OBJECTIVES:Our aim was to determine the quality of antibiotic advice given by antibiotic referral centres (RC) to general practitioners (GP). METHOD:A prospective multicentre audit of antibiotic advice on four urinary tract infections (UTI) and four respiratory infections delivered to GPs by RCs was carried out from May to August 2024. Recommendations were put forward by three senior infectious disease specialists in accordance with the existing guidelines. RESULTS:Fourteen RCs were asked to provide 112 recommendations, and 106 responses were obtained (95 %). Advice was given by a senior physician in 76 cases (72 %) and a resident in the 30 others (38 %). The mean score/5 [± std deviation] per clinical case was 2.7 ± 1.9, with a difference between UTI and respiratory infections: 3.5 ± 1.7 versus 3.0 ± 1.1, p = 0.043, and a higher score for senior physicians as compared to residents: 2.9 ± 1.8 versus 2.0 ± 1.9, p = 0.019. CONCLUSION:The quality of antibiotic-related advice provided by RCs to GPs appeared heterogeneous, and improvement could be facilitated by favouring senior physician intervention.

INTRODUCTION:Our aim was to determine the reasons for appropriate Piperacillin-tazobactam (Pip-Taz) prescriptions. METHOD:This was a prospective multicentre study of two-month Pip-Taz prescription in France. Reading of patient charts allowed for classification of diagnoses as definitive, suspected or unknown. Appropriateness of Pip-Taz was defined according to eight indications: post-operative infection in digestive surgery or urology, fever in onco-hematological patients, healthcare-associated infections (HCAI) in intensive care units, polymicrobial HCAI, infection due to multidrug-resistant bacteria, avoidance of carbapenem use, pulmonary infection in patients with chronic pulmonary disease, and following an internal guideline. Antibiotic reassessment was defined by any modification of Pip-Taz. Risk factors for erroneous Pip-Taz prescription were identified through a multivariate analysis, and participating physicians were interrogated on the subject. RESULTS:From April to July 2024, 259 prescriptions from 14 institutions were included. The diagnosis of infection was definitive in 127 cases (49 %), suspected in 97 (37 %), and unknown in 37 (14 %). Prescriptions were deemed appropriate in 204 cases (79 %). In logistic regression, appropriate Pip-Taz prescription was associated with definitive diagnoses, HCAI, microbiological investigations, advice by infectious disease specialists, and antibiotic reassessment (all adjusted OR ≥ 2.19). All in all, 37/55 prescriptions outside the scope of guidelines were elucidated by the prescribers, the main reason for them being "out of habit" (13/37), and we found a relationship between "unknown diagnosis" and no explanation for Pip-Taz prescription (p < 0.001). CONCLUSION:Pip-Taz appropriateness was associated with correct management, i.e. written diagnosis, microbiological investigation, and reassessment, while prescriptions outside guidelines were related to physician habits, including no written diagnosis.

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 (p = 0.003) and from 112 to 77 (p = 0.025), respectively, but consumption of piperacillin/tazobactam increased from 9 to 21 (p < 0.001). Over the study period, 10 institutions with ≤2 AST had lower AC compared to 20 institutions with ≥3 AST (p < 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 (p = 0.065) and with an acceleration of piperacillin/tazobactam consumption from 2020 to 2022 (p ≤ 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.

Background Need for parenteral administration and total duration of antibiotic therapy for prosthetic joint infection (PJI) are debated. We report our PJI management, in which outpatient care is privileged.Methods This was a retrospective multicentre cohort study of PJI managed from January 2017 to Jun 2021. Microbial diagnosis was based on surgical samples. Surgical procedures and antibiotic treatments were reported. Chronic PJI was defined by a course >1 month. Oral antibiotic therapy (OAT) was defined by exclusive use of oral antibiotics or by <= 3 days of parenteral treatments. Management failure was defined by clinical and/or microbial relapse of PJI over 24 months after surgical treatment.Results One hundred and seventy-two patients from 13 institutions were included: 103 were male (60%) and mean age was (+/- SD): 73 +/- 12 years. Sites for PJI were mainly hip (50%) and knee (35%), being chronic infections in 70 cases (41%). The main bacterial genus in monomicrobial infections was Staphylococcus spp. (60%). We recorded 41 (24%) implant exchanges. An OAT was prescribed in 76 cases (44%), and the median (range) course for parenteral route was 6 days (4-180) for 96 cases. Median (range) duration of antimicrobials was 42 days (21-180). Management failure was observed in 7/76 (9.2%) cases treated with OAT and 15/96 (15.6%) treated with prolonged parenteral therapy. In multivariate analysis, risk factors for failure were a knee PJI [adjusted OR (95% CI) = 3.27 (1.27-8.40)] and a polymicrobial infection [4.09 (1.46-11.49)].Conclusions OAT for 6 weeks for PJI was associated with a low rate of management failure.

