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2026

A consensus-based guideline for personalized bacteriophage therapy
https://doi.org/10.1038/s41591-026-04654-6
free access international
Bacteriophages (phages) – viruses that selectively infect bacteria – are a promising option for personalized therapy of difficult-to-treat bacterial infections. Clinical implementation in many countries worldwide, however, faces multiple hurdles, including a lack of consensus on general principles for phage therapy, infrastructural requirements, procedures for quality-assured phage selection and preparation, clinical administration, monitoring and documentation. Existing guidance provides limited practical
First UK use of bacteriophage therapy with DAIR for chronic Staphylococcus aureus prosthetic joint infection
10.1128/asmcr.00082-26. eCollection 2026 Sep
free access international
Chronic Staphylococcus aureus prosthetic joint infection (PJI) remains difficult to manage when surgical revision and long-term antibiotics are not feasible. Bacteriophage therapy is emerging as a potential adjunct, though experience in orthopedic infections, particularly in the United Kingdom, is limited.
Isolation policies in musculoskeletal infection care: time to move from tradition to evidence
doi: 10.5194/jbji-11-489-2026. eCollection 2026
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A recent scoping review found no evidence supporting routine ward-level isolation or dedicated septic wards for non-multidrug-resistant organism musculoskeletal infections when standard precautions are applied, whereas targeted measures remain appropriate for multidrug-resistant organisms. An international survey revealed wide variation in attitudes and a persistent belief in supporting evidence, highlighting a gap between evidence and perception and supporting a differentiated, risk-based
The French Referral Centers for Complex Bone and Joint Infections (CRIOAc) 18 years after their establishment: Organization, added value, and future perspectives
doi.org/10.1016/j.otsr.2026.104804
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Complex bone and joint infections (BJIs) represent a major public health challenge because of their severity, functional consequences, and the complexity of their management. In 2008, France established a nationwide network of Referral Centers for Complex Bone and Joint Infections (CRIOAc), a pioneering organization based on specialized multidisciplinary team (MDT) meetings and comprehensive national territorial coverage.
Adjuvant multisite bacteriophage cocktail administration as salvage treatment in a patient with a multidrug-resistant Pseudomonas aeruginosa frontal relapsing complex osteitis
https://doi.org/10.1016/j.ijid.2026.108756
free access
Bone infection due to multidrug-resistant (MDR) Pseudomonas aeruginosa is associated with poor outcomes, especially high risk of relapses. Adjunctive multisite phage therapy can be used as a salvage treatment in relapsing cases.
Culture-proven osteoarticular mycoses: an eight-year single-center descriptive study of fungal distribution and antifungal susceptibility trends
https://doi.org/10.1016/j.ijid.2026.108714
free access international
To describe the mycological profile of culture-proven osteoarticular mycoses (OAM) at a 5400-bed university hospital (2017–2024) according to clinical syndromes and assess antifungal resistance trends.

2025

Re-evaluating patient isolation policies for musculoskeletal infections in orthopaedic practice: a scoping review
10.5194/jbji-10-489-2025
free access international
Historically, isolating patients diagnosed with musculoskeletal infections (MSIs) from the general orthopaedic population has been regarded a fundamental aspect of effective infection control. However, this remains controversial. Evolving perspectives on infection prevention, resource constraints, and staffing shortages necessitate a reassessment of current practices. This scoping review examines existing isolation policies for MSIs in orthopaedic practice and provides expert recommendations for
Risk factors of daptomycin overexposure: a case-control study
https://doi.org/10.1128/aac.01139-25
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In our institution, therapeutic drug monitoring of daptomycin is performed routinely and cases of high trough concentrations have been observed in patients without known risk factors. The aim of this study was to identify risk factors of daptomycin overexposure. We performed a case-control study of daptomycin overexposure in patients who received daptomycin between 2013 and 2021.
Peripheral neuropathy during long-term suppressive therapy with tedizolid: a case series
2025 Aug 26:dkaf315. doi: 10.1093/jac/dkaf315
international
Due to its potentially better long-term haematologic tolerance compared to linezolid, tedizolid represents an attractive option for prolonged antibiotic therapy in complicated/chronic Gram-positive infections. However, there is little information regarding the risk of peripheral neurological toxicity, representing another obstacle to the extended use of oxazolidinones. Reporting neurologic adverse events occurring during tedizolid therapy for chronic implant-associated infections.
Bacteriophages for the treatment of musculoskeletal infections-An overview of clinical use, open questions, and legal framework
10.1007/s00132-025-04690-z
Bacteriophages, or simply phages, are viruses that specifically infect and lyse bacteria. As antibiotic resistance becomes a growing global concern, phage therapy is gaining renewed attention as a targeted and effective treatment option. In orthopedics and trauma surgery-disciplines characterized by high rates of chronic and implant-associated infections-phages offer promising new therapeutic avenues, particularly in cases involving multidrug-resistant pathogens or when
Current Applications and the Future of Phage Therapy for Periprosthetic Joint Infections
Antibiotics (Basel) . 2025 Jun 6;14(6):581. doi: 10.3390/antibiotics14060581
free access international
Periprosthetic joint infections (PJI) present significant challenges in orthopedic surgery, largely due to the complexity of treating antibiotic-resistant infections. Phage therapy, which utilizes bacteriophages to target bacterial pathogens, offers a promising supplement to traditional antimicrobial methods. This review discusses the current applications of phage therapy in the management of PJI, exploring its underlying mechanisms, clinical outcomes, and practical considerations.
Pharmacokinetics of Subcutaneous and Intravenous Ceftriaxone in an Older Population: The PhASAge Study
Open Forum Infect Dis . 2025 May 30;12(6):ofaf313. doi: 10.1093/ofid/ofaf313. eCollection 2025 Jun.
free access international
Ceftriaxone is frequently administered subcutaneously in France, especially in older patients, although this practice is currently off-label. This work aims to describe the pharmacokinetics (PK) and pharmacodynamics (PD) and tolerance of ceftriaxone administered by intravenous and subcutaneous routes in older patients.
Debridement, antimicrobial therapy, and implant retention (DAIR) as curative surgical strategy for acute periprosthetic hip and knee infections
J Bone Jt Infect . 2025 Apr 1;10(2):139-142. doi: 10.5194/jbji-10-139-2025. eCollection 2025
free access international
…a summary of the position paper from the European Bone & Joint Infection Society (EBJIS). This is a summary of our position paper on debridement, antimicrobial therapy, and implant retention (DAIR) procedures as curative treatment strategy for acute periprosthetic hip and knee infections. It includes the defined indications as well as the contraindications for DAIR procedures when eradication/cure is intended,
Management of Gram-positive multiresistant bacteria prosthetic joint infection: a narrative review on current and innovative strategies
Clin Microbiol Infect . 2025 Apr 26:S1198-743X(25)00184-3. doi: 10.1016/j.cmi.2025.04.021
Prosthetic joint infection (PJI) is a devastating complication of arthroplasty surgery, mostly caused by Gram-positive pathogens, including S. aureus and coagulase-negative staphylococci (CNS). Multidrug resistance is of major concern in this setting: i) it can negatively impact outcome, restricting the use of the most effective antimicrobials; ii) it may influence the choice of surgical strategies; and iii) it restrains the
Real-Life Cefiderocol Use in Bone and Joint Infection: A French National Cohort
Antibiotics (Basel). 2025 Apr 8;14(4):388. doi: 10.3390/antibiotics14040388
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Cefiderocol (CFD) is a novel siderophore cephalosporin developed for the treatment of infections involving multidrug-resistant (MDR) Gram-negative bacilli (GNB) infections (1–3). For bone and joint infections (BJIs), the use of CFD is currently neither part of its market authorization nor recommended, and has not yet been assessed by large-scale studies. Objectives: To fill the scarcity of data regarding the use

