No abstract

There is no consensus on the antibiotic therapy for bone infection due to the heterogeneous spectrum of diseases. Most authors suggest different durations of treatment based on pathophysiological considerations. However, adverse effects are related, at least in part, to the duration of treatment. We, therefore, investigated a 6 weeks antibiotic combination therapy for all cases of bone infection. Herewith, we report the results of this therapeutic approach. This is a cohort study including all patients presenting with bone infection, regardless of the mechanism involved. The diagnosis was based on bone biopsy obtained through invasive procedures. Chronic bone infection was defined as a history of disease of over 1 month duration. The duration of clinical follow-up following treatment discontinuation was at least 6 months. Cured bone infection was defined as the absence of relapse after antibiotic discontinuation. One hundred and eighteen patients were included between July 2005 and March 2009; 61 presented with bone infection following prosthetic implant (52%) and the 57 remaining patients had bone infection without foreign material (48%). Surgery was required for 80 patients (68%). Microbial agents were identified in 116/118 patients, with 24 patients presenting with polymicrobial sepsis (20%). The mean duration of antibiotic treatment was 42 +/- 0.2 days and the mean clinical follow-up was 27 +/- 14 months. The treatment success rate was 91.5% (108/118). Six weeks of antimicrobial therapy appears to be effective for nearly all bone infections, regardless of the pathophysiology. These results encourage us to pursue attempts to simplify the management of bone infection without obvious prejudice to the patient.

This registry describes our preliminary experience with a novel introducing‐catheter allowing direct percutaneous introduction of the 6F guiding catheter (G‐C), minimizing the puncture size, preventing vessel scraping, and improving the pushability and torque response of the G‐C. In 1995, 203 patients had sheathless PTCA, using this device. Eighty‐five percent were male. Mean age was 65 ± 10 years. Thirty‐nine percent had stable angina, 35% unstable angina, 7% evolving infarction, and 19% recent infarction. Two hundred fifty‐six lesions were treated (1.26/patient). One hundred eight patients (52%) received one (85%) or more than one (15%) stent. The procedural success rate was 98%. Mean coronary stenosis was 82 ± 10% and decreased to 20 ± 15% after PTCA. No major complication occurred. The guiding catheter was immediately removed in 95% of patients, despite heparinization. No patient required surgery or blood transfusion for vascular complications, and only 7 had minor local complications (3.5%). Sheathless angioplasty provides no technical difficulties and has the same safety and quality as conventional angioplasty using a sheath. Immediate removal of the guiding catheter, without keeping vascular access, has no deleterious effect, allows early mobilization, and may limit the risk of vascular complications. Cathet. Cardiovasc. Diagn. 43:331–335, 1998. © 1998 Wiley‐Liss, Inc.