Background Management of prosthetic joint infections (PJIs) due to Candida spp. remains challenging and poorly standardized. Epidemiological patterns and therapeutic strategies may vary between centers and countries, potentially reflecting differences in access to antifungal agents.Methods We performed a secondary analysis of an international, multicenter, retrospective study supported by the European Society of Clinical Microbiology and Infectious Diseases, including Candida PJI diagnosed between 2010 and 2020. Cases met European Bone and Joint Infection Society criteria, combining clinical signs of infection with at least 2 intraoperative samples positive for Candida spp. Follow-up was 2 years. Epidemiology, management, and outcomes were compared across 5 groups: France, Spain, England, Austria, and other countries.Results Overall, 268 cases were included: France (n = 142), Spain (n = 42), England (n = 38), Austria (n = 36), and others (Brazil, Lithuania, Italy; n = 9). Distribution of infected sites was similar across countries (hip 53.4%, knee 43.3%, and other 3.3%), as was species epidemiology (Candida albicans 55.6%, Candida parapsilosis 29.5%, Candida glabrata 7.8%, and Candida tropicalis 5.6%). Surgical strategies differed: 1-stage exchange was more frequent in France (36.0%) and Austria (34.3%), whereas 2-stage exchange predominated in England (42.1%) and Spain (37.2%). Echinocandins were prescribed significantly more often in France (41.8%) than elsewhere. Overall outcomes were poor, with a global failure rate of 43%, without significant differences between countries.Conclusions International differences in epidemiology and management of Candida PJI appear limited. Variations in surgical and antifungal strategies did not translate into improved outcomes, highlighting the need for optimized and standardized management approaches in future collaborative prospective studies worldwide and clinical.

Background/Objectives: Limited robust data support the use of antibiotic combinations in the treatment of orthopedic infections. However, in certain situations, the combination of antibiotics seems to be beneficial. This review aims to outline the circumstances under which a combination of antibiotics may be utilized in the treatment of orthopedic infections. Methods: We reviewed the existing guidelines on orthopedic infections and focused on situations where antibiotic combinations are recommended or proposed optionally. We chose vitro and animal studies that provide evidence for the effectiveness of several widely recommended combinations. Results: The combinations serve multiple purposes: they provide empirical coverage while awaiting microbiological results, offer targeted treatment for difficult-to-treat infections, and facilitate oral treatment primarily for staphylococcal infections. The objectives include enhancing bacterial coverage against Gram-positive and Gram-negative bacteria, achieving synergistic effects with bactericidal agents, and reducing the risk of antibiotic resistance. The review outlines specific combinations for fracture-related infections, periprosthetic joint infections, spinal infections, and anterior cruciate ligament reconstruction infections, emphasizing the importance of tailoring antibiotic choices based on local epidemiology and patient history. The review also addresses potential drawbacks of combination therapy, such as toxicity, higher costs, and drug interactions, underscoring the complexity of managing orthopedic infections effectively. Conclusions: According to the guidelines, several different proposals are made, depending in part on the countries’ epidemiology. In a well-defined situation, various authors propose either monotherapy or a combination of antibiotics. When a combination is suggested, the choice of antibiotics is based on the expected effect: broadening the spectrum, enhancing bactericidal activity, achieving a synergistic effect, or reinforcing biofilm activity to optimize the treatment.

