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Hugues B, Emsen B, Pina Vegas L, Lepeule R, Ternacle J, Huguet R, Decousser JW, Fiore A, Lim P, Itti E, Chevalier X, Abulizi M, Eymard F. PET/CT for osteoarticular septic grafts in endocarditis: A large monocentric cohort. Joint Bone Spine 2023; 90:105577. [PMID: 37076094 DOI: 10.1016/j.jbspin.2023.105577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Benjamin Hugues
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Berivan Emsen
- AP-HP, Henri-Mondor Hospital, Department of Nuclear Medicine, 94000 Créteil, France
| | - Laura Pina Vegas
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Raphaël Lepeule
- AP-HP, Henri-Mondor Hospital, Department of Microbiology, 94000 Créteil, France
| | - Julien Ternacle
- CHU de Bordeaux, Haut-Lévêque Hospital, Department of Cardiology, 33600 Pessac, France
| | - Raphaëlle Huguet
- AP-HP, Henri-Mondor Hospital, Department of Cardiology, 94000 Créteil, France
| | | | - Antonio Fiore
- AP-HP, Henri-Mondor Hospital, Department of Thoracic Surgery, 94000 Créteil, France
| | - Pascal Lim
- AP-HP, Henri-Mondor Hospital, Department of Cardiology, 94000 Créteil, France
| | - Emmanuel Itti
- AP-HP, Henri-Mondor Hospital, Department of Nuclear Medicine, 94000 Créteil, France
| | - Xavier Chevalier
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Mukedaizi Abulizi
- AP-HP, Henri-Mondor Hospital, Department of Nuclear Medicine, 94000 Créteil, France
| | - Florent Eymard
- AP-HP, Henri-Mondor Hospital, Department of Rheumatology, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France.
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KHENG M, ALEXIS JF, WALTER G, MOSNIER É, MALMONTET T, PIERRE DEMAR M, TAUCH V, VESIN G, ABBOUD P, ROQUES F, DJOSSOU F, EPELBOIN L. [Sacroiliitis with Erysipelothrix Rhusiopathiae revealing tricuspid endocarditis, the first case reported on the Guiana Shield: clinical case and review of the literature]. Med Trop Sante Int 2022; 2:mtsi.v2i3.2022.256. [PMID: 36284553 PMCID: PMC9557821 DOI: 10.48327/mtsi.v2i3.2022.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/01/2022] [Indexed: 06/16/2023]
Abstract
We report here an atypical case of acute sacroiliitis caused by Erysipelothrix rhusiopathiae revealing tricuspid endocarditis in a 53-year-old woman without medical history. She was admitted to Cayenne hospital because of intense right hip and thigh pain, associated with fever. A right sacroiliitis was visible on the computed tomography (CT) scan, confirmed on MRI. Transesophageal echocardiography revealed a large mobile tricuspid vegetation. Blood cultures were positive for E. rhusiopathiae. CT scan showed pulmonary alveolar opacities, consistent with septic emboli. Clinical improvement was obtained under ceftriaxone followed by ciprofloxacin for 6 weeks of treatment. We present a review of bone and joint infections caused by E. rhusiopathiae. So far, not a single case has been reported in Latin America.
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Affiliation(s)
- Mathilde KHENG
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Jean Francky ALEXIS
- Service de cardiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Gaëlle WALTER
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Émilie MOSNIER
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Thomas MALMONTET
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Magalie PIERRE DEMAR
- Laboratoire de microbiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Vilyn TAUCH
- Service de radiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Guillaume VESIN
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Philippe ABBOUD
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - François ROQUES
- Service de chirurgie thoracique, Centre hospitalier universitaire de Martinique, Fort-de-France, Martinique, France
| | - Félix DJOSSOU
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
- Laboratoire de microbiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
| | - Loïc EPELBOIN
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
- Laboratoire de microbiologie, Centre hospitalier Andrée Rosemon, Cayenne, Guyane, France
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Habre C, Botti P, Laurent M, Ceroni D, Toso S, Hanquinet S. Benefits of diffusion-weighted imaging in pediatric acute osteoarticular infections. Pediatr Radiol 2022; 52:1086-1094. [PMID: 35376979 PMCID: PMC9107444 DOI: 10.1007/s00247-022-05329-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/08/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contrast-enhanced magnetic resonance imaging (MRI) is recommended for the diagnosis of acute osteoarticular infections in children. Diffusion-weighted imaging (DWI) may be an alternative to the injection of gadolinium. OBJECTIVE To evaluate unenhanced MRI with DWI in comparison to contrast-enhanced MRI for the diagnostic work-up of acute osteoarticular infections in children. MATERIALS AND METHODS This retrospective study included 36 children (age range: 7 months-12 years) with extra-spinal osteoarticular infections and MRI performed within 24 h of admission. MRI protocol included short tau inversion recovery (STIR), water-only T2 Dixon, T1, DWI, and gadolinium-enhanced T1 sequences. Two readers reviewed three sets of images: 1) unenhanced sequences, 2) unenhanced sequences with DWI and 3) unenhanced followed by contrast-enhanced sequences (reference standard). Sensitivity and specificity of sets 1 and 2 were compared to set 3 and assessed to identify osteoarticular infections: osteomyelitis (long bones, metaphyseal equivalents), septic arthritis and abscess (soft tissues, bone). RESULTS All 14 cases of osteomyelitis in the metaphyses and diaphyses of long bones and all 27 cases of septic arthritis were identified by unenhanced sequences, but 4/16 abscesses were missed. For the diagnosis of abscess, DWI increased sensitivity to 100%. Among the 18 osteomyelitis in metaphyseal equivalents, 4 femoral head chondroepiphyses were identified by contrast-enhanced sequences only. CONCLUSION MRI for suspected pediatric acute osteoarticular infections is the best diagnostic modality to guide patient management. An unenhanced protocol with DWI may be an alternative to a contrast-based protocol, even in the presence of an abscess. However, gadolinium remains necessary to assess for chondroepiphyseal involvement of the femoral head.
