Publications by authors named "Laurence Legout"

29 Publications

  • Page 1 of 1

Tolerability of High Doses of Daptomycin in the Treatment of Prosthetic Vascular Graft Infection: A Retrospective Study.

Infect Dis Ther 2014 Dec 4;3(2):215-23. Epub 2014 Sep 4.

Infectious Diseases Department, Dron Hospital, Tourcoing, France.

Introduction: In treatment of prosthetic vascular graft infection (PVGI), appropriate antimicrobial treatment is crucial for controlling the septic process and preventing re-infection of the new graft. Glycopeptides are the mainstay of treatment for device-related infections by methicillin-resistant Staphylococcus aureus strains, but with some limitations, especially concerning vancomycin-intermediate and glycopeptide-intermediate S. aureus. We report our experience using a high dose of daptomycin (DAP) for treatment of PVGI.

Methods: We reviewed medical reports of 26 patients treated with high doses of DAP (>8 mg/kg) and beta-lactams/aminosides for PVGI, defined as positive bacterial culture of intraoperative specimens or blood samples and/or clinical, biological, and radiological signs of infection. Clinical success was defined by resolution of all clinical signs at the end of follow-up, without the need for additional antibiotic therapy, and/or negative culture in case of new surgery.

Results: Cultures of intraoperative samples were positive in 21 patients (80.8%). Blood and intraoperative cultures were concomitantly positive in 10 patients. The main microorganism identified in microbiological samples was S. aureus (n = 18). Surgery was performed in 23 patients (88.4%). The mean duration of the DAP regimen was 12.3 ± 11.9 days. DAP was discontinued in 26 patients [need to switch to microbiological results (n = 19), bacterial pneumonia (n = 2), and increased creatine phosphokinase levels (n = 4)]. One patient had myalgia, while 9 received concomitant statins.

Conclusion: High-dose DAP therapy shows a satisfactory toxicity profile even in severely ill patients with multiple comorbidities, and may favorably compete with vancomycin, especially concerning the risk of induced nephrotoxicity.
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http://dx.doi.org/10.1007/s40121-014-0035-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269615PMC
December 2014

Factors predictive of treatment failure in staphylococcal prosthetic vascular graft infections: a prospective observational cohort study: impact of rifampin.

BMC Infect Dis 2014 Apr 28;14:228. Epub 2014 Apr 28.

Infectious Diseases Department, Dron Hospital of Tourcoing, Rue du Président Coty, Tourcoing 59208, France.

Background: There exists considerable debate concerning management of prosthetic vascular graft infection (PVGI), especially in terms of antimicrobial treatment. This report studies factors associated with treatment failure in a cohort of patients with staphylococcal PVGI, along with the impact of rifampin (RIF).

Methods: All data on patients with PVGI between 2006 and 2010 were reviewed. Cure was defined as the absence of evidence of infection during the entire post-treatment follow-up for a minimum of one year. Failure was defined as any other outcome.

Results: 84 patients (72 M/12 F, median age 64.5 ± 11 y) with diabetes mellitus (n = 25), obesity (n = 48), coronary artery disease (n = 48), renal failure (n = 24) or COPD (n = 22) were treated for PVGI (median follow-up was 470 ± 469 d). PVGI was primarily intracavitary (n = 47). Staphylococcus aureus (n = 65; including 17 methicillin-resistant S. aureus) and coagulase-negative Staphylocococcus (n = 22) were identified. Surgical treatment was performed in 71 patients. In univariate analysis, significant risk factors associated with failure were renal failure (p = 0.04), aortic aneurysm (p = 0.03), fever (p = 0.009), aneurysm disruption (p = 0.02), septic shock in the peri-operative period (p = 0.005) and antibiotic treatment containing RIF (p = 0.03). In multivariate analysis, 2 variables were independently associated with failure:septic shock [OR 4.98: CI 95% 1.45-16.99; p=0.01] and antibiotic containing rifampin [OR: 0.32: CI95% 0.10-0.96; p=0.04].

Conclusion: Results of the present study suggest that fever, septic shock and non-use of antibiotic treatment containing RIF are associated with poor outcome.
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http://dx.doi.org/10.1186/1471-2334-14-228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049509PMC
April 2014

Periprosthetic joint infections: clinical and bench research.

ScientificWorldJournal 2013 27;2013:549091. Epub 2013 Oct 27.

Infectious Disease Department, Alpes-Leman Hospital, Route de Findrol, 74130 Contamines sur Arve, France ; Infectious Disease Department, Dron Hospital, Rue du President Coty, 59208 Tourcoing, France.

Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections.
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http://dx.doi.org/10.1155/2013/549091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826319PMC
July 2014

Pathogen-driven decision for implant retention in the management of infected total knee prostheses.

Int Orthop 2013 Aug 22;37(8):1471-5. Epub 2013 May 22.

Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland.

Purpose: In prosthetic joint infections (PJIs) of the knee, debridement with implant retention is associated with a high risk of recurrence.