En France, l'exercice privé de l'infectiologie est actuellement marginal. Cependant, le nombre de praticiens exerçant ainsi tend à augmenter régulièrement : on en compte aujourd'hui une trentaine. Cette pratique étant peu connue, nous avons souhaité réaliser une enquête afin de mieux nous connaître et faire connaître notre mode d'exercice. Au cours du premier semestre 2022, nous avons réalisé une enquête (voir document annexe 1) auprès des infectiologues libéraux afin de mieux les connaître et de pouvoir échanger avec les autorités qui connaissent mal cette spécialité. Sur les 33 médecins infectiologues privés connus, 31 ont répondu à l'enquête. Cette dernière montre que, même si cela ne semble pas évident à première vue, cette spécialité peut être pratiquée dans le secteur privé et qu'elle ne diffère pas beaucoup de l'activité dans le secteur public, que ce soit en termes de pathologies traitées, de recherche clinique et de publications ou encore d'enseignement. La grande différence vient de la rémunération, qui est pénalisée par l'absence de codes spécifiques à la spécialité et l'absence d'actes techniques rémunérateurs. L'infectiologie libérale est complémentaire du public et ne doit pas lui être opposée. C'est une pratique viable qui va se développer compte tenu des bénéfices que les établissements peuvent en tirer, notamment avec les contraintes de qualité et de bonnes pratiques de prescription des antibiotiques. In France, the private practice of infectiology is currently marginal. However, the number of infectious diseases specialists (IDS) tends to increase regularly and currently approximately thirty of them practice in the private sector. As this practice is not well known, we carried out a survey to better describe the profiles and organizations of private-sector IDS, with the objective of making them better known to the public and health care authorities. During the first semester of 2022, we conducted a survey among private infectious disease specialists by means of a standardized questionnaire (see appendix 1). Of the 33 known private infectious disease physicians, 31 responded to the survey. This survey shows that this specialty, even if at first glance it does not seem obvious, can be practiced in the private sector and that it does not differ much from the activity in the public sector, either in terms of pathologies treated, clinical research and publications or teaching. The big difference comes from the remuneration which is penalized by the absence of specific codes for the specialty and the absence of remunerative technical acts. Liberal infectiology is complementary to the public and should not be opposed to it. It is a viable practice that should be developed given the benefits that institutions can derive from it, particularly with the constraints of quality and good antibiotic prescription practices.

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%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 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.

A 75-year-old man had a replacement of his tibia, due to a primary bone sarcoma, with a silver-coated megaprosthesis (Figure, A). At 3-year follow-up, he presented with gray-blue colored skin overlying the prosthesis (Figure, B). This indicated release of silver from the prosthesis and a diagnosis of localized argyria. There was no clinical consequence of this colored skin. Unfortunately, in the follow-up, he presented with an infection of this megaprosthesis. After several attempts to treat this infection, he asked for an amputation.

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.

Background Vascular graft infection (VGI) remains a severe disease with high mortality and relapse rates. We performed a retrospective single-center cohort study to highlight factors associated with long-term all-cause mortality in patients with vascular graft infection. Methods All patients hospitalized in our facility over 10 years for VGI were included. VGI was defined by the presence of a vascular graft or an aortic stent graft (stent or fabric), associated with 2 criteria among clinical, biological, imaging, or microbiological elements in favor of VGI. The primary outcome was all-cause mortality. Empirical antibiotic therapy was considered as appropriate when all involved pathogens were susceptible in vitro to the antibiotics used. The surgical strategy was defined as nonoptimal when the graft was not removed in a late-onset surgery (>3 months) or no surgery was performed. Results One hundred forty-six patients were included. Empirical antibiotic therapy was administered in 98 (67%) patients and considered appropriate in 55 (56%) patients. Surgery was performed in 136 patients (96%) and considered as optimal in 106 (73%) patients. In multivariable analysis, appropriate empirical antibiotic therapy was associated with a lower probability of mortality (hazard ratio, 0.47 [95% confidence interval, .30-.79]; P = .002). Long-term survival did not differ according to whether the surgical strategy was considered optimal or not (log-rank = 0.66). Conclusions Appropriate empirical antibiotic therapy is a cornerstone of the management of VGI. Whenever possible, antibiotics must be associated with optimal surgical management. However, surgery could potentially be avoided in comorbid patients who are treated with appropriate antibiotics. Appropriate empirical antibiotic therapy for vascular graft infection is associated with better survival. Long-term survival does not differ whether or not the surgical strategy is considered optimal. Efficient antibiotic treatment may help to avoid surgery for patients with comorbidities, without causing long-term excess mortality.