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Affiliation(s)
- Céline Habre
- Pediatric Radiology Unit, Radiology Division, Diagnostic Department, Children's Hospital, University Hospitals of Geneva, CH-1211, Geneva 14, Switzerland.
| | - Paul Botti
- Pediatric Radiology Unit, Radiology Division, Diagnostic Department, Children's Hospital, University Hospitals of Geneva, CH-1211, Geneva 14, Switzerland
| | - Méryle Laurent
- Pediatric Radiology Unit, Radiology Division, Diagnostic Department, Children's Hospital, University Hospitals of Geneva, CH-1211, Geneva 14, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Surgery Division, Department of Women-Children-Teenagers, Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Seema Toso
- Pediatric Radiology Unit, Radiology Division, Diagnostic Department, Children's Hospital, University Hospitals of Geneva, CH-1211, Geneva 14, Switzerland
| | - Sylviane Hanquinet
- Pediatric Radiology Unit, Radiology Division, Diagnostic Department, Children's Hospital, University Hospitals of Geneva, CH-1211, Geneva 14, Switzerland
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Ojha SC, Chen K, Sun C, Ahmed S, Sheng YJ, Deng CL. Clinical Relevance of Xpert MRSA/SA in Guiding Therapeutic Decisions for Staphylococcal Infections: A Diagnostic Test Accuracy Analysis. Infect Dis Ther 2022; 11:1205-1227. [PMID: 35451743 PMCID: PMC9124268 DOI: 10.1007/s40121-022-00632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/30/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Rapid identification of the causal organism and antibiotic resistance is crucial for guiding targeted therapy in patients with suspected staphylococcal infection. A meta-analysis was carried out to evaluate the diagnostic relevance of Xpert™ MRSA/SA (Xpert) from clinical samples of various origins for limiting the use of unnecessary empirical methicillin-resistant Staphylococcus aureus (MRSA) therapy. Methods Five databases, including the Cochrane Library, Scopus, PubMed, Web of Science, and Embase, were comprehensively inspected from inception to October 12, 2021. The pooled summary estimates were evaluated using a bivariate random-effects model. Results Our inclusion criteria were met by 49 publications containing 68 datasets out of 735 citations. A total of 21 studies (n = 4996) examined the accuracy of Xpert in detecting methicillin-sensitive S. aureus (MSSA), while 47 studies (n = 45,430) examined the accuracy of Xpert in detecting MRSA. As compared to MRSA, Xpert’s diagnostic performance for MSSA detection was markedly higher [sensitivity: 0.97 (0.96–0.98), specificity: 0.97 (0.97–0.98), area under curve (AUC): 0.99 (0.99–1.0)]. Xpert’s pooled sensitivity and specificity differed marginally across sample types, including screening of colonization, lower respiratory tract (LRT), osteoarticular, and bloodstream samples. Notably, the Xpert pooled specificity was consistently ≥ 92% against microbiological culture across all sample types. The diagnostic efficiency heterogeneity was not explained by a meta-regression and subgroup analysis of research design, sample conditions, and sampling methods (P > 0.05). Conclusion Our findings suggest that Xpert could be used as the favoured screening test for the early detection of staphylococcal infection in a variety of sample types, with the goal of guiding therapeutic decisions. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00632-w.
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Affiliation(s)
- Suvash Chandra Ojha
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China. .,Southwest Medical University, Jiangyang District, Luzhou, 646000, China.
| | - Ke Chen
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.,Southwest Medical University, Jiangyang District, Luzhou, 646000, China
| | - Changfeng Sun
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.,Southwest Medical University, Jiangyang District, Luzhou, 646000, China
| | - Sarfraz Ahmed
- Department of Basic Sciences, University of Veterinary and Animal Sciences Lahore, Sub-campus, Narowal, 51600, Pakistan
| | - Yun-Jian Sheng
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.,Southwest Medical University, Jiangyang District, Luzhou, 646000, China
| | - Cun-Liang Deng
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
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Mainard N, Saab M, Dartus J, Martinot P, Loiez C, Titecat M, Dezeque H, Putman S, Senneville E, Migaud H. The benefits of systematic intraoperative sampling during lower limb arthroplasties due to sequelae from prior osteoarticular infections: A retrospective study of 92 cases. Orthop Traumatol Surg Res 2022; 108:103189. [PMID: 34933132 DOI: 10.1016/j.otsr.2021.103189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/08/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Osteoarticular infections (OAIs) of native joints lead to cartilage damage which may require subsequent arthroplasty. There is no consensus on systematic intraoperative microbiological sampling when performing an arthroplasty on a native joint with a history of OAI. We carried out a retrospective study to: (1) identify the frequency of the persistence of the microorganism(s) involved during the initial, presumed cured OAI, when performing an arthroplasty for sequelae of osteoarthritis, (2) to find an association between the length of time between the OAI and arthroplasty, and the recurrence of bacterial infection, (3) to assess the influence of the presence of hardware on the risk of infectious recurrence. HYPOTHESIS Systematic sampling is justified during a subsequent arthroplasty after an OAI, even after a prolonged period. MATERIAL AND METHOD This single-center, retrospective descriptive study included all patients whose indication for arthroplasty resulted from osteoarthritis, osteitis or bacterial osteomyelitis of a native joint, or in the aftermath of an infection post osteosynthesis. All patients were considered to have recovered from the initial infection at the time of the arthroplasty. Between 2008 and 2019, 92 patients were included in the study, with an average age of 56.5years (range: 21-97years). OAI occurred at a mean age of 35years (range: 1-84years). The average time from OAI to implantation was 15years (range: 1-65years). The bacteria most frequently found in the initial OAI was Staphylococcus aureus, involved in 35.8% of cases (n=33/92). RESULTS The intraoperative samples came back positive in 17% of cases (n=16/92), including 9 positive for the same bacteria as the OAI (56%, n=9/16). For these 16 cases, the time between the OAI and the arthroplasty was 1year for 5 patients, between 1 and 15years for 5 patients and greater than 15years for 6 patients. For 3 positive patients, the information on the initial microorganism was not known and 4 patients were positive for a bacterium different from the initial one. The time from the initial OAI to the arthroplasty was not associated with positive results (p=0.38). There was no significant difference between a positive culture at the time of arthroplasty and the initial type of OAI [native joint versus presence of hardware and/or open fracture (p=0.41)]. CONCLUSION The results of this work suggest there is value in microbiological sampling when performing an arthroplasty on a previously infected joint, regardless of the duration of the infection. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Nicolas Mainard
- Département de chirurgie pédiatrique, hôpital Jeanne-de-Flandre, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France; Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France.
