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

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

Atypical Infections in Tsunami Survivors

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

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

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 80.4years, 19 immunosuppressed), in association with 1.5-threemonths 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 sevenyears (range four-20years), 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 PJI

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

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

Les infections de prothèses vasculaires (aspects diagnostiques, thérapeutiques et pronostiques)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Periprosthetic Joint Infections: Clinical and Bench Research

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

Tolérance de l'association Cefepim-fluoroquinolone dans les infections ostéoarticulaires chroniques à Bacilles à gram négatif multirésistants

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les arthrites septiques non gonococciques de l’adulte : aspects pratiques

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

Successful treatment of Candida parapsilosis (fluconazole-resistant) osteomyelitis with caspofungin in a HIV patient

Treating Candida arthritis is challenging. We report a case of Candida parapsilosis arthritis successfully treated with caspofungin. We illustrate the likelihood of severe infections due fluconazole resistant C. parapsilosis after extensive fluconazole use and discuss the role of newer antifungal agents in the treatment of arthritis due to Candida spp