Metallosis is a rare but severe complication of arthroplasty. Prosthetic Joint Infections (PJI) may be observed in patients presenting metallosis. In this study, we aimed to assess characteristics of metallosis and to compare them to patients with PJI epidemiology, management and outcome. A retrospective monocenter study including all consecutive cases of metallosis between 2019 and 2024 were included. Samples for microbiology and pathology are collected for all patients having surgery in our center. Demographic, clinical, pathology, microbiology, imaging, surgical treatment, and outcome data were collected. Diagnosis of metallosis was based on clinical signs and confirmed by pathology results. Metallosis data for patients with infection were compared to a group of 100 patients presenting PJI. Sixty-two patients with metallosis diagnosis were included. Mean age was 67.2 ± 9.5 yo, 30 (49.2%) patients were male, Charlson score was 3.00 [2.00, 4.00]. Site of metallosis included hip 27 (43.5%), knee 32 (51.6%), shoulder 2 (3.2%). Fifty patients (80.6%) had local signs of inflammation; median CRP was 26mg/L [18-36]. Among all patients, 23 cases of loosening (37.7%), 13 (21.3.%) instability, 3 (4.9%) prosthesis dislocation. Among 62 patients, 29 (46.8%) had a diagnosis of metallosis with infection. Clinical signs in this group showed 25 (86.2%) local inflammation, median CRP was 27mg/L [29-38], 9 (14.5%) fistula and 3 (4.8%) patients with fever. Median delay between clinical symptoms and surgery was 3.48 [2.73-4.14] months. Treatment consisted in surgery with one-stage exchange in 55 (88.7%) patients. A favorable outcome was found in 24 (82.8%) patients. Comparing patients with metallosis-infection to patients with PJI only, no difference was found for delay between clinical signs and surgery (p=0.74), clinical manifestations (p=0.35), treatment (p=0.42) and outcome (p=0.16). However, microbial epidemiology of metallosis-infection showed mainly coagulase negative staphylococci like S. epidermidis (n=19; 65.5%) (p=0.03) and C. acnes (n=8; 27.6%) (p=0.05) significantly different from species of PJI group involving more frequently S. aureus and streptococci species. Our study reports that almost one half of patients with metallosis present an infection. Demography and clinical presentation of metallosis cases are very close to PJI explaining that its diagnosis may be challenging. Microbiology of metallosis-infection shows significant species differences but metallosis doesn't seem to be worsening clinical or surgical evolution.

Fracture-related infections (FRIs) represent a significant complication in orthopedic trauma care, often leading to delayed bone healing, prolonged hospital stays, and increased patient morbidity. Pathogenesis involves microbial contamination during injury or surgery, compounded by patient-related risk factors such as diabetes, smoking, or immunosuppression. Diagnosis of FRI relies on a combination of clinical, radiological, and microbiological criteria. Common signs include persistent pain, swelling, erythema, purulent discharge, and non-union of the fracture. FRIs are classified based on the timing of infection onset into acute, delayed, and chronic forms, each requiring tailored management strategies. Treatment generally involves aggressive surgical debridement, possible hardware removal or retention, and targeted antibiotic therapy. In cases of severe tissue loss, reconstructive procedures may be necessary to restore bone and soft tissue integrity. Treatment strategies include early administration of prophylactic antibiotics, meticulous surgical technique, and timely soft tissue coverage in open fractures. A multidisciplinary approach involving orthopedic surgeons, infectious disease specialists, and microbiologists is essential for successful management. Early recognition and appropriate intervention are crucial to improving outcomes and minimizing long-term disability in patients with fracture-related infections.

In march 2020, the International Working Group on the Diabetic Foot (IWGDF) published an update of the 2015 guidelines on the diagnosis and management of diabetic foot infection (DFI). While we (the French ID society, SPILF) endorsed some of these recommendations, we wanted to update our own 2006 guidelines and specifically provide informative elements on modalities of microbiological diagnosis and antibiotic treatment (especially first- and second-line regiments, oral switch and duration). The recommendations put forward in the present guidelines are addressed to healthcare professionals managing patients with DFI and more specifically focused on infectious disease management of this type of infection, which clearly needs a multidisciplinary approach. Staging of the severity of the infection is mandatory using the classification drawn up by the IWGDF. Microbiological samples should be taken only in the event of clinical signs suggesting infection in accordance with a strict preliminarily established protocol. Empirical antibiotic therapy should be chosen according to the IWGDF grade of infection and duration of the wound, but must always cover methicillin-sensitive Staphylococcus aureus. Early reevaluation of the patient is a fundamental step, and duration of antibiotic therapy can be shortened in many situations. When osteomyelitis is suspected, standard foot radiograph is the first-line imagery examination and a bone biopsy should be performed for microbiological documentation. Histological analysis of the bone sample is no longer recommended. High dosages of antibiotics are recommended in cases of confirmed osteomyelitis.

