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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 1 - 1
1 Dec 2017
Vaznaisiene D Sulcaite R Jomantiene D Beltrand E Spucis A Reingardas A Kymantas V Mickiene A Senneville E
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Aim

To assess the spread of foot infection and its impact on the outcomes of major amputations of lower extremities in diabetic patients.

Method

In a multicentre retrospective and prospective cohort study, we included adult diabetic patients (≥ 18 years) who underwent a major amputation of a lower limb in 5 hospitals between 2000 and 2009, 2012 and 2014. A total of 51 patients were included (of which 27 (52.94%) were men and 24 (47.06%) were women) with the mean age of 65.51 years (SD=16.99). Concomitant section's osseous slice biopsy (BA) and percutaneous bone biopsy of the distal site (BD) were performed during limb amputation. A new surgical set-up and new instruments were used to try and reduce the likelihood of cross-contamination during surgery. A positive culture was defined as the identification of at least 1 species of bacteria not belonging to the skin flora or at least 2 bacteria belonging to the skin flora (CoNS (coagulase negative staphylococci), Corynebacterium spp, Propionibacterium acnes) with the same antibiotic susceptibility profiles. A doubtful culture was defined as the identification of 1 species of bacteria belonging to the skin flora. The patients were followed-up for 1 year. Stump outcomes were assessed on the delay of complete healing, equipment, need of re-intervention and antibiotics.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 73 - 73
1 Dec 2017
Pierret F Migaud H Loiez C Valette M Beltrand E Yombi J Cornu O Senneville E Cauter MV
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Aim

The treatment of a chronic prosthetic joint infection (PJI) is a combination of the bacteria's identification, a «carcinological» surgery and an appropriate antibiotherapy. In case of gram positive cocci infection, rifampicin is often used.

The aim of this study is to determine which factors are responsible for the development of resistance to rifampicine.

Method

All patients had a total hip (THA) or knee (TKA) arthroplasty with a chronic infection. They were treated with a two-time surgery. All of them received a bi-antibiotic treatment. In case of gram positive cocci infection, and according to the susceptibility test, they received rifampicin. The 221 patients were operated from July 1997 to November 2013 in 3 university centers (one Belgian and two French) and were retrospectively analysed. The demographical, clinical and bacterial data as well as the antibiotic treatment were collected. The healing was defined as the absence of recurrence during the 2 years following surgery.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_15 | Pages 28 - 28
1 Dec 2015
Nguyen S Pradier M Valette M Choisy P Digumber M Migaud H Beltrand E Senneville E
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There is currently no consensus on the use of suppressive antibiotic therapy (SAT) in prosthetic joint infections (PJI) (1). We describe herein the experience of a French Reference Centre for Complex Osteo-Articular Infections on use of oral cyclines (doxycline and minocycline) for SAT.

A retrospective analysis was performed on consecutive patients with PJI who received oral cyclines (doxycycline or minocycline) for SAT between January 2006 and June 2014. All patients had surgical management, followed by systemic antibiotic treatment and SAT instauration thereafter. Remission was defined as an asymptomatic patient with a functioning prosthesis.

Seventy-nine patients with a mean age of 63.8 ± 16.8 years were included. Sixteen patients (20%) had neoplasia, 9 (11%) diabetes mellitus, 10 (13%) rheumatoid arthritis, and 6 patients (8%) were receiving corticosteroids or chemotherapy.

There were 37 knee (47%), 36 hip (46%), 4 elbow (5%), and 2 shoulder (3%) infections, with a mean delay from implantation of 7.37 ± 6.94 months (range 1–27). Surgical management consisted in debridement and implant retention for 60 patients (76%), or in implant exchange for 19 patients (24%).

Main pathogens were coagulase-negative staphylococci (37%) and Staphylococcus aureus (41%); 23 patients had polymicrobial infection (29%).

The most frequent initial antibiotic regimens debuted before SAT were rifampicin combinations (70%). Mean duration of curative antibiotic therapy was 103 ± 75 days.

Indications of SAT were (i) patients unsuitable for or refusing further surgery (n=23), suboptimal (ii) surgery (n=26) or (iii) curative antibiotic therapy (n=11), (iv) complex orthopaedic surgery (n=11), and (v) immunosuppressive status (n=8). Seventy-three patients received doxycycline and 6 patients received minocycline as SAT (n=48). Mean SAT duration was 625± 536 days (range 30–2900), with a mean follow-up of 765 ± 572 days.

Adverse events were reported in 13 patients (16%), leading to SAT discontinuation in 5 (6%).

During follow-up, 59 patients were considered in remission (75%), and 20 failed including 13 relapses (16%) and 7 reinfections (9%). Among failure patients, 10 pathogens resistant to doxy/minocycline were identified, including 5 with acquisition of cycline resistance.

In our study, SAT with cyclines is associated to a 75% remission rate, with an acceptable tolerability.