2024

Bacteriophage therapy in musculoskeletal infections: from basic science to clinical application
https://doi.org/10.1530/EOR-24-0042
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The treatment of musculoskeletal infections (MSIs), including periprosthetic joint infection (PJI) and fracturerelated infection (FRI), is often complicated by biofilm-related challenges necessitating multiple revision surgeries and incurring substantial costs. The emergence of antimicrobial resistance (AMR) adds to the complexity of the problem, leading to increased morbidity and healthcare expenses. There is an urgent need for novel antibacterial strategies, with the
Access to phage therapy at Hospices Civils de Lyon in 2022: Implementation of the PHAGEinLYON Clinic programme
Int J Antimicrob Agents . 2024 Dec;64(6):107372. doi: 10.1016/j.ijantimicag.2024.107372. Epub 2024 Nov 2.
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Objectives: To describe the PHAGEinLYON Clinic programme, set up in 2022 to improve access to phage therapy in France using pharmaceutical-grade phages. Methods: All phage therapy requests received during 2022 were collected prospectively, and reviewed retrospectively to analyse the decision and the patient care pathway (NCT05883995).
Contribution of ultrasound in the management of ballistic nerve injury during the 2020 Nagorno‑Karabakh war
J Ultrasound. 2024 Dec 15. doi: 10.1007/s40477-024-00974-w. Online ahead of print. PMID: 39674962
Twenty-five Armenian soldiers who sustained BPNI of 44 different nerves during the Second Nagorno-Karabakh War in 2020 benefited from multidisciplinary team management including ultrasound examination.
Prosthetic Joint Infections Caused by Mycobacterium tuberculosis Complex—An ESGIAI–ESGMYC Multicenter, Retrospective Study and Literature Review
free access
While tuberculosis remains a significant global health concern, prosthetic joint infections (PJIs) caused by members of the Mycobacterium tuberculosis complex are exceptionally rare. Our objective is to perform a retrospective search of new cases of this disease and analyze all cases available in the literature of tuberculous PJIs, aiming to detect factors that may influence patient outcomes
Bacteriophage therapy as an innovative strategy for the treatment of Periprosthetic Joint Infection: a systematic review
https://doi.org/10.1007/s00264-024-06295-1
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Abstract Background Periprosthetic Joint Infection (PJI) following hip and knee arthroplasty is a catastrophic complication in orthopaedic surgery. It has long been a key focus for orthopaedic surgeons in terms of prevention and management. With the increasing incidence of antibiotic resistance in recent years, finding more targeted treatment methods has become an increasingly urgent issue. Bacteriophage Therapy (BT) has emerged
A Review of Phage Therapy for Bone and Joint Infections
© 2024. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.
international
There is a strong rationale for using phages in patients with bone and joint infections (BJIs). Indeed, specific phages can infect and replicate in bacterial pathogens and have also demonstrated their activity in vitro against biofilm produced by different bacteria. However, there is a high variability of the different clinical forms of BJI, and their management is complex and frequently

2023

Phages and phage-borne enzymes as new antibacterial agents
Clin Microbiol Infect . 2023 Oct 20:S1198-743X(23)00528-1. doi: 10.1016/j.cmi.2023.10.018
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Background: Persistent and resistant infections caused by bacteria are increasing in numbers and pose a treatment challenge to the medical community and public health. However, solutions with new agents that will enable effective treatment are lacking or delayed by complex development and authorizations. Bacteriophages are known as a possible solution for invasive infections for decades but were seldom used in
Diagnostic, clinical management and outcome of bone flap-related osteomyelitis following cranioplasty
International Journal of Infectious Diseases Volume 137, December 2023, Pages 48-54
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Objectives: To describe diagnostic, management and outcome of bone flap-related osteomyelitis following cranioplasty. Methods: Patients followed-up in our tertiary care hospital for a bone flap-related osteomyelitis after cranioplasty were included in a retrospective cohort (2008-2021). Determinants of treatment failure were assessed using logistic regression and Kaplan-Meier curves analysis.
Case report: Continuous infusions of ceftazidime-avibactam and aztreonam in combination through elastomeric infusors for 12 weeks for the treatment of bone and joint infections due to metallo-β-lactamase producing Enterobacterales
Front Med (Lausanne). 2023; 10: 1224922.
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Among carbapenem-resistant Enterobacterales, metallo-beta-lactamase producing strains represent a growing therapeutic challenge. While the association of aztreonam and ceftazidime-avibactam has been investigated in recent years for the treatment of infections involving these strains, little to no clinical data support the use of this association for the treatment of bone and joint infections. We report two cases of complex bone and joint
Daptomycin Exposure as a Risk Factor for Daptomycin-Induced Eosinophilic Pneumonia and Muscular Toxicity
Clin Infect Dis . 2023 Jun 19:ciad386. doi: 10.1093/cid/ciad386. Online ahead of print.
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High-dose daptomycin is increasingly used in patients with bone and joint infection (BJI). This raises concerns about a higher risk of adverse events (AEs), including daptomycin-induced eosinophilic pneumonia (DIEP) and myotoxicity. We aimed to examine pharmacokinetic and other potential determinants of DIEP and myotoxicity in patients with BJI receiving daptomycin.
Case Studies and Literature Review of Francisella tularensis–Related Prosthetic Joint Infection
Emerg Infect Dis . 2023 Jun;29(6):1118-1126. doi: 10.3201/eid2906.221395.
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Tularemia is a zoonotic infection caused by Francisella tularensis. Its most typical manifestations in humans are ulceroglandular and glandular; infections in prosthetic joints are rare. We report 3 cases of F. tularensis subspecies holarctica–related prosthetic joint infection that occurred in France during 2016–2019. We also reviewed relevant literature and found only 5 other cases of Francisella-related prosthetic joint infections worldwide,
Cost-effectiveness of a bone substitute delivering gentamicin in the treatment of chronic osteomyelitis of long bones: Protocol for the CONVICTION randomized multicenter study
Frontiers in Medicine 023 Mar 30:10:1116711. doi: 10.3389/fmed.2023.1116711. eCollection 2023.
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Chronic osteomyelitis is a serious osteoarticular infection that most often occurs in the long bones, responsible for significant morbidity with the risk of fracture and amputation. Despite advances in both antibiotics and surgical treatment, the probability of recurrence of infection remains at around 20%. Cerament-G (BONESUPPORT AB, Sweden) is a synthetic bone substitute that fills the bone void left by