Methods: A single-centre cohort study was performed with extensive analysis of the literature covering 1980-2012.

Results: In 21 patients (mean age 80.4 years, 19 immunosuppressed), in association with 1.5-three months of antibiotic treatment, an attempt was made to salvage the prosthesis by open (11 patients) or arthroscopic (ten patients) debridement. After a mean follow-up of seven years (range four-20 years), patients were in remission in seven cases (33 %). Remission was achieved in 0 % of all methicillin-resistant Staphylococcus aureus (MRSA) infections (zero/three), in 0 % (zero/three) of methicillin-resistant coagulase-negative staphylococcal infections, in 29 % (two/seven) of methicillin-sensitive S. aureus infections and in 75 % (three/four) of infections due to streptococci. The literature review focused on implant preserving approaches yielded 599 cases with an overall success rate of 47 % (284/599) and significantly more remissions in streptococcal vs staphylococcal knee PJIs (43/54 vs 144/324; p < 0.01, odds ratio 4.9, 95 % confidence interval 2.4-10.9).

Conclusions: In addition to established indications for explantation such as implant loosening, sinus tract or methicillin resistance, the decision for debridement and retention of knee PJIs should also depend on the pathogen. Implant preservation is futile with methicillin-resistant staphylococci, but seems to be a valid option for streptococcal PJIs.
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http://dx.doi.org/10.1007/s00264-013-1923-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728396PMC
August 2013

Evaluation of rapid mecA gene detection versus standard culture in staphylococcal chronic prosthetic joint infections.

Diagn Microbiol Infect Dis 2012 Aug 6;73(4):318-21. Epub 2012 Jun 6.

Institute of Microbiology, University Hospital Center, Lille, France.

In case of periprosthetic joint infections, the antibiotic treatment administered intraoperatively entails consequences on bacterial ecology with potential secondary effects. This study evaluates the rapid detection of methicillin-resistant staphylococci (MRS) by Xpert® technology directly on intraoperative samples. Xpert® technology was compared to conventional culture for 104 clinical specimens performed on 30 patients. The performance of the test expressed in terms of sensitivity, specificity, positive predictive value, and negative predictive value was, respectively, 87.1%, 100%, 100%, and 94.5% for the 104 specimens, and 92.3%, 100%, 100%, and 94.4% for the 30 patients. With the rapid detection of MRS, the use of vancomycin was limited for 17 of these 30 patients. In conclusion, this technique would allow the implementation of first-line antibiotic treatment adapted to the presence of MRS or not within approximately 1 h and would strongly reduce the use of broad-spectrum antibiotics.
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http://dx.doi.org/10.1016/j.diagmicrobio.2012.04.011DOI Listing
August 2012

First initial community-acquired meningitis due to extended-spectrum beta-lactamase producing Escherichia coli complicated with multiple aortic mycotic aneurysms.

Ann Clin Microbiol Antimicrob 2012 Feb 9;11. Epub 2012 Feb 9.

Infectious diseases department, Dron hospital, Tourcoing, France.

We report the first case of extended-spectrum beta-lactamase producing E. coli community-acquired meningitis complicated with multiple aortic mycotic aneurysms. Because of the acute aneurysm expansion with possible impending rupture on 2 abdominal CT scan, the patient underwent prompt vascular surgery and broad spectrum antibiotic therapy but he died of a hemorrhagic shock. Extended-spectrum beta-lactamase producing E. coli was identified from both blood and cerebrospinal fluid culture before vascular treatment. The present case report does not however change the guidelines of Gram negative bacteria meningitis in adults.
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http://dx.doi.org/10.1186/1476-0711-11-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3297508PMC
February 2012

Vascular graft infections.

Curr Opin Infect Dis 2012 Apr;25(2):154-8

Service de Réanimation et Maladies Infectieuses, CHRU, Lille, France.

Purpose Of Review: This review provides a focus on infections of prosthetic vascular grafts used to treat peripheral arterial diseases.

Recent Findings: The incidence of infections varies between 1 and 6%. Risk factors of infection are not well identified. Main causative pathogens are Gram-negative bacilli, Staphylococcus aureus, and coagulase-negative staphylococci, without clear differences according to location of graft and time of onset of infection. There is no consensual diagnostic criterion. The basic principles for management of graft infections have been known for many years. A surgical approach combining graft excision, complete debridement, and maintaining distal vascular flow is required. Antimicrobial therapy is always instituted to reduce sepsis and prevent secondary graft infection, but there are no evidence-based data to recommend any regimen. However, antibiotics should have bactericidal activity whatever the bacteria growth phase, reduce the microbial burden, penetrate within the biofilm, and prevent further biofilm formation. Mortality and morbidity from these infections remain significant.

Summary: A multidisciplinary approach with a limited number of reference centres, recruiting sufficient numbers of patients to perform controlled trials, and to provide expert recommendations, could be the best way to answer unresolved questions and improve the prognosis.
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http://dx.doi.org/10.1097/QCO.0b013e3283501853DOI Listing
April 2012

Outcome and predictors of treatment failure in total hip/knee prosthetic joint infections due to Staphylococcus aureus.