Objective: The objective was to compare the microbiological characteristics and treatment of early and late surgical site infections (SSIs) in instrumented spinal surgery. Methods: Those patients admitted for SSIs in a single center between January 2010 and December 2022 were included. The subjects were divided into early (eSSIs) and late (lSSIs) SSIs, and demographic, microbiological, treatment, and follow-up data were collected. Results: Instrumented spinal surgery was performed in 2136 patients. Ninety-six cases of infections were identified (prevalence = 4.5%), with 47.9% eSSIs and 52.1% lSSIs. In 58.7% of the cases, the eSSIs were monomicrobial: Staphylococcus aureus (37%) and Enterobacterales (33.3%) were the main bacteria involved. In 66% of the cases, the lSSIs, were monomicrobial: Cutibacterium acnes (30.3%) and staphylococci were predominant. Enterobacterales were isolated in more than 70% of the polymicrobial samples in both the eSSIs and lSSIs. The treatment of the eSSIs mostly consisted of lavage-debridement surgery associated with antibiotic treatment, while the treatment of the lSSIs combined hardware removal or replacement and long-duration antibiotic treatment. A negative outcome was observed in 17.1% of the eSSIs and 5.7% of the lSSIs. Enterobacterales were associated with negative outcomes of eSSIs. Conclusions: Enterobacterales were found in most of the polymicrobial infections regardless of the time of infection onset. Further large studies should be conducted to precisely determine the management and prevention regarding the increasing Gram-negative bacteria SSIs.

BACKGROUND:Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI. METHODS:This was a retrospective observational multinational study including patients diagnosed with Candida-related PJI between 2010 and 2021. Treatment outcome was assessed at 2-year follow-up. RESULTS:A total of 269 patients were analyzed. Median age was 73.0 (interquartile range [IQR], 64.0-79.0) years; 46.5% of patients were male and 10.8% were immunosuppressed. Main infection sites were hip (53.0%) and knee (43.1%), and 33.8% patients had fistulas. Surgical procedures included debridement, antibiotics, and implant retention (DAIR) (35.7%), 1-stage exchange (28.3%), and 2-stage exchange (29.0%). Candida spp identified were Candida albicans (55.8%), Candida parapsilosis (29.4%), Candida glabrata (7.8%), and Candida tropicalis (5.6%). Coinfection with bacteria was found in 51.3% of cases. The primary antifungal agents prescribed were azoles (75.8%) and echinocandins (30.9%), administered for a median of 92.0 (IQR, 54.5-181.3) days. Cure was observed in 156 of 269 (58.0%) cases. Treatment failure was associated with age >70 years (OR, 1.811 [95% confidence interval {CI}: 1.079-3.072]), and the use of DAIR (OR, 1.946 [95% CI: 1.157-3.285]). Candida parapsilosis infection was associated with better outcome (OR, 0.546 [95% CI: .305-.958]). Cure rates were significantly different between DAIR versus 1-stage exchange (46.9% vs 67.1%, P = .008) and DAIR versus 2-stage exchange (46.9% vs 69.2%, P = .003), but there was no difference comparing 1- to 2-stage exchanges (P = .777). CONCLUSIONS:Candida PJI prognosis seems poor, with high rate of failure, which does not appear to be linked to immunosuppression, use of azoles, or treatment duration.

Objectives: Blood-culture-negative infective endocarditis (BCNE) is found in 2 to 48% of cases of infective endocarditis (IE) (Houpikian and Raoult, 2005) [1]. IE and vertebral osteomyelitis due to Chlamydia sp. are difficult to diagnose. Patients and methods: A case report of Chlamydia psittaci IE is provided, associated with a literature review. Results: We report the first case of Chlamydia psittaci IE, revealed by a spondylodiscitis. Questioning of the patient, imaging, serologies and PCR techniques on valves confirmed the diagnosis. Conclusion: C. psittaci IE is rare but probably underdiagnosed. In case of negative blood cultures, questioning patients with IE about their contacts with animals is relevant. PCR techniques are reference tools for diagnosis confirmation when valve or vertebral samples are available.