2022

Staphylococcus lugdunensis prosthetic joint infection: A multicentric cohort study
Journal of Infection 85 (2022) 652–659
free access international
Objectives: To describe Staphylococcus lugdunensis prosthetic joint infection (PJI) management and out-come. Methods: Adults with proven S. lugdunensis PJI were included in a multicentric retrospective cohort. Determinants for failure were assessed by logistic regression and treatment failure-free survival curve analysis (Kaplan-Meier).
Optimisation préopératoire afin de prévenir les infections de prothèses articulaires
Revue de Chirurgie Orthopédique et Traumatologique Available online 29 December 2022
free access
Au cours des dernières décennies, des progrès significatifs ont été réalisés dans la prévention de l’infection des prothèses articulaires, notamment dans la gestion de l’environnement et de l’antibioprophylaxie. Toutefois, une part significative du risque est liée au profil du patient, avec des facteurs de risque modifiables ou non. Basé sur la littérature récente, nous proposons les attitudes suivantes pour «
Les virus au service de la santé : les bactériophages
médecine/sciences 2022 ; 38 : 1043-51
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Les bactériophages sont des virus naturels très répandus dans l’environnement qui ciblent spécifiquement les bactéries. Leur utilisation en médecine, connue sous le terme phagothérapie, consiste à les isoler, les caractériser, les cultiver, puis les purifier pour traiter des infections bactériennes. Il existe actuellement un renouveau pour la thérapie phagique, et sa mise en œuvre présuppose de disposer de phages actifs
Seventeen Cases of Daptomycin-Induced Eosinophilic Pneumonia in a Cohort of Patients Treated for Bone and Joint Infections: Proposal for a New Algorithm
Oxford University Press 2022 Nov 3;9(11):ofac577. doi: 10.1093/ofid/ofac577. eCollection 2022 Nov
free access international
Background: Daptomycin is increasingly used in the treatment of bone and joint infections (BJIs) and may be responsible for daptomycin-induced eosinophilic pneumonia (DIEP), a potentially severe adverse drug reaction. The aim of this study was to describe DIEP in patients treated at a referral center for the management of BJI, and to revisit current definitions of this disease. Methods: Patients
Prosthetic Knee Joint Infection Due to Candida lusitaniae: A Diagnostic and Therapeutic Odyssey: A Case Study
Diagnostics (Basel). 2022 Oct 31;12(11):2640. doi: 10.3390/diagnostics12112640. PMID: 36359483
free access international
Prosthetic joint infections (PJIs) caused by fungi, although relatively rare, represent a major surgery-related complication. An extremely rare fungal PJI, following revised total knee replacement (TKR) caused by Candida lusitaniae, is reported, and a meticulous review of similar cases is provided. A 74-year-old female, who underwent primary total knee arthroplasty 10 years ago and a revision surgery three weeks ago,
Phage Therapy against Staphylococcus aureus: Selection and Optimization of Production Protocols of Novel Broad-Spectrum Silviavirus Phages
Pharmaceutics . 2022 Sep 6;14(9):1885. doi: 10.3390/pharmaceutics14091885.
free access international
Background: Phage therapy a promising antimicrobial strategy to address antimicrobial resistance for infections caused by the major human pathogen Staphylococcus aureus. Development of therapeutic phages for human use should follow pharmaceutical standards, including selection of strictly lytic bacteriophages with high therapeutic potential and optimization of their production process. Results: Here, we describe three novel Silviavirus phages active against 82% of
Necrotizing external otitis: analysis of relapse risk factors in 66 patients managed during a 12 year period
J Antimicrob Chemother . 2022 Aug 25;77(9):2532-2535. doi: 10.1093/jac/dkac193.
international
Background:  Necrotizing external otitis (NEO) is a severe infection of the skull base that occurs generally in the elderly and/or in diabetic recipients. There are few data in the literature about the therapeutic management of this complex bone infection. Objectives:  To analyse relapses after NEO treatment completion, and to describe the clinical features of NEO. Methods:  We performed a retrospective
Daptomycin Physiology-Based Pharmacokinetic Modeling to Predict Drug Exposure and Pharmacodynamics in Skin and Bone Tissues
Clin Pharmacokinet . 2022 Aug 16. doi: 10.1007/s40262-022-01168-5.
international
Background and objective:  Daptomycin has been recommended in the treatment of bone and joint infection. Previous work showed that the approved dosage of daptomycin may be insufficient to achieve optimal exposure in patients with bone and joint infection. However, those studies assumed that bone exposure was similar to steady-state daptomycin-free plasma concentrations. We sought to establish a physiologically based pharmacokinetic
Osteocutaneous-flap-related osteomyelitis following mandibular reconstruction: a cohort study of an emerging and complex bone infection
J Bone Jt Infect . 2022 Jun 10;7(3):127-136. doi: 10.5194/jbji-7-127-2022. eCollection 2022.
free access international
Osteocutaneous flap (OCF) mandible reconstruction is at high risk for surgical site infection. This study aimed to describe diagnosis, management, and outcome of OCF-related osteomyelitis. All patients managed at our institution for an OCF-related osteomyelitis following mandible reconstruction were included in a retrospective cohort study (2012-2019). Microbiology was described according to gold-standard surgical samples, considering all virulent pathogens, and potential
Activity of Exebacase (CF-301) against Biofilms Formed by Staphylococcus epidermidis Strains Isolated from Prosthetic Joint Infections
Antimicrob Agents Chemother . 2022 Jul 11;e0058822. doi: 10.1128/aac.00588-22.
free access international
Staphylococcus epidermidis is one of the main pathogens responsible for bone and joint infections, especially those involving prosthetic materials, due to its ability to form biofilms. In these cases, biofilm formation, combined with increased antimicrobial resistance, often results in therapeutic failures. In this context, the development of innovative therapies active against S. epidermidis is a priority. The aim of this
Personalized bacteriophage therapy to treat pandrug-resistant spinal Pseudomonas aeruginosa infection
https://doi.org/10.1038/s41467-022-31837-9
free access international
Bone and joint infections (BJI) are one of the most difficult-to-treat bacterial infection, especially in the era of antimicrobial resistance. Lytic bacteriophages (phages for short) are natural viruses that can selectively target and kill bacteria. They are considered to have a high therapeutic potential for the treatment of severe bacterial infections and especially BJI, as they also target biofilms. Here
Paving the way for phage therapy using novel drug delivery approaches
J Control Release . 2022 Jul;347:414-424. doi: 10.1016/j.jconrel.2022.05.021.
free access international
Bacterial resistance against antibiotics is an emergent medical issue. The development of novel therapeutic approaches is urgently needed and, in this context, bacteriophages represent a promising strategy to fight multi resistant bacteria. However, for some applications, bacteriophages cannot be used without an appropriate drug delivery system which increases their stability or provides an adequate targeting to the site of infection.
Necrotizing external otitis: analysis of relapse risk factors in 66 patients managed during a 12 year period
J Antimicrob Chemother. 2022 Jun 13;dkac193. doi: 10.1093/jac/dkac193.
international
Background Necrotizing external otitis (NEO) is a severe infection of the skull base that occurs generally in the elderly and/or in diabetic recipients. There are few data in the literature about the therapeutic management of this complex bone infection. Objectives To analyse relapses after NEO treatment completion, and to describe the clinical features of NEO. Methods We performed a retrospective
Novel strategies to diagnose prosthetic or native bone and joint infections
Expert Rev Anti Infect Ther . 2022 Mar;20(3):391-405.
international
Introduction: Bone and Joint Infections (BJI) are medically important, costly and occur in native and prosthetic joints. Arthroplasties will increase significantly in absolute numbers over time as well as the incidence of Prosthetic Joint Infections (PJI). Diagnosis of BJI and PJI is sub-optimal. The available diagnostic tests have variable effectiveness, are often below standard in sensitivity and/or specificity, and carry
Prophylactic Antibiofilm Activity of Antibiotic-Loaded Bone Cements against Gram-Negative Bacteria
Antibiotics (Basel) . 2022 Jan 21;11(2):137. doi: 10.3390/antibiotics11020137.
free access international
Gram-negative bacilli can be responsible for prosthetic joint infection (PJI) even if staphylococci are the main involved pathogens. Gram-negative PJIs (GN-PJI) are considered difficult-to-treat infections due to the increase in antimicrobial resistance and biofilm formation. To minimize the risk of infection in cases of arthroplasties with cemented prosthesis, bone cement can be loaded with antibiotics, especially gentamicin. In this study,

2021

Septic Arthritis of Facet Joint in Children: A Systematic Review and a 10-year Consecutive Case Series.
Pediatr Infect Dis J . 2021 May 1;40(5):411-417.
international
Background:  Due to the low resolution of historical imaging technologies, descriptions of Septic Arthritis of Facet Joint (SAFJ) in children are scarce, though severe cases are known. We first aimed to estimate the incidence rate of SAFJ in children; we further aimed to specify SAFJ clinical, imaging and laboratory findings, and identify avenues for appropriate management. Methods:  A 10-year consecutive
Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics? : a multicentre observational study
Bone Joint J . 2022 Jan;104-B(1):183-188. doi: 10.1302/0301-620X.104B1.BJJ-2021-0693.R2.
international
Aims: The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. Methods: A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic
Past and Future of Phage Therapy and Phage-Derived Proteins in Patients with Bone and Joint Infection
Viruses 2021, 13, 2414. https://doi.org/10.3390/v13122414
free access international
Phage-derived therapies comprise phage therapy and the use of phage-derived proteins as anti-bacterial therapy. Bacteriophages are natural viruses that target specific bacteria. They were proposed to be used to treat bacterial infections in the 1920s, before the discovery and widespread over-commercialized use of antibiotics. Phage therapy was totally abandoned in Western countries, whereas it is still used in Poland, Georgia
Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin‑rifampin treatment and complex reconstruction were needed for the cure
Arthroplasty (2021) 3:43 https://doi.org/10.1186/s42836-021-00097-1
free access international
Background: Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii, a strictly intracellular pathogen that can cause acute and chronic infection. Chronic Q fever can occur in immunocompetent as well as in immunocompromised hosts, as a persistent localized infection. The main localizations are endocardial, vascular and, less frequently, osteoarticular. The most frequent osteoarticular form is spondyliscitis. Recommended
Cost of off-label antibiotic therapy for bone and joint infections: a 6-year prospective monocentric observational cohort study in a referral centre for management of complex osteo-articular infections
J. Bone Joint Infect., 6, 337–346, 2021
free access international
Introduction: Costs related to bone and joint infection (BJI) management are increasing worldwide, particularly due to the growing use of off-label antibiotics that are expensive treatments (ETs), in conjunction with increasing incidence of multi-drug-resistant pathogens. The aim of this study was to evaluate the whole costs related to these treatments during the patient route, including those attributed to the rehabilitation
Arthroscopic “Debridement and Implant Retention” With Local Administration of Exebacase (Lysin CF-301) Followed by Suppressive Tedizolid as Salvage Therapy in Elderly Patients for Relapsing Multidrug-Resistant S. epidermidis Prosthetic Knee Infection
Front Med (Lausanne). 2021 May 14;8:550853. doi: 10.3389/fmed.2021.550853. eCollection 2021.
international
Exebacase, a recombinantly produced lysin has recently (i) reported proof-of-concept data from a phase II study in S. aureus bacteremia and (ii) demonstrated antibiofilm activity in vitro against S. epidermidis. In patients with relapsing multidrug-resistant (MDR) S. epidermidis prosthetic knee infection (PKI), the only surgical option is prosthesis exchange. In elderly patients who have undergone several revisions, prosthesis explantation could be associated with definitive loss of function
Lysosomal alkalization to potentiate eradication of intra-osteoblastic Staphylococcus aureus in the bone and joint infection setting.
Clin Microbiol Infect. 2021 May 4:S1198-743X(21)00218-4. doi: 10.1016/j.cmi.2021.04.030.
international
Objectives: Beyond intracellular penetration, acidic lysosomal pH might affect the intracellular activity of some antimicrobials. This study evaluated the ability of lysosomotropic alkalizing agents to potentiate the antimicrobial eradication of an intra-osteoblastic Staphylococcus aureus reservoir in the setting of bone and joint infection (BJI). Methods: MICs of 16 anti-staphylococcal molecules active against methicillin-sensitive S. aureus (MSSA) were evaluated at pH
Adherence to oral antibiotic therapy in patients with bone and joint infection: A pilot study
Infect Dis Now. 2021 Jun;51(4):334-339. doi: 10.1016/j.idnow.2020.10.007. Epub 2020 Dec 30.
free access international
Objectives: The management of bone and joint infections (BJI) is complex and requires prolonged antimicrobial therapy. Few data exist on adherence to anti-infectious treatment other than HIV, and none on BJI, even though compliance is considered as a major determinant of clinical outcome. This work aimed at evaluating adherence to oral antimicrobial treatment in patients with BJI. Patients and methods:
Economic study of 2-stage exchange in patients with knee or hip prosthetic joint infection managed in a reference center in France: time to use innovative(s) intervention(s) at the time of reimplantation to reduce the risk of superinfection
Front. Med., 10 May 2021 | https://doi.org/10.3389/fmed.2021.552669
free access international
Objective: Chronic prosthetic joint infections (PJI) are serious complications in arthroplasty leading to prosthesis exchange and potential significant costs for health systems, especially if a subsequent new infection occurs. This study assessed the cost of chronic PJI managed with 2-stage exchange at the Lyon University Hospital, CRIOAc Lyon reference center, France. A threshold analysis was then undertaken to determine the
Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization
BMC Infect Dis. 2021 May 1;21(1):401. doi: 10.1186/s12879-021-06075-x.
free access international
Background: Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate
Pharmacokinetic/Pharmacodynamic Dosage Individualization of Suppressive Beta-Lactam Therapy Administered by Subcutaneous Route in Patients With Prosthetic Joint Infection
Front Med (Lausanne). 2021 Mar 31;8:583086. doi: 10.3389/fmed.2021.583086. eCollection 2021.
free access international
Suppressive parenteral antibiotic therapy with beta-lactams may be necessary in patients with Gram-negative bone and joint infection (BJI). Subcutaneous drug administration can facilitate this therapy in outpatient setting, but there is limited information about this practice. We have developed an original approach for drug dosing in this context, based on therapeutic drug monitoring (TDM) and pharmacokinetic/pharmacodynamic (PK/PD) principles. The objective