Clin Infect Dis 2011 Aug;53(4):334-40

Centre National de Référence des Infections Ostéo-Articulaires Nord-Ouest, Roger Salengro Faculty Hospital of Lille, Lille, France.

Background: Variables associated with the outcome of patients treated for prosthetic joint infections (PJIs) due to Staphylococcus aureus are not well known.

Methods: The medical records of patients treated surgically for total hip or knee prosthesis infection due to S. aureus were reviewed. Remission was defined by the absence of local or systemic signs of implant-related infection assessed during the most recent contact with the patient.

Results: After a mean posttreatment follow-up period of 43.6 ± 32.1 months, 77 (78.6%) of 98 patients were in remission. Retention of the infected implants was not associated with a worse outcome than was their removal. Methicillin-resistant S. aureus (MRSA)-related PJIs were not associated with worse outcome, compared with methicillin-susceptible S. aureus (MSSA)-related PJIs. Pathogens identified during revision for failure exhibited no acquired resistance to antibiotics used as definitive therapy, in particular rifampin. In univariate analysis, parameters that differed between patients whose treatment did or did not fail were: American Society of Anesthesiologists (ASA) score, prescription of adequate empirical postsurgical antibiotic therapy, and use of rifampin combination therapy upon discharge from hospital. In multivariate analysis, ASA score ≤2 (odds ratio [OR], 6.87 [95% confidence interval {CI}, 1.45-32.45]; P = .04) and rifampin-fluoroquinolone combination therapy (OR, 0.40 [95% CI, 0.17-0.97]; P = .01) were 2 independent variables associated with remission.

Conclusions: The results of the present study suggest that the ASA score significantly affects the outcome of patients treated for total hip and knee prosthetic infections due to MSSA or MRSA and that rifampin combination therapy is associated with a better outcome for these patients when compared with other antibiotic regimens.
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http://dx.doi.org/10.1093/cid/cir402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148259PMC
August 2011

Vascular graft infections in the intensive care unit: clinical spectrum and prognostic factors.

J Infect 2011 Mar 24;62(3):204-11. Epub 2010 Dec 24.

Service de Réanimation et Maladies Infectieuses, Hôpital Dron, 135 avenue du Président Coty, Tourcoing, France.

Objectives: To report clinical characteristics and prognosis of vascular graft infections in Intensive Care Unit (ICU).

Methods: Thirty seven patients consecutively admitted in ICU for suspected or definite vascular graft infection between January 2006 and June 2009 were included.

Results: Staphylococcus species (n = 18) and enterobacteriae (n = 16) were the most frequent causative organisms. Twenty six patients (70%) needed mechanical ventilation. Further surgical procedures were performed in 7 patients (19%). In case of definite infection, mortality in ICU was 33%. In non survivors, shock (92% vs 42%, p = 0.01), age > 70 years (73% vs 27%, p = 0.04), POSSUM score > 45 (73% vs 27%, p = 0.04) and extra-anatomic bypass (45% vs 14%, p = 0.05) were more frequent, intra-operative volume of red cells transfusion (6 ± 3 vs 3 ± 2 units, p = 0.006) and of fresh frozen plasma (2.8 ± 2.8 vs 0.7 ± 1.2 units, p = 0.02), and SAPS II score (58 ± 26 vs 38 ± 17, p = 0.03) were higher. Proportion of adequate initial antibiotic therapy was similar in survivors and non survivors (91% vs 100%, p = 0.4). Proportion of patients treated with an aminoglycoside tended to be higher in survivors (59% vs 27%, p = 0.07). By multivariate analysis, only shock was associated with death in ICU (AOR: 16.3; 95% CI: 1.7-152.1; p = 0.01).

Conclusions: Vascular graft infection carries high morbidity and mortality rates in ICU. Extra-anatomic bypass might be associated with higher mortality. Early aminoglycoside prescription might be protective.
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http://dx.doi.org/10.1016/j.jinf.2010.12.006DOI Listing
March 2011

Brain abscesses during Proteus vulgaris bacteremia.

Neurol Sci 2011 Aug 2;32(4):661-3. Epub 2010 Oct 2.

Service Universitaire des Maladies Infectieuses et du Voyageur, Tourcoing, France.

Proteus vulgaris is only rarely the cause of multiple septic metastases. We describe multiple brain abscesses due to P. vulgaris in an immunocompetent patient successfully treated by antibiotic therapy and colonectomy.
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http://dx.doi.org/10.1007/s10072-010-0408-0DOI Listing
August 2011

Tolerability of prolonged linezolid therapy in bone and joint infection: protective effect of rifampicin on the occurrence of anaemia?

J Antimicrob Chemother 2010 Oct 29;65(10):2224-30. Epub 2010 Jul 29.