| | - Marc Saab
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Julien Dartus
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Pierre Martinot
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Caroline Loiez
- Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Service de bactériologie-hygiène, institut de microbiologie, centre de biologie pathologie, CHU Lille, boulevard du Pr-Jules-Leclercq, 59000 Lille, France
| | - Marie Titecat
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Service de bactériologie-hygiène, institut de microbiologie, centre de biologie pathologie, CHU Lille, boulevard du Pr-Jules-Leclercq, 59000 Lille, France
| | - Henri Dezeque
- Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Sophie Putman
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Eric Senneville
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire des maladies infectieuses et du voyageur, hôpital Gustave-Dron, 135, rue du Président-Coty, 59200 Tourcoing, France
| | - Henri Migaud
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
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Ruffenach L, Boeri C, Ronde Oustau C, Bodin F, Bruant-Rodier C, Dissaux C. [A pedicled deep inferior epigastric flap to cover a hip arthroplasty infection]. ANN CHIR PLAST ESTH 2021; 67:101-104. [PMID: 34949489 DOI: 10.1016/j.anplas.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
The deep inferior epigastric perforator (DIEP) flap is a reliable flap mostly used in skin resurfacing after signifiant resection for sarcoma or correction contour deformities. This case is about a pedicled DIEP flap covering the trochanteric region after a total hip arthroplasty infection. A 62years old woman with a BMI at 42kg/m2 presents an infected total hip arthroplasty with a cutaneous defect. The hip prosthesis is changed and covered with a pedicled DIEP flap. This original case reports the used of pedicled DIEP flap in hip coverage. This local fasciocutaneous flap covered the hip osteoarticular infection. The limb is salved and the patient can walked again. The success of this surgery is the collaboration between infectious disease specialist, orthopedic surgeon and plastic surgeon.
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Affiliation(s)
- L Ruffenach
- Service de chirurgie plastique esthétique et reconstructrice, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France.
| | - C Boeri
- Service de chirurgie orthopédique septique, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - C Ronde Oustau
- Service de chirurgie orthopédique septique, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - F Bodin
- Service de chirurgie plastique esthétique et reconstructrice, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - C Bruant-Rodier
- Service de chirurgie plastique esthétique et reconstructrice, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - C Dissaux
- Service de chirurgie plastique esthétique et reconstructrice, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
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7
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Hanène F, Nacef L, Maatallah K, Triki W, Kaffel D, Hamdi W. Tuberculosis arthritis of the ankle mimicking a talar osteochondritis. Foot (Edinb) 2021; 49:101816. [PMID: 34536816 DOI: 10.1016/j.foot.2021.101816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/18/2021] [Accepted: 04/25/2021] [Indexed: 02/04/2023]
Abstract
Tuberculosis arthritis of the ankle accounts for 10% of all cases of osteoarticular tuberculosis (OT). Because of its rarity and insidious symptoms, diagnosing it may be challenging. Furthermore, its imaging findings mimic those of other diseases. The case of ankle tuberculosis arthritis misdiagnosed as talus necrosis is reported. The difficulties faced by clinicians when confronting such situations are also illustrated.
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Affiliation(s)
- Ferjani Hanène
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Lilia Nacef
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Kaouther Maatallah
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Wafa Triki
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Dhia Kaffel
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
| | - Wafa Hamdi
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology Department, La Mannouba, Tunisia; Research Unit UR17SP04, 2010 Ksar Said, Tunis, Tunisia.
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Cojutti PG, Rinaldi M, Gatti M, Tedeschi S, Viale P, Pea F. Usefulness of therapeutic drug monitoring in estimating the duration of dalbavancin optimal target attainment in staphylococcal osteoarticular infections: a proof-of-concept. Int J Antimicrob Agents 2021; 58:106445. [PMID: 34614441 DOI: 10.1016/j.ijantimicag.2021.106445] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/14/2021] [Accepted: 09/25/2021] [Indexed: 11/20/2022]
Abstract
Dalbavancin is increasingly used for the treatment of staphylococcal osteoarticular infections (OIs). Some population pharmacokinetic studies suggest that a regimen of two 1500 mg doses 1 week apart could ensure effective treatment for several weeks. Here we aim to provide clinicians with a proof-of-concept of the potential role that therapeutic drug monitoring may have in giving real-time feedback of the estimated duration of optimal treatment of staphylococcal OIs with dalbavancin in each single patient.
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Wallet F, Le Guern AS, Penven M, Senneville E, Savin C, Loïez C. Yersinia enterocolitica biotype 1B case report: an unusual pathogen in an osteoarticular infection on device. BMC Infect Dis 2020; 20:498. [PMID: 32652941 PMCID: PMC7353708 DOI: 10.1186/s12879-020-05204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Yersinia enterocolitica is an aero-anaerobic Gram-negative coccobacilli of the Enterobacteriaceae family, rarely reported in osteoarticular infection. Case presentation This report case described a rare septic osteoarticular infection on device due to Yersinia enterocolitica biotype 1B. A purulent fistula appeared after osteosynthesis with plate performed abroad 27 days prior to the presentation for a distal femoral fracture. The treatment consisted of surgical irrigation and washing of the femoral plate and a bitherapy by levoflaxacine and ceftriaxone during 3 months. Conclusion Y. enterocolitica biotype 1B is extremely rare in France. Moreover, the strain implicated in this european case is extremely close from the USA reference strain (with only 2 SNP difference) described in a septicemia in Ohio. The extreme proximity of the strains underlines the need for a sustained surveillance of the spread of this pathogen in France.