Further studies are warranted to determine ideal regimens and optimal duration of SAT.

We would like to thank Dron Hospital and Lille University Hospital medical teams.

The authors declare that there are no conflicts of interest.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 78 - 78
1 Sep 2012
Mares O Mares O Luneau S Staquet V Beltrand E Bousquet PJ Maynou C
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Introduction

Acromioclavicular dislocation (ACD) is frequent, at 8% of all shoulder traumas. Management in grade III lesions remains controversial. The present study assessed objective and subjective results at medium-term follow-up (mean, 60 months; range, 12—120 mo) in 27 patients managed by Ligastic® ligament reconstruction for acute dislocation.

Patients and Methods

This is a multicenter, multi-surgeon retrospective study. Between 1998 and 2006, 59 patients were operated on for grade III or IV ACD, in one teaching hospital (Lille, France) and one general hospital (Tourcoing, France). Follow-up was performed by an indepen- dent (non-operator) observer. The 27 acute cases followed up underwent comparative bilateral radioclinical shoulder examination. Initial X-ray assessment found 14 grade-III (52%) and 13 grade-IV (48%) dislocations using Patte's classification.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 519 - 519
1 Nov 2011
Joulie D Loiez C Legout L Dezeque H Roselé B Maynou C Beltrand E Hue E Senneville E Migaud H
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Purpose of the study: Factors affecting the course of Staphylococcus aureus (SA) infected total hip arthroplasty (THA) and total knee arthroplasty (TKA) are poorly understood.

Material and methods: The microbiology laboratory database on patients hospitalised from June 2001 to June 2006 for medical and surgical treatment of an SA infected THA or TKA were reviewed. Data collected were: clinical, radiological, and biological (CRP) status known at least two years after the end of the antibiotic treatment. Success was defined as normal findings in all three domains at last follow-up and failure for any other situation.

Results: The series included 87 patients (43 male and 54 female, mean age 66.5 years, 62 THA, 35 TKA). Material was removed in 51 patients (52.6%). The infection was related to met-R SA in 14 patients (14.4%) and polymicrobial infection in 24 patients (24.7%). Mean duration of intravenous treatment was 7.3±9.4 days and total duration of antibiotic treatment was 115.472.2 d. At mean follow-up of 54.1±19.4 d, the overall success was 62/97 (63.9%). The only parameters significantly associated with failure were delay to management after first signs revealing longer infection (67.9 days vs 144.8 days) and an antibiotic therapy not adapted bacteriological results to immediately after surgery. (28.6% vs 3/28; 4.8%). In this series, met-R SA was not a risk factor of failure.

Conclusion: This work suggests that delayed surgical management and quality of antibiotic treatment for the first revision are factors affecting the prognosis of SA infected THA and TKA. These results are in favour of a multidisciplinary approach to care for these patients.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 264 - 264
1 Jul 2008
SENNEVILLE E MELLIEZ H PINOIT Y LEGOUT L SOENEN M BELTRAND E MAYNOU C MIGAUD H
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Purpose of the study: Because of its specific properties, linezolid (LZD) is an alternative to glycopeptides for the treatment of BJI causes by resistant Gram-positive cocci. The efficacy and tolerance of long-term (> 28d) administration remain to be determined with precision.

Material and methods: This was a retrospective analysis of the files of patients who received long-term LZD for BJI with a post-treatment follow-up of at least twelve months.

Results: Between January 2001 and December 2003, 68 patients (mean age 54.6 years) received LZD (600 mg/12h) intravenously then orally for a mean duration of 14.6 weeks on average (range 6–36 weeks). The orthopedic implants were infected in 31 patients (45.6%, 27 prostheses and 4 external fixators). A fistulization was diagnosed in 29 patients (42.6%). Medical and surgical treatment was undertaken in 51 patients (75%). Germs isolated from deep samples were staphylococci (n=57, 51 meti-R), and strepotococci (n=11). A polymicrobial infection was recorded in six patients (8.8%). Clinical success was achieved in 52 patients (76.5%) at the end of treatment, a result which was sustained for 48 of them to mean follow-up of 16.8 months (range 12–48). Sixty-three episodes of side effects were noted: anemia (n=29), peripheral neuropathy (n=9), nausea (n=14), headache (n=2), neutropenia (n=2), and thrombopenia (n=1), leading to discontinuation of LZD in 23 patients (33.8%) on average 11.9 weeks (range 6–36) after onset of treatment. Fifteen patients (22.1%) required transfusion.

Discussion: Among the patients in this series with BJI, most caused by a multiresistant germ, the rate of success was satisfactory (48/68, 70.6%) with LZD. Treatment was associated with a high frequency of serious adverse effects leading to discontinuation in one-third of patients.

Conclusion: Long-term treatment of BJI with LZD appears to be effective, including in patients with infected orthopedic material. Conversely, tolerance problems can limit is use to infections caused by mul-tiresistant Gram-positive cocci unresponsive to other compounds.