Infectious Diseases Department, Dron Hospital of Tourcoing, Tourcoing, France.

Background: Linezolid therapy has shown high rates of clinical success in patients with osteomyelitis and prosthetic joint infections caused by Gram-positive cocci. Recent studies have demonstrated that linezolid/rifampicin combination therapy prevents the emergence of rifampicin-resistant mutations in vitro. However, linezolid/rifampicin combination-related haematological and neurological toxicities have not been evaluated.

Objectives: To assess the tolerability of prolonged linezolid/rifampicin combination therapy compared with other linezolid-containing regimens in patients with bone and joint infections.

Methods: We reviewed the medical records of 94 patients who had received linezolid for >4 weeks after bone and joint infections. Anaemia was defined as a ≥2 g/dL reduction in haemoglobin, leucopenia as a total leucocyte count <4 × 10(9)/L, and thrombocytopenia as a reduction in platelet count to <75% of baseline.

Results: Anaemia was less frequent among patients on linezolid/rifampicin combination therapy than among patients on linezolid alone or in combination with other drugs (9.3%, 44% and 52%, respectively; P<0.01). In multivariate analysis, age and treatment group were independently associated with anaemia. Thrombocytopenia was reported in 44% of patients on linezolid/rifampicin combination therapy, in 48% of patients on linezolid alone and in 57.7% of patients on other linezolid-containing regimens. Age was the only variable associated with thrombocytopenia (P=0.019) in univariate analysis.

Conclusions: Linezolid/rifampicin combination therapy was associated with a significantly reduced incidence of anaemia among patients with bone and joint infections, but it did not have an effect on thrombocytopenia and peripheral neuropathy rates. Linezolid/rifampicin combination therapy was not associated with poor clinical outcomes.
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http://dx.doi.org/10.1093/jac/dkq281DOI Listing
October 2010

Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty.

J Infect 2010 Jul 9;61(2):125-32. Epub 2010 Jun 9.

Orthopaedic Surgery Service, Geneva University Hospitals & Medical School, Geneva, Switzerland.

Objectives: In the treatment of prosthetic joint infections (PJI), the benefit of antibiotic therapy for more than 6 weeks after surgery is uncertain. We compared PJI cure rates according to the duration of antibiotics, 6 versus 12 weeks.

Methods: A prospective observational non-randomized study in Geneva University Hospitals 1996-2007.

Results: A total of 144 PJI (62 hip arthroplasties, 62 knee arthroplasties, and 20 hip hemiarthroplasties) were included with a prolonged follow-up ranging from 26 to 65 months. Surgical treatment included 60 débridements with implant retention, 10 one-stage exchanges of the prosthesis, 57 two-stage exchanges, and 17 Girdlestone procedures or knee arthrodeses. Seventy episodes (49%) received 6 weeks antibiotic therapy and 74 episodes, 12 weeks. Cure was achieved in 115 episodes (80%). Cure rate did not change according to the duration of intravenous antibiotics (>8 days, 8-21 days, >21 days) (Kruskal-Wallis-test; p = 0.37). In multivariate analysis, none of the following parameters was statistically significantly associated with cure: two-stage exchange (odds ratio 1.1,95%CI 0.2-4.8); number of débridements (0.9, 0.4-1.9); six weeks antibiotherapy (2.7, 0.96-8.3); duration of intravenous course (1.0, 0.96-1.03); sinus tract (0.6, 0.2-1.7); or MRSA infection (0.5, 0.2-1.5), although implant retention showed a tendency for less cure (0.3, 0.1-1.1).

Conclusions: Following surgery for treatment of PJI, antibiotic therapy appears able to be limited to a 6-week course, with one week of intravenous administration. This approach needs confirmation in randomized trials.
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http://dx.doi.org/10.1016/j.jinf.2010.05.005DOI Listing
July 2010

Activity and impact on antibiotic use and costs of a dedicated infectious diseases consultant on a septic orthopaedic unit.

J Infect 2009 Mar 20;58(3):205-12. Epub 2009 Feb 20.

Orthopaedic Surgery Service, Geneva, Switzerland.

Unlabelled: The Orthopaedic Service of the Geneva University Hospitals engages dedicated infectious disease (ID) specialists to assist in the treatment of infected patients. We investigated the daily clinical activity and the impact on antibiotic costs in the Septic Unit since 2000.

Methods: Retrospective analysis of various databases. Prospective survey of clinical activity from January 2008 to March 2008.

Results: According to the survey, the ID specialist performed 265 first-time and 1420 follow-up consultations (average of 11.4 consultations per working day). In 88% of cases the antibiotic regimen initiated by the surgeons was approved. When the ID specialist had to change antibiotic treatment, it was for de-escalation in 43.7%, discontinuance in 32.4%, and initiation in 24.4% of cases. From April 2007 to March 2008, the ID specialist decreased total antibiotic use by 43 DDD/100 patients-days (p=0.0006) in the Septic Unit. Direct antibiotic costs decreased by US$64,380 over the same period, equal to the annual salary of the ID specialist. There was no change in the number of recurrent infections.

