BACKGROUNDBacterial prostatitis can be difficult to treat as more and more bacteria are resistant to fluoroquinolone and/or Sulfamethoxazole-Trimethoprim which are the antibiotics of choice. ...Fosfomycin-Trometamol which is registered for uncomplicated urinary tract infections can be an option when other treatments can't be used. OBJECTIVETo describe a case of prostatitis cured using a prolonged course of Fosfomycin-Trometamol. Patient: A 67 years-old man with a chronic bacterial prostatitis, with recurrences for more than 3 years, due to E. coli was treated with Fosfomycin-Trometamol 3g once a day for a week followed by 3 months of the same dose every two days. Prostatitis was clinically and bacteriologically cured and no relapse occurred after 6 months of follow-up. CONCLUSIONFosfomycin-Trometamol can be a good option for the treatment of bacterial prostatitis when other antibiotics can't be used either for resistance or allergy.
Immunity against
spp. is not well-known for humans.
We've tested T CD8+ lymphocytes in a patient with a chronic prosthetic joint infection due to
spp. to search for a deficit which could have favored ...her infection. As this deficit was found, we've searched for such a deficit in other patients with
spp. Infections, either acute or subacute.
Eight patients were tested and all had a persistent T CD8+ lymphocytes deficit. This is striking as these cells are involved in the response to this type of infection in animal models.
The authors suggest that a deficit in CD8+ T lymphocytes can be one of the causes for the onset of infections with
.
To describe the use of a porous alumina ceramic loaded with antibiotics for the reconstruction of bilateral tibial fractures in a patient who presented with bone loss and infection after a motorcycle ...road injury. A 70-year-old man presented open fractures of his both tibiae (proximal involvement on the right side and diaphyseal on the left side). After initial treatment with multiple débridements and the placement of bilateral external fixators, he had bone loss to both tibiae and had developed infections of both legs with multiple organisms identified ( Stenotrophomonas maltophilia , Enterobacter cloacae , and Pseudomonas aeruginosa ). We used a porous alumina ceramic, designed according to the defects to fill. This ceramic was loaded with antibiotics (gentamicin and vancomycin). The goal was to obtain locally high concentrations of antibiotics to eradicate bacteria that could have remain in the surgical wound. Ceramic parts were placed 4 months after the trauma. Local antibiotic concentrations largely exceeded the pharmacological parameters for antibiotics efficacy. External fixators were removed 3 months after implantation. After a follow-up of more than 1 year, there is no relapse of infection, and the patient resumed walking while ceramic parts were left in place and that bone started colonizing ceramic parts. This ceramic that combines strength and the possibility of antibiotic loading allows thinking of new ways to treat infected fractures with bone loss. Indeed, its mechanical strength provides primary stability, and antibiotics make it possible to secure implantation in an infected area.
Our aim was to determine the impact of antimicrobial stewardship tools (ASTs) and the COVID-19 pandemic on antibiotic consumption (AC). We used the national software Consores
to determine AC in ...DDD/1000 days of hospitalization from 2017 to 2022 in voluntary private hospitals in France. The ASTs considered were: 1. internal guidelines; 2. the list of antibiotics with restricted access; 3. the presence of an antibiotic referent or 4. an ID specialist; and 5. proof of an annual meeting on antimicrobial resistance. Institutions with dedicated units for COVID-19 patients were specified. In 30 institutions, the total AC varied from (means) 390 to 405 DDD/1000 DH from 2017 to 2022. Fluoroquinolones and amoxicillin/clavulanate consumption decreased from 50 to 36 (
= 0.003) and from 112 to 77 (
= 0.025), respectively, but consumption of piperacillin/tazobactam increased from 9 to 21 (
< 0.001). Over the study period, 10 institutions with ≤2 AST had lower AC compared to 20 institutions with ≥3 AST (
< 0.01). COVID-19 units opened in 10 institutions were associated with a trend toward higher macrolide consumption from 15 to 25 from 2017 to 2020 (
= 0.065) and with an acceleration of piperacillin/tazobactam consumption from 2020 to 2022 (
≤ 0.003). Antibiotic consumption in 30 private hospitals in France was inversely related to the number of AST. The COVID-19 pandemic was associated with limited impact on AC, but special attention should be paid to piperacillin/tazobactam consumption.
CONTEXT: To date, there is no gold standard technique for sternum replacement. Current techniques rely on metallic prosthesis, meshes and bars, or bone grafts. However, they have several pitfalls.