Background: Histopathology is one of the diagnostic criteria for prosthetic joint infection (PJI) proposed by all academic societies. The aim of this study was to compare histopathological and microbiological results from samples taken intraoperatively at the same site in patients with suspected or proven PJI. Patients and methods: We conducted a monocenter retrospective study including all patients having undergone surgery from 2007 to 2015 with suspected or proven PJI. During surgery, both histopathological and microbiological samples were taken. Patients with a history of antimicrobial treatment 2 weeks prior to surgery were excluded. We considered as major criteria and gold standard for PJI diagnosis the presence of a sinus tract communication and/or the same microorganism in at least two cultures. Results: Finally, 181 patients who underwent 309 surgeries were included. The median number of samples per surgery was 4 (interquartile range (IQR) = 3-5) for histopathology and 5 (IQR = 4-6) for microbiology. Major criteria were observed in 177 patients (57.3%), while positive histology in at least one intraoperative sample was present in 119 (38.5%). The concordance was 74%. The sensitivity and specificity of histopathology were 61% and 92% respectively. Available ''histopathology-culture" sample pairs numbered 1247. Among them, positive histopathology was found in 292 samples (23%) and culture in 563 (45%). Concordance was 64%. The highest correlation was observed for very early infection (<1 month) (OR: 9.1, 95% CI: 3.6-23) and for virulent microorganisms, such as Staphylococcus aureus (OR: 7.8, 95% CI: 5.2-11.8), Streptococci (OR:7.8; 95% CI: 4-15.2) or Enterobacterales (OR: 7.4; 95% CI: 4.2-13.1). Conclusion: Histopathologic examination is a valuable criterion for PJI diagnosis, but it may lack sensitivity for chronic infections or due to low-virulence pathogens.

Les entérocoques (E. faecalis en particulier) sont souvent identifiés dans les endocardites infectieuses (EI) des patients ayant eu une insertion de bioprothèse de valve aortique par voie trans-fémorale (TAVI). Une hypothèse permettant d'expliquer ce phénomène est l'utilisation d'une antibioprophylaxie, selon les recommandations, par céfazoline, non active sur les entérocoques alors que ces bactéries sont présentes au niveau du site inguinal d'insertion de la valve. Nous avons donc recherché la présence d'entérocoques dans la zone d'insertion. Tous les patients admis pour une procédure de type TAVI ont été inclus consécutivement entre juin 2021 et février 2022 dans une étude prospective monocentrique. Les données démographiques, cliniques, sur l'antibioprophylaxie et les conditions d'asepsie cutanée ont été recueillies. Pour chaque patient, des prélèvements cutanés ont été réalisés avant (P1) et après détersion cutanée (P2) au site de ponction de la TAVI. Les mains de l'opérateur (P3) ont également été prélevées après détersion. Une étude microbiologique a été effectuée pour tous les échantillons. Cent patients ont été inclus avec un âge moyen de 82 ans, un sex ratio H/F de 0,48 et un IMC moyen de 29 kg/m2. Dans cette population, 12 patients étaient porteurs de DECI, 16 avaient un antécédent de chirurgie cardiaque, 78 d'hypertension artérielle et 25 étaient diabétiques. Un antécédent d'EI était noté pour un patient, des épisodes de diarrhée ou de constipation pour 8 et un hématome du site de ponction pour 5. Tous les patients avaient une douche préopératoire et une détersion cutanée par bétadine aqueuse pour 94 patients et chlorhexidine pour 6 patients. L'antibioprophylaxie était la céfazoline pour 99 patients. Tous les patients avaient une douche préopératoire et une détersion cutanée par povidone iodée aqueuse pour 94 patients et chlorhexidine pour 6 patients. Les voies d'accès étaient à la fois fémorale et radiale pour tous les patients. Aucune complication (tamponnade, hémorragie, oedème pulmonaire, décès) n'a été signalée. La culture du prélèvement du site inguinal a été trouvée positive pour 58 %, 11 % et 7 % des échantillons cutanés P1, P2 et P3 respectivement. Des entérocoques ont été identifiés chez 11 patients, uniquement sur P1 : dans 10 cas, E. faecalis et dans un, E. faecium. Les échantillons P2 et P3 n'étaient positifs qu'avec des staphylocoques à coagulase négative. Les entérocoques sont désormais les principales espèces de bactéries trouvées dans l'IE post TAVI. Dans cette étude, nous avons montré qu'ils sont identifiés chez un peu plus de 10% des patients dans la zone d'insertion de prothèse aortique par voie trans-fémorale. Bien qu'ils n'aient pas été retrouvés après détersion, ces résultats doivent conduire à rediscuter le choix de l'antibiotique administré en prophylaxie lors de poses de TAVI. Aucun lien d'intérêt