Conclusions: The main antibiotic-related activity of the dedicated orthopaedic ID specialist in Geneva our institution was to discontinue or adjust a pre-existing antimicrobial therapy. This activity significantly reduced antibiotic use and related costs on a septic orthopaedic unit.
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http://dx.doi.org/10.1016/j.jinf.2009.01.012DOI Listing
March 2009

Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot.

Clin Infect Dis 2009 Apr;48(7):888-93

Diabetic Foot Clinic, Gustave Dron Hospital, Tourcoing, France.

Background: Needle puncture has been suggested as a method for identifying bacteria in the bones in patients with diabetes with osteomyelitis of the foot. However, no studies have compared needle puncture with concomitant transcutaneous bone biopsy, which is the current standard recommended in international guidelines.

Methods: We conducted a prospective study in 2 French diabetes foot clinics. Transcutaneous bone biopsy specimens, needle puncture specimens, and swab samples were collected on the same day for each patient.

Results: Overall, 31 patients were included in the study from July 2006 through February 2008. Twenty-one bone biopsy specimens (67.7%), 18 needle puncture specimens (58%), and 30 swab samples (96.7%) had positive culture results. Staphylococcus aureus was the most common type of bacteria that grew from bone samples, followed by Proteus mirabilis and Morganella morganii. The mean number of bacteria types per positive sample were 1.35, 1.32, and 2.51 for bone biopsy specimens, needle puncture specimens, and swab samples, respectively. Among the 20 patients with positive bone biopsy specimens (69%), 13 had positive needle puncture samples. Overall, the correlation between microbiological results was 23.9%, with S. aureus showing the strongest correlation (46.7%). Results of cultures of bone biopsy and needle puncture specimens were identical for 10 (32.3%) of 31 patients. Bone bacteria were isolated from the needle punctures in 7 (33.3%) of the 21 patients who had positive bone biopsy specimen culture results. If the results of cultures of needle puncture specimens alone had been considered, 5 patients (16.1%) would have received unnecessary treatment, and 8 patients (38.1%) who had positive bone culture results would not have been treated at all.

Conclusions: Our results suggest that needle punctures, compared with transcutaneous bone biopsies, do not identify bone bacteria reliably in patients with diabetes who have low-grade infection of the foot and suspected osteomyelitis.
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http://dx.doi.org/10.1086/597263DOI Listing
April 2009

First case of intrafamily transmission of a new MRSA clone with toxic shock syndrome toxin-1.

Scand J Infect Dis 2008 ;40(8):675-6

Service Régional Universitaire des Maladies Infectieuses et du Voyageur, Tourcoing, France.

We report the first case of intrafamily transmission of a C-MRSA clone harbouring toxic shock syndrome toxin-1 (TSST-1). Because of the risk of this clone to spread in the community, family members of these patients should be screened to detect and prevent the diffusion of recurrent or new infections.
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http://dx.doi.org/10.1080/00365540701827499DOI Listing
December 2008

Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study.

Diabetes Care 2008 Apr 9;31(4):637-42. Epub 2008 Jan 9.

Diabetic Foot Clinic, Dron Hospital, Tourcoing, France.

Objective: The purpose of this article was to identify criteria predictive of remission in nonsurgical treatment of diabetic foot osteomyelitis.

Research Design And Methods: Diabetic patients who were initially treated without orthopedic surgery for osteomyelitis of the toe or metatarsal head of a nonischemic foot between June 2002 and June 2003 in nine French diabetic foot centers were identified, and their medical records were reviewed. Remission was defined as the absence of any sign of infection at the initial or contiguous site assessed at least 1 year after the end of treatment. A total of 24 demographic, clinical, and therapeutic variables including bone versus swab culture-based antibiotic therapy were analyzed.

Results: Fifty consecutive patients aged 62.2 +/- 11.1 years (mean +/- SD) with diabetes duration of 16 +/- 10.9 years were included. The mean duration of antibiotic treatment was 11.5 +/- 4.21 weeks. Bone biopsy was routinely available in four of the nine centers. Overall patient management was similar in the different centers except for the use of rifampin, which was recorded more frequently in patients from centers in which a bone biopsy was available. At the end of a 12.8-month posttreatment mean follow-up, 32 patients (64%) were in remission. Bone culture-based antibiotic therapy was the only variable associated with remission, as determined by both univariate (18 of 32 [56.3%] vs. 4 of 18 [22.2%], P = 0.02) and multivariate analyses (odds ratio 4.78 [95% CI 1.0-22.7], P = 0.04).

Conclusions: Bone culture-based antibiotic therapy is a factor predictive of success in diabetic patients treated nonsurgically for osteomyelitis of the foot.
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http://dx.doi.org/10.2337/dc07-1744DOI Listing
April 2008

It's elemental.

Am J Med 2007 Mar;120(3):233-5

Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.

