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

Uçkay, İlker; Vernaz, Nathalie; Harbarth, Stéphan Juergen; Stern, Richard; Legout, L.; Vauthey, Laetitia; Ferry, Tristan; Lübbeke, Anne; Assal, Mathieu; Lew, Daniel Pablo; Hoffmeyer, Pierre; Bernard, Louis

doi:10.1016/j.jinf.2009.01.012

Cited by 49 publications

(46 citation statements)

References 26 publications

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“…Since the age and underlying conditions of patients cannot be modified, these results stress the need to develop clinical trials aiming to reduce the treatment duration for these infections. Although our results failed to link the occurrence of SAE with an early referral to an infectious disease specialist, an early interaction between surgeons, microbiologists, and infectious disease clinicians might help reduce the incidence of antimicrobial-related SAE, in addition to being cost-efficient regarding the improvement of antibiotic therapy quality in BJI (21,22). For instance, Pestotnik et al (23) showed a decrease by 30% in the incidence of AE after the application of a computerassisted antimicrobial prescription support based on clinician recommendations.…”

Section: Resultsmentioning

confidence: 63%

Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

Valour

Karsenty

Bouaziz

et al. 2014

Antimicrob Agents Chemother

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Bone and joint infections (BJI), including septic arthritis, osteomyelitis, and orthopedic device-related infections (ODI), constitute difficult-to-treat clinical entities, as they chronically evolve and frequently cause a relapse in infection (1-4). Staphylococcus aureus is the leading cause of BJI, accounting for approximately 50% of cases, and it is particularly associated with treatment failure due to its various virulence factors, including its great ability to form biofilms (5-7). These concerns have led to the recommendation of a prolonged antimicrobial course in S. aureus BJI, frequently in combination to avoid the acquisition of drug resistance, with initial administration via the intravenous route and at a high dosage (8-10). It is well known that the prolonged use of antimicrobial combinations is associated with an increased toxicity risk (11), but only limited and conflicting data are found in the literature concerning the prevalence and predictive factors of antimicrobial-related adverse events (AE) occurring during the treatment of BJI. A recent meta-analysis concluded that the incidences of AE are 16.1% for mild AE and 7.7% for moderate and severe AE (12), but some studies found the incidence of AE can reach rates as high as 50% of the patients (13,14). We aimed to describe the occurrence of and risk factors for antimicrobial-related AE in a retrospective cohort study that included patients admitted to a regional reference center with methicillin-susceptible S. aureus (MSSA) BJI. MATERIALS AND METHODSEthics statements. This study received the approval of the French SouthEast ethics committee with the reference number CAL2011-021. In accordance with French legislation, written informed patient consent was not required for any part of the study.Inclusion criteria and data collection. All patients with MSSA BJI who followed up in our institution between 2001 and 2011 were enrolled in a retrospective cohort study. Patients with diabetic foot-and decubitus ulcer-related BJI were excluded because of the particular pathophysiology proceeded by contiguity with bone exposition and implicating diabetesassociated vascular disease and peripheral neuropathy, leading to a specific management of these infections. For each patient, data were collected from medical records, nursing charts, and biological software in an anonymous standardized case report form.Definitions. BJI diagnosis was based upon the existence of clinical and biological evidences of infection and at least one reliable bacteriological

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Section: Resultsmentioning

confidence: 63%

Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

Valour

Karsenty

Bouaziz

et al. 2014

Antimicrob Agents Chemother

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“…5e9,11,12 Likewise, the choice of the duration and spectrum of antibiotic coverage at our medical center could be biased, as we are infectious diseases consultants specialized in orthopedic infections and experts in antimicrobial stewardship; hence potentially able to streamline the empiric choice basing only on local epidemiological data. 28 iii) We did not use results of sonication, 17 PCR 3 or serology 18 procedures; while these auxiliary techniques are designed to identify pathogens that fail to grown on culture because of prior antibiotic exposure but their usefulness is not entirely clear. For example, in one study done in France, among all culture-negative osteoarticular infections only 9% were PCR-positive.…”

Section: Discussionmentioning

confidence: 99%

Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results

Al-Mayahi

Cian

Lipsky

et al. 2015

Journal of Infection

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Summary Summary: Many physicians and surgeons think that prescribing antibiotics before intraoperative sampling does not alter the microbiological results. Methods: Case-control study of adult patients hospitalized with orthopedic infections. Results: Among 2740 episodes of orthopedic infections, 1167 (43%) had received antibiotic therapy before surgical sampling. Among these, 220 (19%) grew no pathogens while the proportion of culture-negative results in the 2573 who had no preoperative antibiotic therapy was only 6%. By multivariate analyses, pre-operative antibiotic exposure was associated with significantly more culture-negative results (odds ratio 2.8, 95% confidence interval 2.1e3.7), more non-fermenting rods and skin commensals (odds ratio 2.8 and 3.0, respectively). Even a single pre-operative dose of antibiotic was significantly associated with subsequent culture-negative results (19/93 vs. 297/2350; c 2 -test, p Z 0.01) and skin commensals (17/74 vs. 274/2350; p Z 0.01) compared to episodes without preceding prophylaxis. Conclusions: Prior antibiotic use, including single-dose prophylactic administrations, is three-fold associated with culture-negative results, non-fermenting rods and resistant skin commensals.

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“…The Orthopaedic Surgery Service of Geneva University Hospitals performs more than 5,000 operations annually [10]. An intravenous dose of 1.5 g of cefuroxime and preoperative chlorhexidine bathing [11] is standard preoperative prophylaxis.…”

Section: Methodsmentioning

confidence: 99%

“…Antibiotic-related parameters were also assessed. Data concerning infections and antibiotic use were cross-checked by an Infectious Diseases physician (IU) [10,13]. SSI was defined as the presence of pus inside a collection or discharge, or progressing erythema around the incision [8,9].…”

Section: Methodsmentioning

confidence: 99%

Occurrence of fever in the first postoperative week does not help to diagnose infection in clean orthopaedic surgery

Uçkay

Agostinho

Stern

et al. 2010

International Orthopaedics (SICOT)

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Postoperative fever is often misinterpreted as a sign of infection, especially when occurring after the third postoperative day. We assessed the epidemiology of postoperative fever in adult orthopaedic patients and its association with infection. Among 1,073 patients participating in a prospective observational study, 198 (19%) had a postoperative fever (>38°C). Thirteen patients (1.2%) had a surgical site infection and 78 patients (7.3%) had remote bacterial infections during their hospital stay. Including asymptomatic bacteriuria, 174 patients were given antibiotic therapy for a median duration of six days. In multivariate analysis, no clinical parameter was associated with fever, including haematoma (odds ratio 0.9, 95%CI 0.6-1.3), infection (1.6, 0.7-3.7), or antibiotic use (1.6, 0.9-3.0). The maximum temperature on each of the first seven postoperative days did not differ between infected and uninfected patients (Wilcoxon rank-sum tests; p>0.10). We conclude that fever, even up to the seventh postoperative day, is not substantially helpful to distinguish infection from general inflammation in clean orthopaedic surgery.

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

Cited by 49 publications

References 26 publications

Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results

Occurrence of fever in the first postoperative week does not help to diagnose infection in clean orthopaedic surgery

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