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Affiliation(s)
- Frédéric Wallet
- CHU Lille, F 59000, Lille, France.,Laboratoire de Bactériologie - Institut de Microbiologie, Centre de Biologie Pathologie, F-59037, Lille Cedex, France
| | - Anne-Sophie Le Guern
- Unité de Recherche Yersinia / Centre National de Référence de la peste et autres yersinioses, Institut Pasteur, F75015, Paris, France
| | - Malo Penven
- CHU Lille, F 59000, Lille, France.,Laboratoire de Bactériologie - Institut de Microbiologie, Centre de Biologie Pathologie, F-59037, Lille Cedex, France
| | - Eric Senneville
- CH Tourcoing, F 59200, Tourcoing, France.,Univ. Lille, F59000, Lille, France.,Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO) Lille, Tourcoing, France
| | - Cyril Savin
- Unité de Recherche Yersinia / Centre National de Référence de la peste et autres yersinioses, Institut Pasteur, F75015, Paris, France
| | - Caroline Loïez
- CHU Lille, F 59000, Lille, France. .,Laboratoire de Bactériologie - Institut de Microbiologie, Centre de Biologie Pathologie, F-59037, Lille Cedex, France. .,Centre de Référence des Infections Ostéo-Articulaires Complexes Nord-Ouest (CRIOAC-NO) Lille, Tourcoing, France.
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10
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Abstract
Septic arthritis in children is a surgical emergency, and prompt diagnosis and treatment are mandatory. If diagnosed quickly and treated correctly, the outcomes can be good. With delay in diagnosis and without proper treatment, outcomes often are quite devastating, with growth disturbance and joint destruction.
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11
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Telenchana-Chimbo P, Barrera-Carmona C, Cevallos-Quintero E, Jiménez-Prieto F, Solórzano L, Soria C, Soria C. [Prevalence of osteoarticular infections by Enterobacteria producing extended-spectrum -lactamases]. Acta Ortop Mex 2019; 33:232-236. [PMID: 32246593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Infections of enterobacteria producing extended-spectrum -lactamases place a heavy burden on health systems. Little is known in osteoarticular infections, so this work studied the prevalence of these infections in a third-level hospital. MATERIAL AND METHODS Prevalence study in patients of a Traumatology Service during 2016, with infection criteria provided by the CDC in Atlanta, Georgia. The VITEK® 2 AST-N272 (bioMérieux) system was used for bacterial identification at the species level and for antimicrobial susceptibility tests. RESULTS 7.85% (n = 86) were reported with osteoarticular infections; 22.09% (n = 19) were by enterobacteria BLEEs. An average of 77.1 days of hospitalization (SD 37.7) (46-200 days); isolation of the microorganism occurred 15 days after entry. Sixteen (84.2%) patients had osteomyelitis, three (15.8%) had a prosthetic knee or hip infection. The average number of treatment days was 60 days (21-129 days). Eighteen patients (94.7%) were discharged with resolution of their infectious picture; one patient died with infection over aggregated pneumonia due to carbapenem-resistant K. pneumoniae. DISCUSSION The prevalence of osteoarticular infections by enterobacteria BLEEs could not be accurately calculated, but we consider it to be within what is expected, infection control measures require higher standards and there is a lack of development programs to use antimicrobials rationally to control the emergence of these pathologies.
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Affiliation(s)
| | | | | | | | | | - C Soria
- Universidad de Guayaquil, Ecuador
| | - C Soria
- Hospital Luis Vernaza, Guayaquil, Ecuador
- Universidad Católica de Santiago de Guayaquil, Ecuador
- Universidad San Francisco de Quito, Ecuador
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12
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Rodari P, Marocco S, Buonfrate D, Beltrame A, Piubelli C, Orza P, Fittipaldo VA, Bisoffi Z. Prosthetic joint infection due to Mycobacterium xenopi: a review of the literature with a new case report. Infection 2019; 48:165-171. [PMID: 31098926 DOI: 10.1007/s15010-019-01318-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/07/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Extrapulmonary infections due to M. xenopi, particularly osteoarticular localizations, are rare. The purpose of this paper is to describe a case of prosthetic hip infection and to review the published literature on cases of M. xenopi osteoarticular infections. METHODS Literature search was performed in the following databases: MEDLINE (PubMed), Embase, Central (the Cochrane Library 2019, Issue 1), LILACS (BIREME) (Latin American and Caribbean Health Science Information database) and Clinical Trials databases (14th August 2018). We included all case reports and case series on adult patients diagnosed with bone or joint infection by M. xenopi for whom the treatment and outcome were specified. RESULTS We retrieved 30 cases published between 1982 and 2012, among which 25 (83.3%) were reported from Europe. The two most common infection sites were spine (12/30, 40%) and knee (9/30, 30%). Risk factors for infection were previous invasive procedures (11/30, 36.7%), autoimmune disease (8/30, 26.7%), AIDS (4/30, 13.3%) and other comorbidities (2/30, 6.7%); five patients had no past medical history. All patients were treated with antibiotic combinations, but composition and duration of regimens hugely varied. Surgical intervention was performed in 16 patients (53.3%). Only 11 patients obtained full recovery of articular mobility after treatment. CONCLUSION This work highlights the difficulties in diagnosing and treating M. xenopi osteoarticular infections. Globally, evidence supporting the best practice for diagnosis and treatment of this infection is scanty.
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Affiliation(s)
- Paola Rodari
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy.
| | - Stefania Marocco
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Dora Buonfrate
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Anna Beltrame
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Chiara Piubelli
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Pierantonio Orza
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Veronica Andrea Fittipaldo
- Unità di Revisioni Sistematiche e Linee Guida, Dipartimento di Oncologia, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Zeno Bisoffi
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
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13
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Grosset A, Mangin P, MacNab C, Pfister G, de l'Escalopier N, Cournac JM, Aletti M, Samson T, Rigal S, Mathieu L. Input of a Multi-Disciplinary Meeting in the Treatment of Osteoarticular Infections in French War Casualties. Mil Med 2019; 184:e359-e364. [PMID: 30535350 DOI: 10.1093/milmed/usy369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/02/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Extremity war-wounds present an elevated risk of infection and compromise reconstructive procedures. In a French military hospital, a multi-disciplinary meeting (MDM) was created to standardize the care given to soldiers with osteoarticular infection. The aim of this study was to evaluate the usefulness of MDM decisions. METHODS An observational case study was performed including the French wounded at war treated for an osteoarticular infection between 2004 and 2016. They were separated into two groups according to their time of management: before (group A) or after (group B) the MDM creation in September 2010. Various operative and bacteriological parameters were analyzed retrospectively. A questionnaire was created to evaluate healthcare professionals' satisfaction toward the usefulness of the MDM on their practice. RESULTS During the study period, 38 patients were included: 19 in group A and 19 in group B. Initial tests found an infection with one pathogen in 15 patients, an infection with 2 pathogens in 11 patients, and an infection with 3 or more pathogens in 12 patients. Enterobacter cloacae was the most common pathogen. Pseudomonas aeruginosa and Escherichia coli were also frequent. The mean number of samples taken to conduct the bacteriological tests per operating session was significantly higher for group B than for group A. Twelve of the 14 questioned healthcare professionals believed the MDM was very useful in their patient management. CONCLUSION The MDM seems to have had a beneficial impact on orthopedic surgeon practices. A significant increase of the number of samples taken was the most obvious sign that the French recommended practices for osteoarticular infections were followed since the creation of MDM.
