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1.
J Antimicrob Chemother ; 75(8): 2299-2306, 2020 08 01.
Article in English | MEDLINE | ID: mdl-32407512

ABSTRACT

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 PJI empirically treated with vancomycin+cefepime (n = 89) were enrolled in a prospective observational study and matched with vancomycin+piperacillin/tazobactam-treated historical controls (n = 89) according to a propensity score including age, baseline renal function and concomitant use of other nephrotoxic agents. The two groups were compared using Kaplan-Meier curve analysis, and non-parametric tests regarding the proportion of efficacious empirical regimen and the incidence of empirical therapy-related adverse events (AE). RESULTS: Among 146 (82.0%) documented infections, the EAT was considered efficacious in 77 (98.7%) and 65 (98.5%) of the piperacillin/tazobactam- and cefepime-treated patients, respectively (P = 1.000). The rate of AE, particularly AKI, was significantly higher in the vancomycin+piperacillin/tazobactam group [n = 27 (30.3%) for all AE and 23 (25.8%) for AKI] compared with the vancomycin+cefepime [n = 13 (14.6%) and 6 (6.7%)] group (P = 0.019 and <0.001, respectively), leading to premature EAT discontinuation in 20 (22.5%) and 5 (5.6%) patients (P = 0.002). The two groups were not significantly different regarding their comorbidities, and AKI incidence was not related to vancomycin plasma overexposure. CONCLUSIONS: Based on the susceptibility profile of bacterial isolates from included patients, microbiological efficacy of both strategies was expected to be similar, but vancomycin + cefepime was associated with a significantly lower incidence of AKI.


Subject(s)
Acute Kidney Injury , Anti-Infective Agents , Acute Kidney Injury/chemically induced , Acute Kidney Injury/drug therapy , Adult , Anti-Bacterial Agents/adverse effects , Cefepime , Cohort Studies , Drug Therapy, Combination , Humans , Penicillanic Acid/adverse effects , Piperacillin/adverse effects , Piperacillin, Tazobactam Drug Combination , Retrospective Studies , Vancomycin/adverse effects
3.
Clin Microbiol Infect ; 25(3): 353-358, 2019 Mar.
Article in English | MEDLINE | ID: mdl-29803842

ABSTRACT

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 ß-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 describe the microbiologic epidemiology of PJI according to the chronology of infection. METHODS: This prospective cohort study (2011-2016) evaluated the microbiologic aetiology of 567 PJI according to time of occurrence from prosthesis implantation-early (<3 months), delayed (3-12 months) and late (>12 months)-as well as mechanism of acquisition. RESULTS: Initial microbiologic documentation (n = 511; 90.1%) disclosed 164 (28.9%) Staphylococcus aureus (including 26 (16.1%) methicillin-resistant S. aureus), 162 (28.6%) coagulase-negative staphylococci (including 81 (59.1%) methicillin-resistant coagulase-negative staphylococci), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) streptococci and 60 (10.6%) Cutibacterium acnes. Considering nonhaematogenous late PJI (n = 182), Enterobacteriaceae (n = 7; 3.8%) were less represented than in the first year after implantation (n = 56; 17.2%; p <0.001), without difference regarding nonfermenting GNB (4.6% and 2.7%, respectively). The prevalence of anaerobes (n = 40; 21.9%; including 32 (80.0%) C. acnes) was higher in late PJI (p <0.001). Consequently, a broad-spectrum ß-lactam might be useful in 12 patients (6.6%) with late PJI only compared to 66 patients (20.3%) with early/delayed PJI (p <0.001). CONCLUSIONS: Considering the minority amount of GNB in late postoperative PJI, the empirical use of a broad-spectrum ß-lactam should be reconsidered, especially when a two-stage exchange is planned.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/drug therapy , Arthritis, Infectious/microbiology , Bacterial Physiological Phenomena , Joint Prosthesis/adverse effects , Prosthesis-Related Infections/drug therapy , Prosthesis-Related Infections/microbiology , Aged , Bacteria/growth & development , Female , Humans , Male , Middle Aged , Prospective Studies , Time Factors
4.
J Antimicrob Chemother ; 72(4): 1014-1020, 2017 04 01.
Article in English | MEDLINE | ID: mdl-27999045

ABSTRACT

Objectives: We investigated the epidemiological, clinical, microbiological and genetic characteristics of linezolid-resistant (LZR) Staphylococcus capitis isolates from French ICUs, and compared them with LZR S. capitis isolates from other European countries. Methods: All LZR isolates were subjected to antimicrobial susceptibility testing (AST) and the presence of cfr and optrA genes as well as mutations in the 23S rRNA and ribosomal proteins were investigated using specific PCR with sequencing. The genetic relationship between isolates was investigated using PFGE and WGS. Epidemiological data concerning LZR S. capitis were collected retrospectively in French microbiology laboratories. Results: Twenty-one LZR isolates were studied: 9 from France, 11 from Greece and 1 from Finland. All were resistant to methicillin and aminoglycosides. In addition, this unusual AST profile was identified in S. capitis isolates from seven French hospitals, and represented up to 12% of the S. capitis isolates in one centre. A G2576T mutation in 23S rRNA was identified in all isolates; cfr and optrA genes were absent. All isolates belonged to the same clone on the basis of their PFGE profiles, whatever their geographical origin. WGS found at most 212 SNPs between core genomes of the LZR isolates. Conclusions: We identified and characterized an LZR S. capitis clone disseminated in three European countries, harbouring the same multiple resistance and a G2576T mutation in the 23S rRNA. The possible unrecognized wider distribution of this clone, belonging to a species classically regarded as a low-virulence skin colonizer, is of major concern not least because of the increasing use of oxazolidinones.


Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial , Genotype , Linezolid/pharmacology , Staphylococcal Infections/epidemiology , Staphylococcus/classification , Staphylococcus/drug effects , Adult , Aged , Cluster Analysis , Electrophoresis, Gel, Pulsed-Field , Finland/epidemiology , France/epidemiology , Genes, Bacterial , Genome, Bacterial , Greece/epidemiology , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Molecular Epidemiology , Molecular Typing , Mutation , RNA, Ribosomal, 23S/genetics , Sequence Analysis, DNA , Staphylococcal Infections/microbiology , Staphylococcus/genetics , Staphylococcus/isolation & purification , Young Adult
5.
J Antimicrob Chemother ; 72(2): 372-375, 2017 02.
Article in English | MEDLINE | ID: mdl-27798212

ABSTRACT

BACKGROUND: MRSA is a therapeutic concern worldwide, and a major agent of community-acquired skin and soft tissue infections (CA-SSTIs). While the US epidemiology of MRSA in CA-SSTIs is well described and reports the high prevalence of the USA300 clone, data on the European situation are lacking. OBJECTIVES: To determine the prevalence and clonal characteristics of MRSA in CA-SSTIs in seven European emergency departments. PATIENTS AND METHODS: From April to June 2015, patients presenting to the tertiary hospital emergency department with a Staphylococcus aureus CA-SSTI were prospectively enrolled. S. aureus isolates were characterized by antimicrobial susceptibility testing, detection of Panton-Valentine leucocidin encoding genes and spa-typing, MLST and/or DNA microarray. RESULTS: Two-hundred and five cases of S. aureus-associated CA-SSTIs were included, comprising folliculitis, furuncles, abscesses, paronychia, impetigo, carbuncles and cellulitis. Of the 205 cases, we report an MRSA prevalence rate of 15.1%, with a north (0%) to south (29%) increasing gradient. Fifty-one isolates were Panton-Valentine leucocidin-positive (24.9%), whether MSSA or MRSA, with a heterogeneous distribution between countries. Clonal distribution of MSSA and MRSA showed high diversity, with no predominant circulating clone and no archetypical USA300 CA-MRSA clone. CONCLUSIONS: This original prospective multicentre study highlights stark differences in European MRSA epidemiology compared with the USA, and that the USA300 CA-MRSA clone is not predominant among community-infected patients in Europe.


Subject(s)
Community-Acquired Infections/epidemiology , Emergency Service, Hospital , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Soft Tissue Infections/epidemiology , Staphylococcal Infections/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Bacterial Toxins/genetics , Child , Child, Preschool , Community-Acquired Infections/microbiology , Europe/epidemiology , Exotoxins/genetics , Female , Genotype , Humans , Infant , Leukocidins/genetics , Male , Methicillin-Resistant Staphylococcus aureus/classification , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/genetics , Microarray Analysis , Microbial Sensitivity Tests , Middle Aged , Molecular Epidemiology , Multilocus Sequence Typing , Oligonucleotide Array Sequence Analysis , Prevalence , Prospective Studies , Soft Tissue Infections/microbiology , Staphylococcal Infections/microbiology , Staphylococcal Protein A/genetics , Tertiary Care Centers , Young Adult
6.
Euro Surveill ; 20(23)2015 Jun 11.
Article in English | MEDLINE | ID: mdl-26084314

ABSTRACT

We describe two cases of human infections caused by Staphylococcus aureus clonal complex (CC) 75, also called Staphylococcus argenteus, harbouring the Panton-Valentine leucocidin (PVL). These two sporadic cases were community-acquired, and identified in France in 2014. Both had an epidemiological link with Mayotte, an overseas department of France located in the Indian Ocean off the south-eastern African coast. This report illustrates that, contrary to previous descriptions, S. argenteus can acquire important virulence factors and be responsible for severe infections.


Subject(s)
Community-Acquired Infections , Staphylococcal Infections/diagnosis , Staphylococcus aureus/genetics , Staphylococcus aureus/isolation & purification , Anti-Bacterial Agents/therapeutic use , Bacterial Toxins/genetics , Comoros , Exotoxins/genetics , Female , France , Humans , Infant , Leukocidins/genetics , Male , Polymerase Chain Reaction , Staphylococcal Infections/blood , Staphylococcal Infections/drug therapy , Staphylococcus/drug effects , Staphylococcus aureus/classification , Staphylococcus aureus/drug effects , Treatment Outcome , Young Adult
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