Les infections ostéo-articulaires (IOA) représentent une part importante de l'activité des infectiologues. Nous rapportons l'expérience d'une équipe mobile d'infectiologie, sur une période de 7 ans, dans la prise en charge de ces pathologies. Nous avons réalisé une étude rétrospective (01/01/2016 au 31/12/2022), au sein des établissements partenaires, à partir des avis tracés quotidiennement par notre équipe via le logiciel Voozanoo (application Epiconcept© sur base MySQL). Les IOA étaient classées en 4 catégories: celles sur matériel hors que prothétique (IOM), celles sur prothèse (IOP), celles non associées à du matériel (IOANAM), et les spondylodiscites (SPD). Les analyses statistiques ont été réalisées avec test exact de Fisher, limite de significativité p<0.05. Aucun avis ou patient n'était exclu. Au total, 4916 avis pour IOA (parmi les 14598 tracés) ont été analysés sur la période (702 avis pour IOA/an), pour 2312 patients (330 patients/an), dont 4690 demandes de conseil thérapeutique(95.5% des avis) et 638 demandes d'aide au diagnostic(13% des avis). Parmi l'ensemble des IOA, 489(21,1%) était des IOM, 992(42,9%) des IOP, 720(31,1%) des IOANAM et 111(4,8%) des SPD. Près de 70% des patients (n=1609) avaient une documentation microbiologique lors du premier avis. La différence de fréquence des documentations initiales entre IOM et IOP n'était pas significative (respectivement 69.7% et 65.9%), mais elle l'était entre [IOM + IOP] et IOANAM (67.8% versus 78.4%, p=0.028). A l'inverse, les SPD étaient significativement moins documentées initialement (44%) que les [IOM + IOP] (p=0.019) et les IOANAM (p=0.0012). L'arrêt des antibiotiques a été proposé lors de 543 avis (11%). Les arrêts pour fenêtre clinique étaient plus fréquents en cas de présence de matériel comparativement aux infections sans matériel (75% versus 25%, p<0.0001). Il n'existait pas de différence significative dans la fréquence des arrêts pour fenêtres microbiologiques selon la présence de matériel ou non (45.3% versus 54.7%, p=0.06). Les antibiotiques étaient plus fréquemment considérés non justifiés en cas de matériel (72.2% versus 28.8%, p<0.0001). En cas d'antibiothérapie en cours, 848 avis(17,2%) conduisaient à une adaptation posologique, 944 (19,2%) à une adaptation des molécules aux données de l'antibiogramme, 176(3,6%) à une désescalade et 219(4,5%) à une intensification/escalade des antibiotiques. Dans l'activité d'une EMI multi-site, les avis pour IOA peuvent représenter une part très importante (33.7% des avis dans notre expérience). Il s'agit essentiellement de conseils thérapeutiques, conduisant souvent à des ajustements de doses ou de choix des antibiotiques, voire dans plus de 10% des cas à un arrêt de l'antibiothérapie, surtout en cas d'IOANAM. Les spondylodiscites apparaissent moins souvent documentées avant avis infectieux que les autres IOA, ce qui semble plaider en faveur d'un avis infectiologique standardisé en amont dans la démarche diagnostique de ces infections. Aucun lien d'intérêt