2020

Septic Arthritis of Facet Joint in Children: A Systematic Review and a 10-year Consecutive Case Series
Pediatr Infect Dis J . 2020 Dec 23. doi: 10.1097/INF.0000000000003031. Online ahead of print.
international
Background: Due to the low resolution of historical imaging technologies, descriptions of Septic Arthritis of Facet Joint (SAFJ) in children are scarce, though severe cases are known. We first aimed to estimate the incidence rate of SAFJ in children; we further aimed to specify SAFJ clinical, imaging and laboratory findings, and identify avenues for appropriate management. Methods: A 10-year consecutive
Population pharmacokinetics of daptomycin in patients with bone and joint infection: minimal effect of rifampicin co-administration and confirmation of a sex difference
J Antimicrob Chemother. 2021 Apr 13;76(5):1250-1257. doi: 10.1093/jac/dkab006.
international
Background: Daptomycin is increasingly used in the treatment of bone and joint infection (BJI), but its pharmacokinetics (PK) and dosage requirements have not been thoroughly investigated in this indication. Daptomycin may be co-administered with rifampicin, which raises questions about a potential drug interaction. Objectives: To investigate the population PK and dosage requirements of daptomycin in patients with BJI, and examine
Antibiotics in Bone Cements Used for Prosthesis Fixation: An Efficient Way to Prevent Staphylococcus aureus and Staphylococcus epidermidis Prosthetic Joint Infection
Front Med (Lausanne) . 2021 Jan 20;7:576231. doi: 10.3389/fmed.2020.576231. eCollection 2020.
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Prosthetic joint infections (PJIs) are one of the most frequent reasons for arthroplasty revision. These infections are mostly associated with the formation of biofilm, notably by staphylococci, such as Staphylococcus aureus and Staphylococcus epidermidis. To minimize the rates of PJIs following primary or revision total joint arthroplasty, antibiotic-loaded bone cements (ALBCs) can be used for prosthesis fixation. However, its use is still debated.
Bone and Joint Infection Involving Corynebacterium spp.: From Clinical Features to Pathophysiological Pathways
Front Med (Lausanne) . 2021 Jan 21;7:539501. doi: 10.3389/fmed.2020.539501. eCollection 2020.
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Introduction: Corynebacteria represent often-neglected etiological agents of post-traumatic and/or post-operative bone and joint infection (BJI). We describe here clinical characteristics and bacteriological determinants of this condition. Methods: A retrospective cohort study described characteristics, outcome and determinants of treatment failure of all patients with proven Corynebacterium spp. BJI (i.e., ≥2 culture-positive gold-standard samples). Available strains were further characterized regarding their antibiotic susceptibilies, abilities
Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections
Front Med (Lausanne) . 2020 Dec 23;7:585658. doi: 10.3389/fmed.2020.585658. eCollection 2020.
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Since the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has been a viable option for patients who require intravenous antibiotics when hospitalization is not warranted. While the benefits of OPAT as a measure to improve the efficiency of healthcare delivery (i.e., reduced hospital days) and patient satisfaction are well-documented, OPAT is associated with a number of challenges, including line complications and
Epidemiology of complex bone and joint infections in France using a national registry: The CRIOAc network
J Infect . 2020 Dec 19;S0163-4453(20)30771-4. doi: 10.1016/j.jinf.2020.12.010.
international
Objectives: In France, a network of reference centers for bone and joint infections (BJI) was created in 2008, focused on the management of complex BJI (previous failure, difficult-to-treat microorganisms, heavy comorbidities or surgical procedures). A national registry was implemented from 2012, collecting decisions advised in periodic multidisciplinary meetings. We present here an epidemiological overview. Methods: All consecutive adult patients presented
Tolerance of Prolonged Oral Tedizolid for Prosthetic Joint Infections: Results of a Multicentre Prospective Study
Antibiotics (Basel) . 2020 Dec 23;10(1):E4. doi: 10.3390/antibiotics10010004.
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Objectives: Data on clinical and biological tolerance of tedizolid (TZD) prolonged therapy are lacking. Methods: We conducted a prospective multicentre study including patients with prosthetic joint infections (PJIs) who were treated for at least 6 weeks but not more than 12 weeks. Results: Thirty-three adult patients of mean age 73.3 ± 10.5 years, with PJI including hip (n = 19), knee
Anemia before reimplantation surgery : An overlooked modifiable risk factor of septic revision knee arthroplasty failure
SICOT J . 2020;6:47. doi: 10.1051/sicotj/2020046. Epub 2020 Dec 11.
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Introduction: Preoperative anemia in patients undergoing a two-stage septic revision arthroplasty may be a factor of reinfection, even in the presence of aggressive antimicrobial therapy. Patient Blood Management (PBM) in such patients is challenging. We evaluate the impact of anemia existing before re-implantation on a failure rate after two-stage septic total knee arthroplasty (rTKA), and explore feasibility of a PBM
Phage Therapy as Adjuvant to Conservative Surgery and Antibiotics to Salvage Patients With Relapsing S. aureus Prosthetic Knee Infection
Front. Med., 16 November 2020 | https://doi.org/10.3389/fmed.2020.570572
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Objectives: To report the management of three consecutive patients with relapsing Staphylococcus aureus prosthetic knee infection (PKI) for whom explantation was not feasible who received a phage therapy during a “Debridement Antibiotics and Implant Retention” (DAIR) procedure followed by suppressive antimicrobial therapy. Methods: Each case was discussed individually in our reference center and with the French National Agency (ANSM). The lytic activity
Computerized registry as a potential tool for surveillance and management of complex bone and joint infections in France: French registry of complex bone and joint infections.
Bone Joint Res . 2020 Oct 10;9(10):635-644. doi: 10.1302/2046-3758.910.BJR-2019-0362.R1. eCollection 2020 Oct.
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Aims: The French registry for complex bone and joint infections (C-BJIs) was created in 2012 in order to facilitate a homogeneous management of patients presented for multidisciplinary advice in referral centres for C-BJI, to monitor their activity and to produce epidemiological data. We aimed here to present the genesis and characteristics of this national registry and provide the analysis of
Pseudomonas aeruginosa Implant-Associated Bone and Joint Infections: Experience in a Regional Reference Center in France
Front. Med., 26 October 2020| https://doi.org/10.3389/fmed.2020.513242
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Background: P. aeruginosa implant-associated bone and joint infections (BJI) is considered to be one of the most difficult to treat BJI. The data focusing specifically on this pathogen are sparse, and it seems difficult to extrapolate the results obtained with Enterobacteriaceae. Methods: We performed a retrospective observation study of all P. aeruginosa implant-associated BJI diagnosed at our institution from 2011
Why Reintervention After Total Knee Arthroplasty Fails? A Consecutive Cohort of 1170 Surgeries
J Arthroplasty . 2020 Sep;35(9):2550-2560. doi: 10.1016/j.arth.2020.04.043. Epub 2020 Apr 21.
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Background: The aim of this study was to analyze why contemporary reintervention after total knee arthroplasty (RiTKA) fails. Methods: Between January 2006 and December 2010, from a multicenter cohort of 1170 RiTKAs, we assessed all failures of RiTKA requiring additional surgery. All indications for the index reintervention were included. The minimum follow-up period was 3 years. Results: A total of
Medical innovations to maintain the function in patients with chronic PJI for whom explantation is not desirable: a pathophysiology-, multidisciplinary-, and experience-based approach
SICOT J . 2020;6:26. doi: 10.1051/sicotj/2020021. Epub 2020 Jul 7.
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Introduction: PJI is the most dramatic complication after joint arthroplasty. In patients with chronic infection, prosthesis exchange is in theory the rule. However, this surgical approach is sometimes not desirable especially in elderly patients with multiple comorbidities, as it could be associated with a dramatic loss of function, reduction of the bone stock, fracture, or peroperative death. We propose here
Plasma Cell Infiltration on Histopathological Samples of Chronic Bone and Joint Infections due to Cutibacterium acnes: A series of 21 Cases
J Bone Jt Infect . 2020 Jun 23;5(4):205-211. doi: 10.7150/jbji.46187. eCollection 2020.
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Introduction: Histopathological definition of bone and joint infection (BJI) is based on Mirra’s criterion (≥ 5 polymorphonuclears (PMNs) per field in 5 high power fields (HPFs)). However, this definition does not seem appropriate for chronic BJIs caused by slow-growing germs such as Cutibacterium acnes (C. acnes). The aim of this study was to confirm that Mirra’s criterion is not adequate
Hematogenous osteomyelitis in childhood can relapse many years later into adulthood
Medicine (Baltimore) . 2020 May;99(20):e19617.
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To describe the epidemiological, clinical, laboratory, and radiological features and the management of adult patients who experienced a relapse between 2003 and 2015 of an acute hematogenous osteomyelitis acquired in childhood. A retrospective multicentric cohort study was conducted in 5 centers in France. Thirty-seven patients were included. The median age was 40 years (28–56), and 26 (70%) were male. The
Tolerance and Microbiological Efficacy of Cefepime or piperacillin/tazobactam in Combination With Vancomycin as Empirical Antimicrobial Therapy of Prosthetic Joint Infection: A Propensity-Matched Cohort Study
J Antimicrob Chemother . 2020 May 14;dkaa166. doi: 10.1093/jac/dkaa166.
international
Background: The use of piperacillin/tazobactam with vancomycin as empirical antimicrobial therapy (EAT) for prosthetic joint infection (PJI) has been associated with an increased risk of acute kidney injury (AKI), leading us to propose cefepime as an alternative since 2017 in our reference centre. Objectives: To compare microbiological efficacy and tolerance of these two EAT strategies. Methods: All adult patients with
Efficacy of Bacteriophages in a Staphylococcus aureus Nondiabetic or Diabetic Foot Infection Murine Model
Antimicrob Agents Chemother. 2020 Jan 27;64(2). pii: e01870-19. doi: 10.1128/AAC.01870-19. Print 2020 Jan 27.
international
This study investigated the in vivo efficacy of three bacteriophages combined compared with linezolid in two mouse models (nondiabetic and diabetic) of Staphylococcus aureus foot infection. In both models, a single injection of bacteriophages in the hindpaw showed significant antibacterial efficacy. Linezolid was as effective as bacteriophages in nondiabetic animals but ineffective in diabetic animals. These findings further support preclinical and clinical studies for
Evaluation of the Activity of a Combination of Three Bacteriophages Alone or in Association with Antibiotics on Staphylococcus aureus Embedded in Biofilm or Internalized in Osteoblasts
Antimicrob Agents Chemother. 2020 Feb 21;64(3). pii: e02231-19. doi: 10.1128/AAC.02231-19. Print 2020 Feb 21.
international
Staphylococcus aureus is responsible for difficult-to-treat bone and joint infections (BJIs). This is related to its ability to form biofilm and to be internalized and persist inside osteoblasts. Recently, bacteriophage therapy has emerged as a promising option to improve treatment of such infections, but data on its activity against the specific bacterial lifestyles presented above remain scarce. We evaluated the activity
Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with a debridement, antibiotics and implant retention (DAIR): a retrospective multicenter study in France
J Bone Jt Infect. 2020 Feb 10;5(1):28-34. doi: 10.7150/jbji.40333. eCollection 2020.
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Introduction: In patients undergoing a « debridement, antibiotics, and implant retention » (DAIR) procedure for acute staphylococcal prosthetic joint infection (PJI), post-operative treatment with rifampin has been associated with a higher probability of success.(1,2) However, it is not known whether it is the total dose, delay of introduction or length of therapy with rifampin that is most strongly associated with
Antibiofilm and intraosteoblastic activities of rifamycins against Staphylococcus aureus: promising in vitro profile of rifabutin
J Antimicrob Chemother. 2020 Mar 3. pii: dkaa061. doi: 10.1093/jac/dkaa061
international
BACKGROUND: Targeting biofilm-embedded and intraosteoblastic Staphylococcus aureus, rifampicin gained a pivotal role in bone and joint infection (BJI) treatment. Two other rifamycins, rifabutin and rifapentine, may represent better-tolerated alternatives, but their activity against bacterial reservoirs associated with BJI chronicity has never been evaluated. OBJECTIVES: To evaluate the activities of rifampicin, rifabutin and rifapentine in osteoblast infection models. METHODS: Using three