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Affiliation(s)
- Antoine Grosset
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Philippe Mangin
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Christine MacNab
- Department of Microbiology, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Georges Pfister
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Nicolas de l'Escalopier
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Jean-Marie Cournac
- Department of Internal Medicine, Infectious Disease, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Marc Aletti
- Department of Internal Medicine, Infectious Disease, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Thierry Samson
- Department of Microbiology, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Sylvain Rigal
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Laurent Mathieu
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
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14
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Noguera-Julian A, Monsonis M, Ludwig G, Moreno-Romo D, Gené-Giralt A. Osteoarticular infections: Blood as a determinant factor in the isolation of Kingella kingae. J Microbiol Methods 2019; 161:8-11. [PMID: 30986431 DOI: 10.1016/j.mimet.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 11/20/2022]
Abstract
We assessed the capacity of Kingella kingae to grow in blood culture bottles (BCB), taking into account the concentrations of the microorganism and blood in the culture medium. An initial suspension (McFarland 0.5) of 32 strains of K. kingae was serially diluted. One mL of the initial suspension and 1 mL of the subsequent dilutions were inoculated in two BCB, together with 1 mL of human blood in the 2nd BCB. Also, 1mL serial dilutions of human blood were added to BCBs previously inoculated with 1 mL of K. kingae dilution 1/104. In non-blood-supplemented BCB, 23 strains grew with the initial suspension and only one with the first processed dilution, as compared to all strains with the initial suspension and the 3 first dilutions, 22 with the 4th dilution, and one with the 5th dilution in blood-supplemented BCB. In BCB inoculated with K. kingae dilution 1/104 and decreasing concentrations of human blood, all strains grew with blood dilutions 1/2 and 1/4, 26 with dilution 1/8, 19 with dilution 1/16, 10 with dilution 1/32, and none with dilution 1/64. Increasing time to positivity was observed with both decreasing bacterial (p = .001) and blood concentrations (r = -0.632, p < .0001). The addition of human blood was essential to boost the growth of K. kingae in BCB. If replicated in vivo, these findings would increase the isolation of fastidious K. kingae organisms from pediatric osteoarticular exudates.
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Affiliation(s)
- Antoni Noguera-Julian
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain.
| | - Manuel Monsonis
- Servei de Microbiologia, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Guillermo Ludwig
- Servei de Microbiologia, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - David Moreno-Romo
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Sant Joan de Déu, Barcelona, Spain.
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15
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Boulnois I, Gouron R, Pluquet E, Peltier F, Plancq MC, Deroussen F, Klein C. Late recurrence of an osteoarticular infection caused by Klebsiella pneumoniae in a child. Arch Pediatr 2018; 25:497-499. [PMID: 30361083 DOI: 10.1016/j.arcped.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/14/2018] [Accepted: 09/23/2018] [Indexed: 10/28/2022]
Abstract
Klebsiella pneumoniae is an opportunistic pathogen in neonates. A 23-day-old newborn developed septic arthritis of the right hip due to an ESBL-producing strain. A recurrence on the knee was observed at 4 years of age. A molecular investigation confirmed the clonal link of the strains responsible for the two infections and allowed us to identify virulence factors.
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Affiliation(s)
- I Boulnois
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France
| | - R Gouron
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France
| | - E Pluquet
- Department of Bacteriology, Amiens University Hospital and Jules Verne University of Picardy, Microbiology Research Unit EA4294, Jules Verne University of Picardie, 80054 Amiens, France
| | - F Peltier
- Department of Bacteriology, Amiens University Hospital and Jules Verne University of Picardy, Microbiology Research Unit EA4294, Jules Verne University of Picardie, 80054 Amiens, France
| | - M-C Plancq
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France
| | - F Deroussen
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France
| | - C Klein
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France.
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16
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Abstract
Acute septic arthritis is a condition with the potential for joint destruction, physeal damage, and osteonecrosis, which warrants urgent identification and treatment. The organism most frequently responsible is Staphylococcus aureus; however, our understanding of pathogens continues to evolve as detection methods continue to improve. MRI has improved our ability to detect concurrent infections and is a useful clinical tool where available. The treatment course involves intravenous antibiotics followed by transition to oral antibiotics when clinically appropriate. The recommended surgical treatment of septic arthritis is open arthrotomy with decompression of the joint, irrigation, and debridement and treatment of concurrent infections.
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17
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Joost I, Kaasch A, Pausch C, Peyerl-Hoffmann G, Schneider C, Voll RE, Seifert H, Kern WV, Rieg S. Staphylococcus aureus bacteremia in patients with rheumatoid arthritis - Data from the prospective INSTINCT cohort. J Infect 2017; 74:575-584. [PMID: 28322887 DOI: 10.1016/j.jinf.2017.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/11/2017] [Accepted: 03/08/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) are considered to be at increased risk of severe infections. We here describe the clinical characteristics, course and outcome of RA patients with Staphylococcus aureus bacteremia (SAB). METHODS We conducted a post hoc analysis of data from a German bi-center prospective SAB cohort study (period 2006-2014). Patients were followed-up for one year. Primary and secondary outcomes were survival time and osteoarticular infection (OAI). RESULTS A total of 1069 patients with SAB were analyzed, with 31 patients suffering from RA. RA patients showed significantly more often OAI (15/31 patients, 48% vs. 152/1038, 15%), disseminated infection (12/31, 39% vs. 164/1038, 16%) and severe sepsis/septic shock (12/31, 39% vs. 235/1038, 23%). Day-30 mortality in RA patients was 36% (vs. 19% in non-RA patients, p = 0.034), and day 90 mortality was 58% (vs. 32%, p = 0.003). Multivariate analyses confirmed RA to be an independent risk factor for death (HR 2.3, 95% CI 1.4-3.7) and OAI (OR 4.2, 95% CI 1.8-9.8). CONCLUSIONS Patients with RA exhibit a complicated SAB course and a high mortality, their management is challenging. Adequate antibiotic treatment, prompt invasive diagnostic and therapeutic procedures like joint lavage or surgery are of pivotal importance. Joint damage due to RA may confer a higher risk of acquiring OAI than immunosuppression.