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http://dx.doi.org/10.1016/j.amjmed.2007.01.016DOI Listing
March 2007

[Septic arthritis (non gonococcal) of the adult: practical aspects].

Rev Med Suisse 2006 Dec;2(92):2924-30

Service de chirurgie orthopédique et traumatologie de l'appareil moteur, Département de chirurgie, HUG, 1211 Genève 14.

Septic arthritis is potentially a life-threatening disease and frequently afflicts the most fragile patients. It is crucial to rule-out this diagnosis in a patient presenting with monoarticular arthritis, and the gold-standard is aspiration of the joint. A primary site of infection such as endocarditis or spondylodiscitis must be excluded by appropriate examination and investigative studies. The usual infecting organisms causing septic arthritis are Staphylococcus and Streptococcus species, and in young adults Gonococcus must be considered. Antibiotics should be started promptly after obtaining joint fluid for bacteriologic studies. Efficient drainage and lavage of the joint should be performed without delay because articular cartilage can be damaged quickly. Arthroscopy is a well-accepted technique in treating septic arthritis, particularly when the knee is involved.
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December 2006

Effectiveness and tolerability of prolonged linezolid treatment for chronic osteomyelitis: a retrospective study.

Clin Ther 2006 Aug;28(8):1155-1163

Infectious Diseases Department, Dron Hospital of Tourcoing, Tourcoing, France.

Background: Linezolid is an oxazolidinone agent which is apparently well designed for treating chronic osteomyelitis, but data on effectiveness and tolerability as prolonged therapy is currently lacking.

Objective: The purpose of this study was to assess the effectiveness and tolerability of linezolid in the treatment of chronic osteomyelitis.

Methods: The charts of hospitalized patients who had been treated with linezolid for >4 weeks because of chronic osteomyelitis and were followed up for > or =12 months after the end of treatment were retrospectively reviewed for clinical outcome and tolerability. Cure was defined as the absence of clinical, biological, or radiological evidence of infection throughout the posttreatment follow-up. Linezolid tolerability was assessed on the basis of hematologic properties during treatment.

Results: Of the 66 patients included, all were white (mean [SD] age, 67.7 [18.1] years; 41 men and 25 women; mean [SD] weight, 80.7 [18.6] kg). Thirty-seven (56.1%) patients had infection due to implants including 27 prosthetic joints. Pathogens were predominantly methicillin-resistant staphylococci (49/72 strains, 68.1 %). Every patient was administered N linezolid (600 mg BID) treatment for 6 to 8 days as inpatients, and then, as outpatients, they were switched to PO treatment. Fifty (75.8%) patients received a combination of linezolid and other antimicrobial agents, including rifampin (32 [48.5%]). Surgery was performed in 52 (78.8%) patients. The median hospital stay was 14 days (mean [SD], 19 [11.4] days [range, 7-70 days] ). The median duration of treatment was 13 weeks (mean [SD], 14.3 [8.2] weeks [range, 5-36 weeks]). At the end of treatment, 56 (84.8%) patients were cured, and during the post-treatment follow-up (median duration, 15 months [range, 12-36 months]), 4 relapses occurred, resulting in an overall successful cure for 52 (78.8%) patients. Reversible anemia was reported in 21 patients (31.8%), of whom 16 (24.2%) required blood transfusions. Median time from treatment initiation to anemia onset was 7.3 weeks (range, 4-12 weeks). Peripheral neuropathy was reported in 6 (9.1%) patients, of whom 4 remained symptomatic for up to 24 months after linezolid discontinuation. Other reported adverse events included nausea (6 [9.1%]), diarrhea (1 [1.5%]), and headache (2 [3.0%]), although none of these patients discontinued treatment.

Conclusions: In this retrospective chart review, treatment with linezolid as monotherapy or in combination with antimicrobials and/or surgery was associated with cure of chronic osteomyelitis in 84.8% of subjects at 12 weeks after the end of treatment and 78.8% at follow-up. Adverse events were reported in 51.5% of subjects, and 34.8% of subjects discontinued the study because of adverse events. The potential for severe complications justifies close monitoring of these patients.
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http://dx.doi.org/10.1016/j.clinthera.2006.08.001DOI Listing
August 2006

Suction drainage culture as a guide to effectively treat musculoskeletal infection.

Scand J Infect Dis 2006 ;38(5):341-5

Orthopaedic Surgery Service, University Hospital of Geneva, Switzerland.