2019

The CRIOAc healthcare network in France: A nationwide Health Ministry program to improve the management of bone and joint infection
Orthop Traumatol Surg Res. 2019 Feb;105(1):185-190. doi: 10.1016/j.otsr.2018.09.016. Epub 2018 Nov 6.
international
Background Bone and joint infections (BJIs) have a major clinical and economic impact in industrializedcountries. Its management requires a multidisciplinary approach, and a great experience for the mostcomplicated cases to limit treatment failure, motor disability and amputation risk. To our best knowledgethere is not currently national specific organization dedicated to manage BJI. Is it possible to build at anational level,
Subcutaneous suppressive antibiotic therapy for bone and joint infections: safety and outcome in a cohort of 10 patients
J Antimicrob Chemother 2019; 74: 2060–2064 doi:10.1093/jac/dkz104
international
Background Optimal treatment of prosthetic joint infection and chronic osteomyelitis consists of surgical removal of biofilm-embedded bacteria, followed by a 6–12 week course of antimicrobial therapy. However, when optimal surgery is not feasible, oral prolonged suppressive antibiotic therapy (PSAT) is recommended to prevent prosthesis loosening and/or relapse of infection. Since 2010, we have used infection salvage therapy using offlabel subcutaneous
Subcutaneous teicoplanin in staphylococcal bone and joint infections
Med Mal Infect. 2019 Nov 3. pii: S0399-077X(18)30695-4. doi: 10.1016/j.medmal.2019.10.002.
international
Objective We aimed to describe the use of subcutaneous teicoplanin as an alternative for the treatment of staphylococcal bone and joint infections. Methods A retrospective multicentric cohort (2002–2015) was conducted with patients receiving sub-cutaneous teicoplanin for a staphylococcal bone and joint infection.Results. – Forty patients were assessed. A median loading dose of 9.4 mg/kg/12 h (IQR, 6.1–13.1)was administered to 35
Pubic osteomyelitis: Epidemiology and factors associated with treatment failure
Med Mal Infect. 2019 Nov 18. pii: S0399-077X(19)31064-9. doi: 10.1016/j.medmal.2019.10.012.
international
Objective To describe the epidemiology of pubic osteomyelitis (PO) and to look for factors associatedwith treatment failure. Method Retrospective study describing PO according to outcome: success or failure of initial man-agement. Factors associated with failure determined by univariate Cox analysis. Kaplan-Meier curvecompared between groups by log-rank test.Results. – Twenty-five patients were included over a 13-year period; 24% of PO had
Interaction Between Staphylococcal Biofilm and Bone: How Does the Presence of Biofilm Promote Prosthesis Loosening?
Send to Front Microbiol. 2019 Jul 17;10:1602. doi: 10.3389/fmicb.2019.01602. eCollection 2019.
free access international
With the aging of population, the number of indications for total joint replacement is continuously increasing. However, prosthesis loosening can happen and is related to two major mechanisms: (1) aseptic loosening due to prosthesis micromotion and/or corrosion and release of wear particles from the different components of the implanted material and (2) septic loosening due to chronic prosthetic joint infection
Genetic polymorphisms of ABCB1 (P-glycoprotein) as a covariate influencing daptomycin pharmacokinetics: a population analysis in patients with bone and joint infection
J Antimicrob Chemother 2019; 74: 1012–1020 doi:10.1093/jac/dky541
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Background: Daptomycin has been recognized as a therapeutic option for the treatment of bone and joint infection (BJI). Gene polymorphism of ABCB1, the gene encoding P-glycoprotein (P-gp), may influence daptomycin pharmacokinetics (PK). Objectives: We aimed to examine population PK of daptomycin and its determinants, including genetic factors, in patients with BJI. Patients and methods: We analysed data from patients who
Evaluation of the ability of linezolid and tedizolid to eradicate intraosteoblastic and biofilm-embedded Staphylococcus aureus in the bone and joint infection setting
J Antimicrob Chemother 2019; 74: 625–632 doi:10.1093/jac/dky473
international
Objectives: Prolonged use of linezolid for bone and joint infection (BJI) is limited by its long-term toxicity. The better safety profile of tedizolid, a recently developed oxazolidinone, could offer an alternative. However, its efficacy against biofilm-embedded and intracellular Staphylococcus aureus, the two main bacterial reservoirs associated with BJI chronicity, is unknown. Methods: Using three S. aureus strains (6850 and two
Efficacy of bacteriophages in a S. aureus non-diabetic or diabetic foot infection murine model
Antimicrob Agents Chemother. 2019 Nov 11. pii: AAC.01870-19. doi: 10.1128/AAC.01870-19
international
This study investigated the in vivo efficiency of three combined bacteriophages compared to linezolid, in two mouse models (non-diabetic or diabetic) of S. aureus foot infection. In both models, a single injection of bacteriophages showed a significant antibacterial efficacy in the hindpaw. Linezolid was as effective as bacteriophages in non-diabetic animals but ineffective in diabetic animals. These findings support further preclinical and clinical studies
Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study
Clin Microbiol Infect . 2019 Mar;25(3):353-358. doi: 10.1016/j.cmi.2018.04.035. Epub 2018 May 25.
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OBJECTIVES: The high microbiologic diversity encountered in prosthetic joint infection (PJI) makes the choice of empirical antimicrobial therapies challenging, especially in cases of implant retention or one-stage exchange. Despite the risk of dysbiosis and toxicity, the combination of vancomycin with a broad-spectrum β-lactam is currently recommended in all cases, even if Gram-negative bacilli (GNB) might be less represented in late PJI. In this context, this study aimed to