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Affiliation(s)
- Insa Joost
- Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany.
| | - Achim Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19, 50937, Cologne, Germany
| | - Christine Pausch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Gabriele Peyerl-Hoffmann
- Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany
| | - Christian Schneider
- Institute of Microbiology and Hygiene, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19, 50937, Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany; Center for Chronic Immunodeficiency, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Germany.
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18
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Oppegaard O, Skrede S, Mylvaganam H, Kittang BR. Temporal trends of β-haemolytic streptococcal osteoarticular infections in western Norway. BMC Infect Dis 2016; 16:535. [PMID: 27716100 PMCID: PMC5050853 DOI: 10.1186/s12879-016-1874-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Beta-haemolytic streptococci are important contributors to the global burden of osteoarticular infections (OAI). Knowledge on the disease traits specific for streptococcal OAI, however, remains scarce. We wished to explore temporal trends of OAI caused by Group A Streptococci (GAS), Group B Streptococci (GBS) and Group C and G Streptococci (GCGS), and furthermore, to describe the associated host and pathogen characteristics. METHODS All cases of microbiologically verified β-haemolytic streptococcal OAI in Health Region Bergen, Norway, in the period 1999-2013 were retrospectively identified. Clinical data were extracted from medical records. Microbial isolates were submitted to antibiotic susceptibility testing and molecular typing. RESULTS A total of 24 GAS, 45 GBS and 42 GCGS acute OAI were identified. The cumulative incidence of GCGS OAI, but not GAS or GBS OAI, increased significantly from the first to the last 5-year period (IRR 5.7, p = 0.0003), with the annual incidence peaking at 1.9/100 000 in 2013. GAS OAI generally produced the most acute and severe clinical presentation, whereas GBS and GCGS predominantly affected the elderly, and were significantly associated with the presence of host risk factors of systemic and focal origin, respectively. CONCLUSIONS We found a significantly increasing incidence of GCGS OAI, likely related to the presence of host susceptibility factors, including prosthetic material and pre-existing joint disease. With an increasing application of therapeutic and diagnostic bone and joint procedures, the rising trend of OAI caused by GCGS is likely to continue. Sustained epidemiological attentiveness to GCGS seems warranted.
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Affiliation(s)
- Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Steinar Skrede
- Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Haima Mylvaganam
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Bård Reiakvam Kittang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
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Lallemand E, Arvieux C, Coiffier G, Polard JL, Albert JD, Guggenbuhl P, Jolivet-Gougeon A. Use of MALDI-TOF mass spectrometry after liquid enrichment (BD Bactec™) for rapid diagnosis of bone and joint infections. Res Microbiol 2016; 168:122-129. [PMID: 27677682 DOI: 10.1016/j.resmic.2016.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 08/19/2016] [Accepted: 09/16/2016] [Indexed: 11/17/2022]
Abstract
Advantages of MALDI-TOF MS (MS) were evaluated for diagnosis of bone and joint infections after enrichment of synovial fluid (SF) or crushed osteoarticular samples (CSs). MS was performed after enrichment of SF or crushed osteoarticular samples CS (n = 108) in both aerobic and anaerobic vials. Extraction was performed on 113 vials (SF: n = 47; CS: n = 66), using the Sepsityper® kit prior identification by MS. The performances of MS, score and reproducibility results on bacterial colonies from blood agar and on pellets after enrichment in vials, were compared. MS analysis of the vial resulted in correct identification of bacteria at a species and genus level (80.5% and 92% of cases, respectively). The reproducibility was superior for aerobic Gram-positive bacteria (Staphylococci and Gram-positive bacilli: 100% colonies), as compared to aerobic Gram-negative bacilli (89.7%), anaerobes (83.3%) and Streptococcus/Enterococcus (58.8%). MS performance was significantly better for staphylococci than for streptococci on all identification parameters. For polymicrobial cultures, identification (score>1.5) of two species by MS was acceptable in 92.8% of cases. Use of MS on enrichment pellets of bone samples is an accurate, rapid and robust method for bacterial identification of clinical isolates from osteoarticular infections, except for streptococci, whose identification to species level remains difficult.
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Affiliation(s)
- Elise Lallemand
- EA 1254 Microbiologie/INSERM NUMECAN, Université de Rennes 1, 2, avenue du Pr Léon Bernard, 35043 Rennes, France; Pole Biologie, Rennes University Hospital, 35043 Rennes, France
| | - Cédric Arvieux
- Service des Maladies Infectieuses, Rennes University Hospital, 2 rue Henri Le Guilloux, 35043 Rennes, France; Centre de Référence en Infections Ostéo-Articulaires du Grand Ouest (CRIOGO), France
| | - Guillaume Coiffier
- Centre de Référence en Infections Ostéo-Articulaires du Grand Ouest (CRIOGO), France; Service de Rhumatologie, Hôpital Sud, CHU, F-35000 Rennes, France; INSERM UMR U991/NUMECAN, F-35000 Rennes, France
| | - Jean-Louis Polard
- Centre de Référence en Infections Ostéo-Articulaires du Grand Ouest (CRIOGO), France; Service de Chirurgie orthopédique, Rennes University Hospital, 2 rue Henri Le Guilloux, 35043 Rennes, France
| | - Jean-David Albert
- Centre de Référence en Infections Ostéo-Articulaires du Grand Ouest (CRIOGO), France; Service de Rhumatologie, Hôpital Sud, CHU, F-35000 Rennes, France; INSERM UMR U991/NUMECAN, F-35000 Rennes, France
| | - Pascal Guggenbuhl
- Centre de Référence en Infections Ostéo-Articulaires du Grand Ouest (CRIOGO), France; Service de Rhumatologie, Hôpital Sud, CHU, F-35000 Rennes, France; INSERM UMR U991/NUMECAN, F-35000 Rennes, France; Université de Rennes 1, F-35000 Rennes, France
| | - Anne Jolivet-Gougeon
- EA 1254 Microbiologie/INSERM NUMECAN, Université de Rennes 1, 2, avenue du Pr Léon Bernard, 35043 Rennes, France; Pole Biologie, Rennes University Hospital, 35043 Rennes, France; Centre de Référence en Infections Ostéo-Articulaires du Grand Ouest (CRIOGO), France; Université de Rennes 1, F-35000 Rennes, France.