Following surgery for musculoskeletal infection, a positive suction drainage culture (SDC) is consistent with persistent sepsis. Our objective was to determine the effect of a negative SDC obtained in subsequent operations on the outcome of a musculoskeletal infection. 99 patients were prospectively enrolled, all treated surgically for musculoskeletal infection utilizing suction drainage and appropriate antimicrobial therapy. Surgery consisted of irrigation, debridement, and prosthetic exchange or implant removal. SDC was considered negative if all bottles resulted in negative cultures. Following SDC results, patients were placed into 1 of 2 treatment groups: 1) Negative SDC, and no new operation; or 2) Positive SDC, and new operation(s) until SDC was negative. Antibiotic therapy ranged from 6-12 weeks (osteomyelitis) to 10-21 d (soft tissue). Both groups were similar with regard to baseline characteristics. Cure was obtained in 91.8% of patients (56/61) in group 1 and 91.6% of patients (22/24) in group 2. Similar results were obtained in patients with an infection in the presence of an implant. In conclusion, a negative SDC following surgery for a musculoskeletal infection is a strong indication of eventual outcome.
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http://dx.doi.org/10.1080/00365540500488899DOI Listing
July 2006

Recurrent osteomyelitis caused by infection with different bacterial strains without obvious source of reinfection.

J Clin Microbiol 2006 Mar;44(3):1194-6

Division of Infectious Diseases, Geneva University Hospital, Switzerland.

Recurrence of osteomyelitis by the same bacterial strain is well known. We report three patients with a second episode of osteomyelitis at the same site caused by different strains of bacteria from the original. Formerly infected and altered bone surface might present a region of diminished resistance for a new infection.
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http://dx.doi.org/10.1128/JCM.44.3.1194-1196.2006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1393085PMC
March 2006

Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures.

Clin Infect Dis 2006 Jan 21;42(1):57-62. Epub 2005 Nov 21.

Diabetic Foot Clinic, Dron Hospital, Tourcoing, France.

Background: We assessed the diagnostic value of swab cultures by comparing them with corresponding cultures of percutaneous bone biopsy specimens for patients with diabetic foot osteomyelitis.

Methods: The medical charts of patients with foot osteomyelitis who underwent a surgical percutaneous bone biopsy between January 1996 and June 2004 in a single diabetic foot clinic were reviewed. Seventy-six patients with 81 episodes of foot osteomyelitis who had positive results of culture of bone biopsy specimens and who had received no antibiotic therapy for at least 4 weeks before biopsy constituted the study population.

Results: Pathogens isolated from bone samples were predominantly staphylococci (52%) and gram-negative bacilli (18.4%). The distributions of microorganisms in bone and swab cultures were similar, except for coagulase-negative staphylococci, which were more prevalent in bone samples (P < .001). The results for cultures of concomitant foot ulcer swabs were available for 69 of 76 patients. The results of bone and swab cultures were identical for 12 (17.4%) of 69 patients, and bone bacteria were isolated from the corresponding swab culture in 21 (30.4%) of 69 patients. The concordance between the results of cultures of swab and of bone biopsy specimens was 42.8% for Staphylococcus aureus, 28.5% for gram-negative bacilli, and 25.8% for streptococci. The overall concordance for all isolates was 22.5%. No adverse events--such as worsening peripheral vascular disease, fracture, or biopsy-induced bone infection--were observed, but 1 patient experienced an episode of acute Charcot osteoarthropathy 4 weeks after bone biopsy was performed.

Conclusions: These results suggest that superficial swab cultures do not reliably identify bone bacteria. Percutaneous bone biopsy seems to be safe for patients with diabetic foot osteomyelitis.
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http://dx.doi.org/10.1086/498112DOI Listing
January 2006

Atypical infections in tsunami survivors.

Emerg Infect Dis 2005 Oct;11(10):1591-3

University Hospitals of Geneva, Geneva, Switzerland.

After a tsunami hit Asia in December 2004, 2 survivors had severe infections due to multidrug-resistant and atypical bacteria and rare fungi weeks afterwards. Treating these infections is challenging from a clinical and microbiologic point of view.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366756PMC
http://dx.doi.org/10.3201/eid1110.050715DOI Listing
October 2005

[Severe Streptococcus agalactiae infection of the diabetic foot.]

Presse Med 2005 Apr;34(7):491-494

Département de médecine.

A DELETERIOUS ROLE OF STREPTOCOCCUS AGALACTIAE?: Introduction Screening strategies among pregnant women have decreased the incidence of group B Streptococcus, which causes severe neonatal infections. The incidence of these infections has increased among diabetic patients, however. OBJECTIVES: To specify the characteristics of diabetic foot infections in which surgical samples have isolated one or several germs including group B Streptococcus, study its risk factors and determine its course. Materials and methods We retrospectively evaluated the records of all patients admitted to the University Hospital of Geneva from January 1999 through October 2004, with diagnoses of severe foot infection (+/- osteomyelitis) documented during surgery. RESULTS: Twenty-five severe diabetic foot infections were identified, 21 with osteomyelitis. The most common risk factors were age older than 60 years (n=10), chronic renal failure (n=7), severe arteriopathy (n=6), and immune depression (n=2). Most lesions were classified as grade 3 or 4 of Wagner's classification. 80% of the surgical samples were polymicrobial. Blood cultures were positive in 4 patients, one in septic shock. Half the patients (n=13) underwent amputation, despite initially appropriate antibiotic treatment. No patients died but 3 relapsed. CONCLUSION: Group B streptococcal foot infections often occur in fragile patients with immune depression or severe arterial disease. Despite intensive antibiotic therapy and adequate debridement, amputation is often required in diabetic patients because of severe damage to the tissue and poor vascularization.
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April 2005

[Severe Streptococcus agalactiae infection of the diabetic foot. A deleterious role of Streptococcus agalactiae?].