2018

Innovations et prise en charge des infections ostéoarticulaires : Des thérapies anti-infectieuses pour maintenir la fonction !
E-Mem Acad Natle Chir. 2018;17(4):007.
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Objectif : décrire les approches innovantes qui peuvent contribuer à améliorer le pronostic des infections ostéoarticulaires (IOA). En effet, le l’impact individuel et sociétal des IOA est considérable et largement sous-estimé, en particulier chez les patients souffrant d’une IOA chronique. Méthodes : sur la base des dix ans d’expérience de notre centre régional de référence dédié à la prise en
Cefoxitin: Interesting Perspectives on a Neglected Intravenous Beta-lactam
Mediterr J Infect Microb Antimicrob 2018;7:36. doi: 10.4274/mjima.2018.36
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Cefoxitin is a beta-lactam antibiotic belonging to the cephamycins class, up to now only used in clinical practice for prophylaxis during surgery. Recently, its use has increased due to the spread of infections caused by extended-spectrum beta-lactamase-producing bacteria, particularly urinary tract infections. It has a broad antimicrobial spectrum and is also effective in polymicrobial bone and joint infections or skin
Salvage Debridement, Antibiotics and Implant Retention (“DAIR”) With Local Injection of a Selected Cocktail of Bacteriophages: Is It an Option for an Elderly Patient With Relapsing Staphylococcus aureus Prosthetic-Joint Infection?
Open Forum Infect Dis. 2018 Oct 24;5(11):ofy269. doi: 10.1093/ofid/ofy269. eCollection 2018 Nov
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Local injection of a bacteriophages mix during debridement, antibiotics and implant retention (“DAIR”) was performed to treat a relapsing Staphylococcus aureus chronic prosthetic joint infection (PJI). This salvage treatment was safe and associated with a clinical success. Scientific evaluation of the potential clinical benefit of bacteriophages as antibiofilm treatment in PJI is now feasible and required.
Non-compliance with IDSA guidelines for patients presenting with methicillin-susceptible Staphylococcus aureus prosthetic joint infection is a risk factor for treatment failure
Med Mal Infect. 2018 May;48(3):207-211. doi: 10.1016/j.medmal.2017.09.016. Epub 2017 Nov 6.
international
Objective: The long-term impact of treatment strategies proposed by the IDSA guidelines for patients presenting with methicillin-susceptibleS. aureus (MSSA) prosthetic joint infection (PJI) is not well-known. Patients and methods: Retrospective (2000–2010) cohort study including patients presenting with MSSA hip or knee PJI. A univariate Coxanalysis was performed to determine if the non-compliance with IDSA surgical guidelines was a risk factor
Association between biofilm formation phenotype and clonal lineage in Staphylococcus aureus strains from bone and joint infections
PLoS One. 2018 Aug 30;13(8):e0200064. doi: 10.1371/journal.pone.0200064. eCollection 2018.
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Biofilm formation is a critical virulence factor responsible for treatment failure and chronicity in orthopaedic device-related infections (ODIs) caused by Staphylococcus aureus. Clonal lineages differ in terms of their biofilm forming capacities. The aim of this study was to investigate the correlation between the clonal complex (CC) affiliation and biofilm phenotype of 30 clinical S. aureus isolates responsible of ODI based on i) early biofilm formation using BioFilm Ring Test® and mature biofilm formation using crystal violet assays, ii) biofilm composition using DNase and proteinase
Prospective Cohort Study of the Tolerability of Prosthetic Joint Infection Empirical Antimicrobial Therapy
Antimicrob Agents Chemother. 2018 Sep 24;62(10). pii: e00163-18. doi: 10.1128/AAC.00163-18. Print 2018 Oct.
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The empirical use of vancomycin in combination with a broad-spectrum beta-lactam is currently recommended after the initial surgery of prosthetic joint infection (PJI). However, the tolerability of such high-dose intravenous regimens is poorly known. Adult patients receiving an empirical antimicrobial therapy (EAT) for a PJI were enrolled in a prospective cohort study (2011 to 2016). EAT-related adverse events (AE) were described according to the common terminology criteria for AE (CTCAE), and their determinants were assessed
Prolonged Cefoxitin Infusion Using Mobile Elastomeric Infusors In Outpatients With Bone And Joint Infection
J Bone Jt Infect. 2018 Sep 7;3(4):182-186. doi: 10.7150/jbji.27718. eCollection 2018.
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We reviewed all outpatients with bone and joint infection treated with cefoxitin in continuous intravenous infusion using mobile elastomeric infusors in our regional reference center between 2014 and 2017. The stability of cefoxitin provides an interesting and well-tolerated alternative for continuous infusion in outpatients with polymicrobial bone and joint infection.
Erysipelas or cellulitis with a prosthetic joint in situ
J Bone Jt Infect. 2018 Oct 4;3(4):222-225. doi: 10.7150/jbji.25519. eCollection 2018.
free access international
We describe a case of a 60-year old male who developed an acute prosthetic joint infection (PJI) of the knee, secondary to erysipelas of the lower leg due to beta-hemolytic Group G streptococci. As it is unknown how often this phenomenon occurs in patients with prosthetic implants and which patients are most prone to develop this complication, we analyzed: i) the incidence of
Outpatient parenteral antibiotic therapy: Evaluation of practices and limits of use in rural areas in France
Med Mal Infect. 2018 Mar;48(2):130-135. doi: 10.1016/j.medmal.2017.09.008. Epub 2017 Oct 16.
international
OBJECTIVES To evaluate outpatient parenteral antibiotic therapy (OPAT) practices in a French rural area. MATERIAL AND METHODS Descriptive study assessing knowledge, practices, and limitations of OPAT use among hospital practitioners (HP), family physicians (FP), and private nurses (PN). RESULTS OPAT (mainly ceftriaxone and penicillins) was used by 69.6%, 73.3%, and 97.7% of the 23 HPs, 45 FPs, and 46 PNs mostly
Population pharmacokinetics and probability of target attainment of ertapenem administered by subcutaneous or intravenous route in patients with bone and joint infection
J Antimicrob Chemother. 2018 Apr 1;73(4):987-994. doi: 10.1093/jac/dkx477.
international
BACKGROUND: Ertapenem is a therapeutic option in patients with Gram-negative bone and joint infection (BJI). The subcutaneous (sc) route of administration is convenient in the outpatient setting and has shown favourable pharmacokinetics (PK), but available data on ertapenem are limited. OBJECTIVES: To perform population PK analysis and pharmacokinetic/pharmacodynamic (PK/PD) simulation of ertapenem administered by the intravenous (iv) or sc route to patients with
Pressure ulcer-related pelvic osteomyelitis: evaluation of a two-stage surgical strategy (debridement, negative pressure therapy and flap coverage) with prolonged antimicrobial therapy
BMC Infect Dis. 2018 Apr 10;18(1):166. doi: 10.1186/s12879-018-3076-y
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Background A two-stage surgical strategy (debridement-negative pressure therapy (NPT) and flap coverage) with prolonged antimicrobial therapy is usually proposed in pressure ulcer-related pelvic osteomyelitis but has not been widely evaluated. Methods Adult patients with pressure ulcer-related pelvic osteomyelitis treated by a two-stage surgical strategy were included in a retrospective cohort study. Determinants of superinfection (i.e., additional microbiologicalfindings at reconstruction) and
Salvage Debridement, Antibiotics and Implant Retention (“DAIR”) With Local Injection of a Selected Cocktail of Bacteriophages: Is It an Option for an Elderly Patient With Relapsing Staphylococcus aureus Prosthetic-Joint Infection?
Open Forum Infect Dis. 2018 Oct 24;5(11):ofy269. doi: 10.1093/ofid/ofy269. eCollection 2018 Nov.
free access international
Local injection of a bacteriophages mix during debridement, antibiotics and implant retention (“DAIR”) was performed to treat a relapsing Staphylococcus aureus chronic prosthetic joint infection (PJI). This salvage treatment was safe and associated with a clinical success. Scientific evaluation of the potential clinical benefit of bacteriophages as antibiofilm treatment in PJI is now feasible and required.
Relevance of Modified Debridement-Irrigation, Antibiotic Therapy and Implant Retention Protocol for the Management of Surgical Site Infections: A Series of 1694 Instrumented Spinal Surgery.
J Bone Jt Infect. 2018 Dec 24;3(5):266-272. doi: 10.7150/jbji.28765. eCollection 2018.
free access international
Introduction Management of surgical site infections (SSI) after instrumented spinal surgery remains controversial. The debridement-irrigation, antibiotic therapy and implant retention protocol (DAIR protocol) is safe and effective to treat deep SSI occurring within the 3 months after instrumented spinal surgery. Methods This retrospective study describes the outcomes of patients treated over a period of 42 months for deep SSI after