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Lora-Tamayo J, Euba G, Cobo J, Horcajada JP, Soriano A, Sandoval E, Pigrau C, Benito N, Falgueras L, Palomino J, Del Toro MD, Jover-Sáenz A, Iribarren JA, Sánchez-Somolinos M, Ramos A, Fernández-Sampedro M, Riera M, Baraia-Etxaburu JM, Ariza J. Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial. Int J Antimicrob Agents 2016; 48:310-6. [PMID: 27524103 DOI: 10.1016/j.ijantimicag.2016.05.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/04/2016] [Accepted: 05/28/2016] [Indexed: 02/08/2023]
Abstract
Levofloxacin plus rifampicin (L+R) is the treatment of choice for acute staphylococcal prosthetic joint infection (PJI) managed with debridement and implant retention (DAIR). Long courses have been empirically recommended, but some studies have suggested that shorter treatments could be as effective. Our aim was to prove that a short treatment schedule was non-inferior to the standard long schedule. An open-label, multicentre, randomised clinical trial (RCT) was performed. Patients with an early post-surgical or haematogenous staphylococcal PJI, managed with DAIR and initiated on L+R were randomised to receive 8 weeks of treatment (short schedule) versus a long schedule (3 months or 6 months for hip or knee prostheses, respectively). The primary endpoint was cure rate. From 175 eligible patients, 63 were included (52% women; median age, 72 years): 33 patients (52%) received the long schedule and 30 (48%) received the short schedule. There were no differences between the two groups except for a higher rate of polymicrobial infection in the long-schedule group (27% vs. 7%; P = 0.031). Median follow-up was 540 days. In the intention-to-treat analysis, cure rates were 58% and 73% in patients receiving the long and short schedules, respectively (difference -15.7%, 95% CI -39.2% to 7.8%). Forty-four patients (70%) were evaluable per-protocol: cure rates were 95.0% and 91.7% for the long and short schedules, respectively (difference 3.3%, 95% CI -11.7% to 18.3%). This is the first RCT suggesting that 8 weeks of L+R could be non-inferior to longer standard treatments for acute staphylococcal PJI managed with DAIR.
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Affiliation(s)
- Jaime Lora-Tamayo
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre "i+12", Madrid, Spain.
| | - Gorane Euba
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Javier Cobo
- Servicio de Enfermedades Infecciosas, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Pablo Horcajada
- Servicio de Enfermedades Infecciosas, Hospital del Mar, IMIM, CEXS-UPF, Barcelona, Spain
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clínic i Provincial, IDIBAPS, Barcelona, Spain
| | - Enrique Sandoval
- Servicio de Traumatología, Fundación Jiménez Díaz, Madrid, Spain
| | - Carles Pigrau
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natividad Benito
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Falgueras
- Servicio de Enfermedades Infecciosas, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Julián Palomino
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - María Dolores Del Toro
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain
| | - Alfredo Jover-Sáenz
- Unidad Funcional de Infección Nosocomial y Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain
| | - Mar Sánchez-Somolinos
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Ramos
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Marta Fernández-Sampedro
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Melchor Riera
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Javier Ariza
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Barcelona, Spain
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21
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Abstract
For a child with a suspected bone or joint infection, knowledge of the workup and initial therapy is important to provide quality care. Fever and pain are hallmarks of a pediatric osteoarticular infection, although occasionally the signs and symptoms can be more subtle. The use of C-reactive protein to diagnose and validate effective management of treatment has become standard. Multiple reports confirm the success of much shorter intravenous (IV) courses than traditionally taught. The ideal IV and oral antibiotic duration, as well as defining the markers indicating need for surgical intervention, are questions yet to be answered.
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22
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Angelakis E, Thiberville SD, Million M, Raoult D. Sternoclavicular joint infection caused by Coxiella burnetii: a case report. J Med Case Rep 2016; 10:139. [PMID: 27246557 PMCID: PMC4888605 DOI: 10.1186/s13256-016-0948-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 12/25/2022] Open
Abstract
Background Few cases of Q fever osteoarticular infection have been reported, with chronic osteomyelitis as the most common manifestation of Q fever osteoarticular infection. Here we present the case of a sternoclavicular joint infection caused by Coxiella burnetii and localized by positron emission tomography scanning. Case presentation A 67-year-old French man from south France was hospitalized for fever and confusion. An examination revealed subclavicular and axillary lymph node enlargement. Computed tomography scanning and transesophageal echocardiogram were normal, and magnetic resonance imaging scanning did not reveal signs of infection. An immunofluorescence assay of an acute serum sample was positive for C. burnetii and he was treated with 200 mg doxycycline for 21 days. An immunofluorescence assay of convalescent serum sampled after 2 months revealed very high C. burnetii antibody titers. To localize the site of the infection, we performed positron emission tomography scanning, which revealed intense fluorodeoxyglucose uptake in his right sternoclavicular joint; treatment with 200 mg oral doxycycline daily and 200 mg oral hydroxychloroquine three times daily for 18 months was initiated. Conclusions Q fever articular infections may be undiagnosed, and we strongly urge the use of positron emission tomography scanning in patients with high C. burnetii antibody titers to localize the site of C. burnetii infection.
