <0.001). Consequently, a broad-spectrum β-lactam might be useful in 12 patients (6.6%) with late PJI only compared to 66 patients (20.3%) with early/delayed PJI (p <0.001). CONCLUSIONS: 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.
Authors: S Albac; D Labrousse; D Hayez; N Anzala; D Bonnot; P Chavanet; E Aslangul; D Croisier Journal: Antimicrob Agents Chemother Date: 2020-01-27 Impact factor: 5.191
Authors: Hussam Tabaja; Don Bambino Geno Tai; Elena Beam; Matthew P Abdel; Aaron J Tande Journal: Open Forum Infect Dis Date: 2022-04-14 Impact factor: 4.423
Authors: Don Bambino Geno Tai; Robin Patel; Matthew P Abdel; Elie F Berbari; Aaron J Tande Journal: Clin Microbiol Infect Date: 2021-06-12 Impact factor: 8.067
Authors: Marie Titécat; Caroline Loïez; François Demaeght; Jean-Thomas Leclerc; Théo Martin; Hervé Dezèque; Henri Migaud; Eric Senneville Journal: Front Med (Lausanne) Date: 2021-05-17