2017

Intraosteoblastic activity of daptomycin in combination with oxacillin and ceftaroline against MSSA and MRSA
J Antimicrob Chemother. 2017 Dec 1;72(12):3353-3356. doi: 10.1093/jac/dkx314.
international
Background: The Staphylococcus aureus intracellular reservoir is associated with bone and joint infection (BJI) chronicity. As daptomycin is increasingly prescribed in BJI, strategies for improving its reduced intracellular activity should be promoted. Objectives: Based on the known in vitro synergy of daptomycin with β-lactams, the aim of the present study was to evaluate the intracellular activity of these combinations in
Clinical metagenomics of bone and joint infections: a proof of concept study
Sci Rep. 2017 Aug 10;7(1):7718. doi: 10.1038/s41598-017-07546-5.
free access international
Bone and joint infections (BJI) are severe infections that require a tailored and protracted antibiotic treatment. Yet, the diagnostic based on culturing samples lacks sensitivity, especially for hardly culturable bacteria. Metagenomic sequencing could potentially address those limitations. Here, we assessed the performances of metagenomic sequencing on 24 BJI samples for the identification of pathogens and the prediction of their antibiotic susceptibility.
The not-so-good prognosis of streptococcal periprosthetic joint infection managed by implant retention: the results of a large multicenter study
Clin Infect Dis. 2017 Jun 15;64(12):1742-1752. doi: 10.1093/cid/cix227.
free access international
Background: Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. Methods: A retrospective, observational, multicenter, international study was performed during 2003–2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The
Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study
Eur J Clin Microbiol Infect Dis. 2017 Sep;36(9):1577-1585. doi: 10.1007/s10096-017-2971-2. Epub 2017 Apr 4.
international
During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed

2016

Diagnostic des infections ostéo-articulaires
Revue Francophone des laboratoires – N° 480 - Mars 2016. Doi : 10.1016/S1773-035X(16)30087-9
international
Le diagnostic microbiologique des infections ostéo-articulaires est complexe et nécessite une collaboration forte entre orthopédistes, infectiologues et biologistes. Il est obligatoire de réaliser des prélèvements dans les conditions les plus strictes d’asepsie au bloc chirurgical avec un acheminement rapide au laboratoire de bactériologie. La multiplication des prélèvements facilite l’interprétation des résultats. Une fois au laboratoire, ces prélèvements doivent être traités
Methicillin-susceptible strains responsible for postoperative orthopedic infection are not selected by the use of cefazolin in prophylaxis
Diagn Microbiol Infect Dis. 2016 Mar;84(3):266-7. doi: 10.1016/j.diagmicrobio.2015.11.013. Epub 2015 Nov 17.
international
Comparison of methicillin-susceptible Staphylococcus aureus (MSSA) isolates responsible for bone and joint infection (BJI, n=73) and nasal colonization (n=57) revealed similar prevalence of β-lactamase (blaZ) type A production, associated with cefazolin hydrolysis, suggesting that blaZ type A-carrying MSSA isolates implicated in postoperative BJI are not selected by cefazolin prophylaxis
Adaptive processes of Staphylococcus aureus isolates during the progression from acute to chronic bone and joint infections in patients
Cell Microbiol. 2016 Oct;18(10):1405-14. doi: 10.1111/cmi.12582. Epub 2016 Apr 1.
international
Staphylococcus aureus bone and joint infection (BJI) is associated with significant rates of chronicity and relapse. In this study, we investigated how S. aureus is able to adapt to the human environment by comparing isolates from single patients with persisting or relapsing BJIs that were recovered during the initial and recurrent BJI episodes. In vitro and in vivo assays and
Pristinamycin in the treatment of MSSA bone and joint infection
J Antimicrob Chemother. 2016 Apr;71(4):1063-70. doi: 10.1093/jac/dkv457. Epub 2016 Jan 21.
international
OBJECTIVES: The aim of this study was to evaluate pristinamycin in the treatment of MSSA bone and joint infection (BJI). PATIENTS AND METHODS: A retrospective, single-centre cohort study (2001-11) investigated outcome in adults receiving pristinamycin for MSSA BJI and pristinamycin-related adverse events (AEs). RESULTS: One hundred and two MSSA BJIs were assessed in 98 patients [chronic infection, 33.3%; and orthopaedic
Teicoplanin-based antimicrobial therapy in Staphylococcus aureus bone and joint infection: tolerance, efficacy and experience with subcutaneous administration
BMC Infect Dis . 2016 Nov 3;16(1):622. doi: 10.1186/s12879-016-1955-7.
free access international
BACKGROUND: Staphylococci represent the first etiologic agents of bone and joint infection (BJI), leading glycopeptides use, especially in case of methicillin-resistance or betalactam intolerance. Teicoplanin may represent an alternative to vancomycin because of its acceptable bone penetration and possible subcutaneous administration. METHODS: Adults receiving teicoplanin for S. aureus BJI were included in a retrospective cohort study investigating intravenous or subcutaneous
Daptomycin > 6 mg/kg/day as salvage therapy in patients with complex bone and joint infection: cohort study in a regional reference center
BMC Infect Dis. 2016 Feb 17;16:83. doi: 10.1186/s12879-016-1420-7.
free access international
BACKGROUND: Even if daptomycin does not have approval for the treatment of bone and joint infections (BJI), the Infectious Diseases Society of America guidelines propose this antibiotic as alternative therapy for prosthetic joint infection. The recommended dose is 6 mg/kg/d, whereas recent data support the use of higher doses in these patients. METHODS: We performed a cohort study including consecutive
Pharmacokinetic Variability of Daptomycin during Prolonged Therapy for Bone and Joint Infections
Antimicrob Agents Chemother. 2016 Apr 22;60(5):3148-51. doi: 10.1128/AAC.02597-15. Print 2016 May.
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The interindividual and intraindividual variabilities in daptomycin pharmacokinetics were investigated in 23 patients (69 pharmacokinetic profiles) who were treated for several months for bone and joint infections. Population daptomycin clearance was significantly influenced by renal function and was significantly higher in male than in female patients. We observed significant intraindividual changes in daptomycin clearance, which were uncorrelated with changes in
Pathophysiological Mechanisms of Staphylococcus Non-aureus Bone and Joint Infection: Interspecies Homogeneity and Specific Behavior of S. pseudintermedius
Front Microbiol. 2016 Jul 12;7:1063. doi: 10.3389/fmicb.2016.01063. eCollection 2016.
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Implicated in more than 60% of bone and joint infections (BJIs), Staphylococci have a particular tropism for osteoarticular tissue and lead to difficult-to-treat clinical infections. To date, Staphylococcus aureus internalization in non-professional phagocytic cells (NPPCs) is a well-explored virulence mechanism involved in BJI chronicity. Conversely, the pathophysiological pathways associated with Staphylococcus non-aureus (SNA) BJIs have scarcely been studied despite their
Rapid bench identification of methicillin-sensitive and methicillin-resistant Staphylococcus aureus: A multicenter comparative evaluation of Alere PBP2a Culture Colony Test (Alere) Versus Slidex MRSA detection (bioMérieux)
Diagn Microbiol Infect Dis. 2016 Aug;85(4):419-21. doi: 10.1016/j.diagmicrobio.2016.04.008. Epub 2016 Apr 12.
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Using 30 clinical isolates of Staphylococcus aureus representative of the most prevalent clones circulating in France, the performance of the Alere™ PBP2a Culture Colony Test (CCT) and the Slidex® MRSA detection kit (SMD) were compared in 5 different labs. CCT demonstrated better performance and was easier to conduct in routine.
Preliminary results of a new antibiotic susceptibility test against biofilm installation in device-associated infections: the Antibiofilmogram®
Pathog Dis. 2016 Aug;74(6). pii: ftw057. doi: 10.1093/femspd/ftw057. Epub 2016 Jun 16.
international
Biofilms are complex communities of microorganisms embedded in an extracellular matrix and adherent to a surface. The development was described as a four-stage process leading to the formation of a mature biofilm which was resistant to immune system and antibiotic actions. In bone and joint infections (BJIs), the formation of biofilms is a leading cause of treatment failure. Here we