...AIMS: The aim of this article is to report the results of sternal replacement with a porous alumina ceramic sternum.
SETTINGS AND DESIGN: Surgeries were performed in two teaching hospitals in France.
METHODS: We designed a porous alumina ceramic prosthesis which possesses interesting characteristics for this surgery such as great biocompatibility, a certain level of bacterial resistance, radiolucency, and compatibility with radiotherapy. The implant is stitched to the ribs with suture thread and does not require osteosynthesis material.
RESULTS: Six patients with a mean age of 60.6 years received this prosthesis. Indication was tumor in five cases and mediastinitis in one case. The mean follow-up is 20 months (3-37 months). No major complication occurred and healing was fine for all patients. Patients did not complain of breathing discomfort or pain related to the prosthesis.
CONCLUSIONS: This new technique is promising even if there are only six patients in this study.
We report two cases of endocarditis due to Moraxella osloensis. Only one previous case of such infection has been described. These infections occurred in immunocompromised patients (B-cell chronic ...lymphocytic leukaemia and kidney graft associated with Hodgkin's disease) and both patients had a favourable outcome with a complete cure of their infectious endocarditis. This bacterium could be an emerging pathogen revealed by MALDI-TOF. Indeed, its characterisation within the Moraxella group by use of biochemistry-based methods is difficult. Moreover, this strain could be particularly involved in immunocompromised patients.
Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin ...(IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%,
< 0.001) and DC (19.4% vs. 5.8%,
< 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months,
= 0.02). Arthralgia (OR 4.90,
= 0.0012), DO of PET/CT (OR 4.09,
= 0.016), CRP > 30 mg/L (OR 3.70,
= 0.033), and chills (OR 3.06,
= 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.
Summary Background Duration of treatment for patients with vertebral osteomyelitis is mainly based on expert recommendation rather than evidence. We aimed to establish whether 6 weeks of antibiotic ...treatment is non-inferior to 12 weeks in patients with pyogenic vertebral osteomyelitis. Methods In this open-label, non-inferiority, randomised controlled trial, we enrolled patients aged 18 years or older with microbiologically confirmed pyogenic vertebral osteomyelitis and typical radiological features from 71 medical care centres across France. Patients were randomly assigned to either 6 weeks or 12 weeks of antibiotic treatment (physician's choice in accordance with French guidelines) by a computer-generated randomisation list of permuted blocks, stratified by centre. The primary endpoint was the proportion of patients who were classified as cured at 1 year by a masked independent validation committee, analysed by intention to treat. Non-inferiority would be declared if the proportion of cured patients assigned to 6 weeks of treatment was not less than the proportion of cured patients assigned to 12 weeks of treatment, within statistical variability, by an absolute margin of 10%. This trial is registered with EudraCT, number 2006-000951-18, and Clinical Trials.gov , number NCT00764114. Findings Between Nov 15, 2006, and March 15, 2011, 359 patients were randomly assigned, of whom six in the 6-week group and two in the 12-week group were excluded after randomisation. 176 patients assigned to the 6-week treatment regimen and 175 to the 12-week treatment regimen were analysed by intention to treat. 160 (90·9%) of 176 patients in the 6-week group and 159 (90·9%) of 175 of those in the 12-week group met the criteria for clinical cure. The difference between the groups (0·05%, 95% CI −6·2 to 6·3) showed the non-inferiority of the 6-week regimen when compared with the 12-week regimen. 50 patients in the 6-week group and 51 in the 12-week group had adverse events, the most common being death (14 8% in the 6-week group vs 12 7% in the 12-week group), antibiotic intolerance (12 7% vs 9 5%), cardiorespiratory failure (7 4% vs 12 7%), and neurological complications (7 4% vs 3 2%). Interpretation 6 weeks of antibiotic treatment is not inferior to 12 weeks of antibiotic treatment with respect to the proportion of patients with pyogenic vertebral osteomyelitis cured at 1 year, which suggests that the standard antibiotic treatment duration for patients with this disease could be reduced to 6 weeks. Funding French Ministry of Health.
Local Argyria due to Silver-Coated Megaprosthesis Denes, Eric; El Balkhi, Souleiman; Fiorenza, Fabrice
The American journal of medicine,
June 2022, 2022-Jun, 2022-06-00, 20220601, Volume:
135, Issue:
6
Journal Article
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