The introduction of transcatheter pulmonary valve implantation (TPVI) has greatly benefited the manage-ment of right ventricular outflow tract dysfunction. Infective endocarditis (IE) is a feared complication of TPVI that affects valve durability and patient outcomes. Current recommendations provide only limited guidance on the management of IE after TPVI (TPVI-IE). This article, by a group of experts in congeni-tal heart disease in children and adults, interventional cardiology, infectious diseases including IE, and microbiology, provides a comprehensive review of the current evidence on TPVI-IE, including its inci-dence, risk factors, causative organisms, diagnosis, and treatment. The incidence of TPVI-IE varies from 13-91/1000 person-years for Melody valves to 8-17/1000 person-years for SAPIEN valves. Risk factors include history of IE, DiGeorge syndrome, immunosuppression, male sex, high residual transpulmonary gradient and portal of bacteria entry. Staphylococci and streptococci are the most common culprits, whereas Staphylococcus aureus is associated with the most severe disease. In addition to the modified Duke criteria, a high residual gradient warrants a strong suspicion. Imaging studies are helpful for the diagnosis. Intravenous antibiotics guided by blood culture results are the mainstay of treatment. Inva-sive re-intervention may be required. TPVI-IE in patients with congenital heart disease exhibits several distinctive features. Whether specific valve types are associated with a higher risk of TPVI-IE requires further investigation. Patient and parent education regarding IE prevention may have a role to play and should be offered to all patients.(c) 2023 Elsevier Masson SAS. All rights reserved.

Les bacilles à Gram négatif (BGN) représentent une part non négligeable des infections ostéo-articulaires (IOA). Nous présentons les données de notre équipe mobile, issues des avis pour IOA à BGN, sur 7 ans. Nous avons réalisé une étude rétrospective (2016-2022), au sein des établissements partenaires. L'extraction des données a été obtenue à partir des avis multi-site tracés au jour le jour en utilisant le logiciel Voozanoo (application Epiconcept©, base MySQL). Les IOA étaient classées en infection orthopédique sur matériel(IOM), infection orthopédique sur prothèse(IOP), infection ostéo-articulaire non associée à du matériel(IOANAM), infection sur matériel rachidien(IMR) et spondylodiscite(SPD). Les analyses statistiques ont été réalisées avec test exact de Fisher. Aucun avis/patient n'était exclu. L'analyse a porté sur 1769 patients présentant une documentation bactérienne lors du 1er avis. Parmi eux, 340(19,2%) présentaient une infection à BGN, dont 65(19,1%) étaient une IOM, 99(29,1%) une IOP, 137(40,3%) une IOANAM, 28 (8,2%) une IMR et 11 (3,2%) une SPD. Les bactéries les plus fréquentes étaient E. coli (104; 30,6%), P. aeruginosa(73; 21,5%) et autres Enterobacterales(163; 47,9%), dont 50 Enterobacter spp(14,7%), 41 Proteus spp(12,1%), 22 S. marcescens, 18 K. oxytoca, 16 K. pneumoniae, 14 M. morganii, 6 Providencia spp, 4 K. aerogenes et 3 C. freundii. Les BGN représentaient 19,4%, 15,4%, 24,7%, 15% et 22,4% des bactéries responsables respectivement d'IOM, d'IOP, d'IOANAM, d'IMR et de SPD. On notait une sur-représentation des BGN en l'absence de matériel(24,5% versus 16,5%, p=0,001). E. coli était particulièrement fréquent dans les SPD(16,3% de l'ensemble des bactéries identifiées versus 2% pour Pseudomonas et 4,1% pour les autres Enterobacterales, p<0,05). Les données sur les résistances aux C3G et autres antibiotiques n'étaient pas disponibles, mais parmi les Enterobacterales, 99 souches(39,6%) appartenaient au groupe 3, dont 57(21,7%) étaient à moyen/haut risque de production d'AmpC. P. aeruginosa était sur-representé au sein des IOANAM(6,5% des documentations totales) versus 3,3%, 2,8% et 3,8% pour les IOM, IOP et IMR(p<0.05). Le même phénomène, à l'exception des IOP, était noté pour les autres Enterobacterales: 12.4% des documentations totales des IOANAM versus 7,1% des IOP et 6,4% des IMR (p<0.05). Le taux d'IOA dues à des BGN apparait plus faible en présence de matériel que sur os ou articulation native. Près d'un quart des patients présentent une infection à Enterobacterale groupe 3 à moyen/haut risque de production d'AmpC. Ces données peuvent permettre de guider l'antibiothérapie probabiliste, lorsqu'elle est indiquée, en proposant, en accord avec les recommandations récentes de l'ESCMID/IDSA, le céfépime plutôt qu'une C3G ou l'association pipéracilline-tazobactam. De plus, la probabilité d'une infection à P.aeruginosa(plus de 20% des infections à BGN dans notre série), renforce le choix de la céfépime en première intention par rapport aux C3G. Aucun lien d'intérêt