2015

Antimicrobial activity against intraosteoblastic Staphylococcus aureus
Antimicrob Agents Chemother. 2015 Apr;59(4):2029-36. doi: 10.1128/AAC.04359-14. Epub 2015 Jan 20.
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Although Staphylococcus aureus persistence in osteoblasts, partly as small-colony variants (SCVs), can contribute to bone and joint infection (BJI) relapses, the intracellular activity of antimicrobials is not currently considered in the choice of treatment strategies for BJI. Here, antistaphylococcal antimicrobials were evaluated for their intraosteoblastic activity and their impact on the intracellular emergence of SCVs in an ex vivo osteoblast
Delta-toxin production deficiency in Staphylococcus aureus: a diagnostic marker of bone and joint infection chronicity linked with osteoblast invasion and biofilm formation
Clin Microbiol Infect. 2015 Jun;21(6):568.e1-11. doi: 10.1016/j.cmi.2015.01.026. Epub 2015 Feb 10.
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Biofilm formation, intra-osteoblastic persistence, small-colony variants (SCVs) and the dysregulation of agr, the major virulence regulon, are possibly involved in staphylococcal bone and joint infection (BJI) pathogenesis. We aimed to investigate the contributions of these mechanisms among a collection of 95 Staphylococcus aureus clinical isolates from 64 acute (67.4%) and 31 chronic (32.6%) first episodes of BJI. The included isolates were compared
Methicillin-susceptible strains responsible for postoperative orthopedic infection are not selected by the use of cefazolin in prophylaxis
Diagn Microbiol Infect Dis. 2016 Mar;84(3):266-7. doi: 10.1016/j.diagmicrobio.2015.11.013. Epub 2015 Nov 17.
international
Comparison of methicillin-susceptible Staphylococcus aureus (MSSA) isolates responsible for bone and joint infection (BJI, n=73) and nasal colonization (n=57) revealed similar prevalence of β-lactamase (blaZ) type A production, associated with cefazolin hydrolysis, suggesting that blaZ type A-carrying MSSA isolates implicated in postoperative BJI are not selected by cefazolin prophylaxis
Dual impact of live Staphylococcus aureus on the osteoclast lineage, leading to increased bone resorption
J Infect Dis. 2015 Feb 15;211(4):571-81. doi: 10.1093/infdis/jiu386. Epub 2014 Jul 8.
international
BACKGROUND: Bone and joint infection, mainly caused by Staphylococcus aureus, is associated with significant morbidity and mortality, characterized by severe inflammation and progressive bone destruction. Studies mostly focused on the interaction between S. aureus and osteoblasts, the bone matrix-forming cells, while interactions between S. aureus and osteoclasts, the only cells known to be able to degrade bone, have been poorly explored. METHODS: We developed an

2014

Management strategies of prosthetic joint infections of the hip
Minerva Ortopedica e Traumatologica 2014 June;65(3):243-9
international
Prosthetic joint infection (PJI) of the hip remains a devastating and costly complication of total hip arthroplasty. The treatment depends on many factors: host comorbidities, the duration of symptoms and the infecting organism. Irrigation and debridement can be performed for acute cases accompanied by modular component exchange. For chronic infections, a single-stage or two-stage revision is possible depending on the
Rapid detection of Staphylococcus aureus and methicillin resistance in bone and joint infection samples: evaluation of the GeneXpert MRSA/SA SSTI assay
Diagn Microbiol Infect Dis . 2014 Mar;78(3):313-5. doi: 10.1016/j.diagmicrobio.2013.11.026. Epub 2013 Dec 6.
international
The GeneXpert MRSA/SA SSTI assay was compared to conventional cultures to detect Staphylococcus aureus and methicillin-resistance from 91 bone and joint infection samples. Sensitivity and specificity were 94.4% and 100%. Three false-positive results were observed, in fact providing from patients known to be infected by S. aureus on the basis of other concomitant osteoarticular samples, which suggests that PCR was
Determinants of methicillin-susceptible Staphylococcus aureus native bone and joint infection treatment failure: a retrospective cohort study.
BMC Infect Dis . 2014 Aug 16;14:443. doi: 10.1186/1471-2334-14-443.
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Background: Although methicillin-susceptible Staphylococcus aureus (MSSA) native bone and joint infection (BJI) constitutes the more frequent clinical entity of BJI, prognostic studies mostly focused on methicillin-resistant S. aureus prosthetic joint infection. We aimed to assess the determinants of native MSSA BJI outcomes. Methods: Retrospective cohort study (2001-2011) of patients admitted in a reference hospital centre for native MSSA BJI. Treatment
Staphylococcus aureus-Related Diabetic Osteomyelitis: Medical or Surgical Management? A French and Spanish Retrospective Cohort
Int J Low Extrem Wounds . 2015 Sep;14(3):284-90.
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Staphylococcus aureus is the main cause of diabetic foot osteomyelitis (DFO) and can be treated medically or by surgery. We investigated the outcome of consecutive patients with a diagnosis of S aureus DFO retrospectively in 4 hospitals according to the type of management, medical (including debridement at bedside) or surgical. The outcome was classified as either favorable or failure (relapse,
Antimicrobial-related Severe Adverse Events During Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus Aureus
Antimicrob Agents Chemother . 2014;58(2):746-55. doi: 10.1128/AAC.02032-13. Epub 2013 Nov 18.
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Prolonged antimicrobial therapy is recommended for methicillin-susceptible Staphylococcus aureus (MSSA) bone and joint infections (BJI), but its safety profile and risk factors for severe adverse events (SAE) in clinical practice are unknown. We addressed these issues in a retrospective cohort study (2001 to 2011) analyzing antimicrobial-related SAE (defined according to the Common Terminology Criteria for Adverse Events) in 200 patients
Methicillin-susceptible Staphylococcus Aureus Clonal Complex 398: High Prevalence and Geographical Heterogeneity in Bone and Joint Infection and Nasal Carriage
Clin Microbiol Infect . 2014 Oct;20(10):O772-5. doi: 10.1111/1469-0691.12567. Epub 2014 Mar 6.
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The prevalence of clonal complex (CC) 398 methicillin-susceptible Staphylococcus aureus (MSSA) was unexpectedly high among bone and joint infections (BJIs) and nasal-colonizing isolates in France, with surprising geographical heterogeneity. With none of the major, most-known staphylococcal virulence genes, MSSA CC398 BJI was associated with lower biological inflammatory syndrome and lower treatment failure rates.
Activation of NK cells in patients with chronic bone and joint infection due to staphylococci expressing or Not the small colony variant phenotype.
Int J Chronic Dis. 2014;2014:280653. doi: 10.1155/2014/280653. Epub 2014 Mar 3.
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Chronic bone and joint infections (BJI) are devastating diseases. Relapses are frequently observed, as some pathogens, especially staphylococci, can persist intracellularly by expressing a particular phenotype called small colony variant (SCV). As natural killer (NK) cells are lymphocytes specialized in the killing of host cells infected by intracellular pathogens, we studied NK cells of patients with chronic BJI due to
Actinomycosis : etiology, clinical features, diagnosis, treatment and management
Infect Drug Resist . 2014 Jul 5;7:183-97. doi: 10.2147/IDR.S39601. eCollection 2014.
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Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. Physicians must be aware of typical clinical presentations (such as cervicofacial actinomycosis following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dental hygiene), but also
Risk factors, diagnosis and management of bone flap osteomyelitis following craniectomy
Journal des Anti-Infectieux - Volume 16, n° 4 - pages 166-174 (décembre 2014)
international
L’ostéite du volet crânien après craniectomie (OVCc) est une infection ostéoarticulaire (IOA) méconnue et il existe peu de données concernant son épidémiologie, ses facteurs de risque, et sa prise en charge. Dans cet article de synthèse, nous reprenons les principales données de la littérature et proposons une stratégie médico-chirurgicale pour la prise en charge des patients présentant une OVCc.