Daptomycin > 6 mg/kg/day as salvage therapy in patients with complex bone and joint infection: cohort study in a regional reference center

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 patients that have received daptomycin >6 mg/kg/d for complex BJI between 2011 and 2013 in a French regional reference center. Factors associated with treatment failure were determined on univariate Cox analysis and Kaplan-Meier curves.Results: Forty-three patients (age, 61 ± 17 years) received a mean dose of 8 ± 0.9 mg/kg/d daptomycin, for a mean 81 ± 59 days (range, 6-303 days). Most had chronic (n = 37, 86 %) implant-associated (n = 37, 86 %) BJI caused by coagulasenegative staphylococci (n = 32, 74 %). A severe adverse event (SAE) occurred in 6 patients (14 %), including 2 cases of eosinophilic pneumonia, concomitant with daptomycin Cmin >24 mg/L. Outcome was favorable in 30 (77 %) of the 39 clinically assessable patients. Predictors for treatment failure were age, non-optimal surgery and daptomycin withdrawal for SAE.Conclusions: Prolonged high-dose daptomycin therapy was effective in patients with complex BJI. However, optimal surgery remains the cornerstone of medico-surgical strategy; and a higher incidence of eosinophilic pneumonia than expected was recorded

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

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 infections involving metallo-beta-lactamase-producing Enterobacterales, successfully treated at our referral center with aztreonam and ceftazidime-avibactam for 12 weeks in continuous infusions through elastomeric infusors

The psychology of passion: A meta-analytical review of a decade of research on intrapersonal outcomes

It is just over a decade since Vallerand et al. (J Personal Soc Psychol 85:756–767, 2003) introduced the dualistic model of passion. In this study, we conduct a meta-analytical review of relationships between Vallerand et al’s two passions (viz. harmonious and obsessive), and intrapersonal outcomes, and test the moderating role of age, gender, domain, and culture. A systematic literature search yielded 94 studies, within which 27 criterion variables were reported. These criterion variables derived from four research areas within the intrapersonal sphere: (a) well-/ill-being, (b) motivation factors, (c) cognitive outcomes and, (d) behaviour and performance. From these areas we retrieved 1308 independent effect sizes and analysed them using random-effects models. Results showed harmonious passion positively corresponded with positive intrapersonal outcomes (e.g., positive affect, flow, performance). Obsessive passion, conversely, showed positive associations with positive and negative

An erupting macrospicule: characteristics derived from SOHO-CDS spectroscopic observations

We report results from the analysis of a sequence of SOHO/CDS observations obtained off-limb in the south polar coronal hole on 6 March 1998. Three successive data sets were obtained with the Normal Incidence Spectrometer (NIS), the first of which showed a jet-like feature visible in the chromospheric and low transition region lines. The morphological characteristics of this feature suggested it was a macrospicule. The two remaining observations of the same region indicated a quiet coronal hole with a density of 108 cm-3 and a temperature rising from $0.95 \times 10^6$ K near the limb to $1.2 \times 10^6$ K at about $4.7 \times 10^4$ km above the limb. These data were averaged and used as “background” for the macrospicule observation. The resulting subtracted spectra showed more details of the feature. In particular, a cloud of plasma was detected at about $3 \times 10^4$ km above the limb. The macrospicule was found to have a density of the order of 1010 cm-3 and a temperature of about $2{-}3 \times 10^5$ K. The initial outflow velocity near the limb was over 80 km s-1. This decreased to a terminal value of 26 km s-1 above about $6 \times 10^4$ km

Pott's disease associated with large and multiple abscesses in a 30-year-old migrant from Chad

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Multifocal melioidosis with femoral osteomyelitis in a healthy 25-year-old traveller

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Implant-associated ESBL-Klebsiella pneumonia producing small colony variant bone and joint infection in a healthy 40-year-old man

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Chronic and severe prosthetic joint infection complicated by amyloid A amyloidosis with renal and bladder impairment

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