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Affiliation(s)
- Emmanouil Angelakis
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France.
| | - Simon-Djamel Thiberville
- UMR190, Aix-Marseille Université / IRD / EHESP French School of Public Health, Marseille, France.,Hospital Louis Raffalli, Medicine D Unit, Infectious Disease and Internal Medicine, Manosque, France
| | - Matthieu Million
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France
| | - Didier Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Aix-Marseille Université, 13005, Marseille, France
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23
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Abstract
The epidemiology and diagnosis of osteoarticular infections (OAI) have changed considerably in recent years, partly due to the development of molecular biology. Kingella kingae is now recognized as the most frequent pathogen in children under 4 years of age, while methicillin-resistant Staphylococcus aureus (SA) has been increasingly reported. Although the clinical course of OAI is mostly benign, with shorter antibiotic regimens and simplified treatments, serious functional impairments and life-threatening complications can still occur, especially in case of delayed diagnosis or infection caused by Panton-Valentine leukocidin-producing strains of SA. Newborns and patients with sickle cell disease have greater risk of orthopaedic sequelae, which need to be detected and managed early. The main sequelae of osteomyelitis are angular limb deformity, due to partial growth arrest, and lower limb discrepancy. Therapeutic options are guided by the patient's age and predictions at maturity. The main complications of septic arthritis are joint stiffness and osteonecrosis. The procedures to consider are arthrodesis, joint reconstruction in immature children, and arthroplasty at the end of growth.
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Saavedra-Lozano J, Calvo C, Huguet Carol R, Rodrigo C, Núñez E, Obando I, Rojo P, Merino R, Pérez C, Downey FJ, Colino E, García JJ, Cilleruelo MJ, Torner F, García L. [SEIP-SERPE-SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis]. An Pediatr (Barc) 2014; 82:273.e1-273.e10. [PMID: 25444035 DOI: 10.1016/j.anpedi.2014.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/02/2014] [Indexed: 11/30/2022] Open
Abstract
This is a Consensus Document of the Spanish Society of Paediatric Infectious Diseases (Sociedad Española de Infectología Pediatrica), Spanish Society of Paediatric Rheumatology (Sociedad Española de Reumatología Pediátrica) and the Spanish Society of Paediatric Orthopaedics (Sociedad Española de Ortopedia Pediátrica), on the treatment of uncomplicated acute osteomyelitis and septic arthritis. A review is presented on the medical and surgical treatment of acute osteoarticular infection, defined as a process with less than 14 days of symptomatology, uncomplicated and community-acquired. The different possible options are evaluated based on the best available scientific knowledge, and a number of evidence-based recommendations for clinical practice are provided.
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Affiliation(s)
| | - C Calvo
- Sociedad Española de Infectología Pediátrica (SEIP); Sociedad Española de Reumatología Pediátrica (SERPE)
| | | | - C Rodrigo
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - E Núñez
- Sociedad Española de Infectología Pediátrica (SEIP); Sociedad Española de Reumatología Pediátrica (SERPE)
| | - I Obando
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - P Rojo
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - R Merino
- Sociedad Española de Reumatología Pediátrica (SERPE)
| | - C Pérez
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - F J Downey
- Sociedad Española de Ortopedia Pediátrica (SEOP)
| | - E Colino
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - J J García
- Sociedad Española de Infectología Pediátrica (SEIP)
| | | | - F Torner
- Sociedad Española de Ortopedia Pediátrica (SEOP)
| | - L García
- Sociedad Española de Infectología Pediátrica (SEIP)
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Ramírez A, Abril JC, Cano J. DRESS syndrome due to antibiotic therapy of osteoarticular infections in children: two case reports. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 59:360-4. [PMID: 25052739 DOI: 10.1016/j.recot.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/13/2014] [Accepted: 05/20/2014] [Indexed: 11/30/2022] Open
Abstract
Osteoarticular infection in children frequently occurs before 10 years of age. Surgical drainage is sometimes required, whereas acute osteomyelitis can be treated with antibiotic therapy alone. The duration of antibiotic therapy varies, 2 weeks is sufficient for septic arthritis, whereas 6 weeks is often required for complicated cases. Some of these antibiotic drugs present direct complications with low clinical impact in certain individuals. Hypersensitivity to these drugs causes different reactions in children. DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe and potentially life-threatening drug reaction. It is characterised by high fever, malaise, lymphadenopathy and skin rash. From a clinical perspective, these symptoms can lead to an exacerbation of the initial infectious process for which treatment was commenced. The liver is the organ most often affected in DRESS syndrome associated with haematological changes, potentially similar to sepsis. We present two cases of children with osteoarticular infections who developed DRESS syndrome after antibiotic therapy. Both patients made a complete recovery after cessation of the antibiotic drugs used.
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Affiliation(s)
- A Ramírez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario del Niño Jesús, Madrid, España.
| | - J C Abril
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario del Niño Jesús, Madrid, España
| | - J Cano
- Servicio de Pediatría, Hospital Universitario del Niño Jesús, Madrid, España
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26
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Ceroni D, Cherkaoui A, Kaelin A, Schrenzel J. Kingella kingae spondylodiscitis in young children: toward a new approach for bacteriological investigations? A preliminary report. J Child Orthop 2010; 4:173-5. [PMID: 21455474 PMCID: PMC2839857 DOI: 10.1007/s11832-009-0233-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 12/17/2009] [Indexed: 02/03/2023] Open
Abstract
As the result of improved bacteriological techniques, Kingella kingae is a slow-growing Gram-negative coccobacillus that is emerging as an important cause of spondylodiscitis in children younger than 3 years of age. The high pharyngeal carrier rates of this slow-growing Gram-negative coccobacillus combined with the low incidence of identified K. kingae infections is possibly explained by a low virulence of this bacterium. The use of specific real-time polymerase chain reaction (PCR) on blood samples and throat swabs opens new prospects in the bacteriological investigations of young children suspected to have spondylodiscitis, an approach that could prevent, in the future, unnecessary invasive interventions.
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Affiliation(s)
- Dimitri Ceroni
- />Pediatric Orthopedic Service, University Hospital of Geneva, 1211 Geneva 14, Switzerland
| | - Abdessalam Cherkaoui
- />Clinical Microbiology Laboratory, Service of Infectious Diseases, University Hospital of Geneva, 1211 Geneva 14, Switzerland
| | - André Kaelin
- />Pediatric Orthopedic Service, University Hospital of Geneva, 1211 Geneva 14, Switzerland
| | - Jacques Schrenzel
- />Clinical Epidemiology Service, University Hospital of Geneva, 1211 Geneva 14, Switzerland
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