Aim Prosthetic joint infection (PJI) due to Candida spp. is a severe complication of arthroplasty but is little reported. This study describes Candida PJI epidemiology, management, and outcome. Method We performed a retrospective, observational multinational study with support of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Patients diagnosed with PJI due to Candida spp. between 1990 and 2021 were included. Demographic, clinical, laboratory, imaging, medical/surgical treatment, and outcome data were collected within a standardized database. Treatment failure was defined either as a Candida infection recurrence, superinfection, or death due to infection. Results Data from 151 patients across 18 centers were analyzed. Mean age was 69.5 ± 13.1yo, 78 (51.7%) patients were male, and 21 (13.9%) were immunosuppressed. Site of infection included hip (55.0%), knee (41.7%), shoulder (2.6%), and femur (0.7%). Twenty-five (16.6%) patients were febrile, and 58 (38.4%) had fistula. Mean number of previous surgeries on the same anatomical site was 3.3±2.3. Surgeries were DAIR (33.8%), one-stage exchange (19.9%), two-stage exchange (39.1%), and implant removal (6.0%). Candida species identified were C. albicans (60.3%), C. parapsilosis (26.5%), C. glabrata (7.3%), and C. tropicalis (5.3%). Co-infection with bacteria was found in 69 (45.7%) cases. Fluconazole (62.9%) and caspofungin (14.6%) were the main antifungal agents prescribed for 148.6 ± 167.5 days. Favorable outcome was found in 54/144 (37.5%) cases. Failure was associated with the number of previous surgeries (OR 1.249, 95%CI 1.061–1.469; p-value=0.007), while treatment by fluconazole was associated with cure (OR 0.336, 95%CI 0.160–0.707; p-value=0.004). Conclusions This study provides epidemiologic and outcome data on Candida PJIs. Although poor overall, the prognosis did not seem associated with immunosuppression, type of surgery, fungal species or treatment duration.

Background COVID-19 constitutes a global health emergency of unprecedented proportions. Preventive measures, however, have run up against certain difficulties in low and middle-income countries. This is the case in socially and geographically marginalized communities, which are excluded from information about preventive measures. This study contains a dual objective, i) to assess knowledge of COVID-19 and the preventive measures associated with it concerning indigents in the villages of Diebougou's district in Burkina Faso. The aim is to understand if determinants of this understanding exist, and ii) to describe how their pathways to healthcare changed from 2019 to 2020 during the COVID-19 pandemic. Methods The study was conducted in the Diebougou healthcare district, in the south-west region of Burkina Faso. We relied on a cross-sectional design and used data from the fourth round of a panel survey conducted among a sample of ultra-poor people that had been monitored since 2015. Data were collected in August 2020 and included a total of 259 ultra-poor people. A multivariate logistic regression to determine the factors associated with the respondents' knowledge of COVID-19 was used. Results Half of indigents in the district said they had heard about COVID-19. Only 29% knew what the symptoms of the disease were. The majority claimed that they protected themselves from the virus by using preventive measures. This level of knowledge of the disease can be observed with no differences between the villages. Half of the indigents who expressed themselves agreed with government measures except for the closure of markets. An increase of over 11% can be seen in indigents without the opportunity for getting healthcare compared with before the pandemic. Conclusions This research indicates that COVID-19 is partially known and that prevention measures are not universally understood. The study contributes to reducing the fragmentation of knowledge, in particular on vulnerable and marginalized populations. Results should be useful for future interventions for the control of epidemics that aim to leave no one behind.