ABSTRACT
BACKGROUND AND PURPOSE: There is little published data on the diagnostic and therapeutic management of lower-limb stump infections (excluding toe and forefoot amputations). PATIENTS AND METHODS: We made a retrospective observational study of 72 patients having undergone a major lower-limb amputation for a vascular or traumatic reason, complicated by post-surgical stump infection, between January 1, 2000 and December 31, 2009. RESULTS: Stump infection was diagnosed more than 6weeks after amputation in half of the patients. Staphylococcus was the most frequently isolated bacterium. Ultrasonography and CT scan combined with fistulography were useful to confirm the diagnosis and to determine the extension of infection. Thirty-two patients (44%) needed surgical revision in addition to antibiotic treatment. Patients diagnosed with bone infection more frequently required complementary surgery than those with soft tissue infection (P<0.001). CONCLUSION: The optimal management of this type of infection requires obtaining reliable bacteriological documentation (abscess aspiration in case of soft tissue infection or bone biopsy in case of osteomyelitis) to adapt to the antibiotic treatment. The management should be multidisciplinary (orthopedic or vascular surgeons, rehabilitation specialists, and infectious diseases physicians). Most patients may use prosthesis once the infection is treated.
Subject(s)
Amputation Stumps , Amputation, Surgical , Leg/surgery , Surgical Wound Infection/epidemiology , Abscess/epidemiology , Abscess/microbiology , Abscess/therapy , Adult , Aged , Aged, 80 and over , Algorithms , Amputation, Surgical/rehabilitation , Amputation Stumps/diagnostic imaging , Amputation Stumps/microbiology , Amputation Stumps/surgery , Artificial Limbs , Coinfection , Combined Modality Therapy , Cutaneous Fistula/diagnosis , Cutaneous Fistula/epidemiology , Cutaneous Fistula/microbiology , Cutaneous Fistula/therapy , Debridement , Female , France/epidemiology , Humans , Leg Ulcer/epidemiology , Leg Ulcer/microbiology , Leg Ulcer/therapy , Male , Middle Aged , Osteomyelitis/diagnosis , Osteomyelitis/drug therapy , Osteomyelitis/epidemiology , Osteomyelitis/microbiology , Osteomyelitis/surgery , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/therapy , Radiography , Recurrence , Retrospective Studies , Soft Tissue Infections/diagnosis , Soft Tissue Infections/epidemiology , Soft Tissue Infections/microbiology , Soft Tissue Infections/therapy , Staphylococcal Infections/diagnosis , Staphylococcal Infections/epidemiology , Staphylococcal Infections/therapy , Surgical Wound Infection/diagnosis , Surgical Wound Infection/microbiology , Surgical Wound Infection/therapy , UltrasonographyABSTRACT
The spread of multiresistant Staphylococcus and Enterococcus strains required the development of new drugs. Linezolid is the first molecule of a new antibiotic family, oxazolidinones, with an original mechanism of action. In this general review, the authors first present its antibacterial activity, its pharmacokinetic properties, its therapeutic uses in serious Gram-positive infections, pneumonia, skin and soft tissue infections, and also in other indications. They then explain the rules for administration and tolerability.