Presse Med 2005 Apr;34(7):491-4

Département de médecine, Hôpital universitaire cantonal, Genève, Suisse.

Introduction: Screening strategies among pregnant women have decreased the incidence of group B Streptococcus, which causes severe neonatal infections. The incidence of these infections has increased among diabetic patients, however.

Objectives: To specify the characteristics of diabetic foot infections in which surgical samples have isolated one or several germs including group B Streptococcus, study its risk factors and determine its course.

Materials And Methods: We retrospectively evaluated the records of all patients admitted to the University Hospital of Geneva from January 1999 through October 2004, with diagnoses of severe foot infection (+/- osteomyelitis) documented during surgery.

Results: Twenty-five severe diabetic foot infections were identified, 21 with osteomyelitis. The most common risk factors were age older than 60 years (n=10), chronic renal failure (n=7), severe arteriopathy (n=6), and immune depression (n=2). Most lesions were classified as grade 3 or 4 of Wagner's classification. 80% of the surgical samples were polymicrobial. Blood cultures were positive in 4 patients, one in septic shock. Half the patients (n=13) underwent amputation, despite initially appropriate antibiotic treatment. No patients died but 3 relapsed.

Conclusion: Group B streptococcal foot infections often occur in fragile patients with immune depression or severe arterial disease. Despite intensive antibiotic therapy and adequate debridement, amputation is often required in diabetic patients because of severe damage to the tissue and poor vascularization.
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April 2005

Risk factors for anaemia in patients on prolonged linezolid therapy for chronic osteomyelitis: a case-control study.

J Antimicrob Chemother 2004 Oct 25;54(4):798-802. Epub 2004 Aug 25.

Infectious Diseases Department, Dron Hospital, 135 rue du Président Coty, 59200 Tourcoing, France.

Objectives: The intrinsic properties of the new antibiotic linezolid make it an attractive candidate for the treatment of chronic osteomyelitis. However, data regarding the tolerance of long-term linezolid administration are still lacking.

Methods: The medical charts of patients given linezolid for >4 weeks were retrospectively analysed, especially their haematology. In a case-control study, we compared the respective characteristics of patients who developed anaemia during linezolid therapy and those who did not.

Results: Forty-five adults with chronic osteomyelitis received 600 mg linezolid intravenously twice daily for 7 days, and then orally, for a mean total duration of 15.9 weeks (range, 6-36). Anaemia episodes requiring blood transfusion occurred in 13/45 patients (28.9%). Median time from treatment initiation to anaemia onset was 7.4 weeks (range, 4-16). Anaemia was significantly associated with premature linezolid therapy cessation (P = 0.0012). No linezolid-related thrombocytopenia was observed. By univariate analysis, four variables were associated with the occurrence of anaemia: age >58 years, alcohol abuse, diabetes mellitus and low haemoglobin before linezolid treatment. Logistic regression analysis revealed two independent risk factors for anaemia: age >58 years (OR = 20.5, 95% CI 0.69-599; P = 0.0001) and pre-treatment haemoglobin <10.5 g/dL (OR = 16.49, 95% CI 1.06-255; P = 0.04).

Conclusions: Profound anaemia may occur in adult patients with chronic osteomyelitis on prolonged linezolid therapy, and often necessitates linezolid cessation. These patients are likely to be aged >58 years and to have low pre-treatment haemoglobin. The results for the present series might help physicians to identify patients who should not be given long-term linezolid treatment for chronic osteomyelitis.
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http://dx.doi.org/10.1093/jac/dkh409DOI Listing
October 2004

Pasteurella multocida aortic valve endocarditis: case report and literature review.

J Heart Valve Dis 2003 Mar;12(2):261-3

Service de chirurgie cardiovasculaire, Hopital cardiologique, CHRU de Lille, France.

Pasteurella multocida is a rare cause of infective endocarditis that occurs mostly in immunocompromised patients and is therefore associated with a high mortality rate. The case is reported of a 48-year-old male patient with liver cirrhosis, who developed aortic valve endocarditis caused by P. multocida. The infection was detected by blood cultures. The patient presented with generalized symptoms and initial neurologic symptoms suggestive of meningitis. Transthoracic echocardiography conducted after the discovery of a diastolic murmur revealed a large vegetation on the aortic valve, and notable insufficiency. These findings were confirmed at surgery, where-upon the patient underwent aortic valve replacement using a bioprosthetic valve. Subsequently he developed a recurrent episode of endocarditis that was successfully treated with antibiotic therapy. Other similar cases reported in the literature are reviewed.
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March 2003