Background Bacterial 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. Objective To 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. Conclusion Fosfomycin-Trometamol can be a good option for the treatment of bacterial prostatitis when other antibiotics can't be used either for resistance or allergy.

Surgical InfectionsVol. 22, No. 10 Letters to the EditorAcute Renal Failure in Patients with Indwelling Double-J Stents: It Is Not Always a Device Dysfunction, Think Fungus BallsEric Denes, Matthieu Lanoé, and Franck SaloméEric DenesAddress correspondence to: Dr. Eric Denes, Infectiologie, Polyclinique de Limoges–Chénieux, 18 rue du Général Catroux, 87000 Limoges, France E-mail Address: denes.eric@gmail.comInfectious Diseases Department, ELSAN Polyclinique de Limoges, Limoges, France.Search for more papers by this author, Matthieu LanoéUrology Surgery Department, ELSAN Polyclinique de Limoges, Limoges, France.Search for more papers by this author, and Franck SaloméUrology Surgery Department, ELSAN Polyclinique de Limoges, Limoges, France.Search for more papers by this authorPublished Online:24 Nov 2021https://doi.org/10.1089/sur.2021.155AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Acute Renal Failure in Patients with Indwelling Double-J Stents: It Is Not Always a Device Dysfunction, Think Fungus Balls." Surgical Infections, 22(10), p. 1099FiguresReferencesRelatedDetails Volume 22Issue 10Dec 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Eric Denes, Matthieu Lanoé, and Franck Salomé.Acute Renal Failure in Patients with Indwelling Double-J Stents: It Is Not Always a Device Dysfunction, Think Fungus Balls.Surgical Infections.Dec 2021.1099-1099.http://doi.org/10.1089/sur.2021.155Published in Volume: 22 Issue 10: November 24, 2021Online Ahead of Print:July 9, 2021PDF download

Background: Immunity against Pasteurella spp. is not well-known for humans. Methods: We've tested T CD8+ lymphocytes in a patient with a chronic prosthetic joint infection due to Pasteurella 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 Pasteurella spp. Infections, either acute or subacute. Results: 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. Conclusion: The authors suggest that a deficit in CD8+ T lymphocytes can be one of the causes for the onset of infections with P. multocida.

Le « gold standard » pour la prise en charge des médiastinites est actuellement l'utilisation de la thérapie par pression négative suivi d'un lambeau musculaire qui peut entraîner des complications à type de douleur, perte de force du membre supérieur, instabilité sternale… L'implantation d'un dispositif médical (DM) est classiquement contre-indiquée due au risque d'infection. Par ailleurs, la diffusion des antibiotiques est mauvaise au niveau du médiastin et du sternum et encore plus lorsque les artères mammaires internes ont étés prélevées, limitant l'efficacité d'antibiotiques avec des volumes de distribution faibles. Nous avons développé un DM chargé en antibiotique permettant un relargage local et ainsi une optimisation des concentrations et une protection de l'implantation. Nous avons utilisé une prothèse sternale en alumine poreuse chargée en gentamicine seule ou en association avec de la vancomycine. Le but est de remplacer mécaniquement le sternum tout en protégeant l'implantation avec l'antibiotique. Ce DM a été implanté chez 4 patients avec des destructions sternales nécessitant un remplacement. L'antibiotique n'ayant qu'un rôle prophylactique, une antibiothérapie par voie systémique était prescrite classiquement. À noter que chez le patient #4, le S. epidermidis en cause était résistant à la gentamicine (CMI : 384 μg/mL) et à la vancomycine (CMI : 8 μg/mL). Il s'agissait de 4 hommes (67,6 ans) ayant présenté une médiastinite dans les suites d'une chirurgie cardiaque. Le délai moyen entre le début de l'infection et l'implantation était de 9,5 mois. Lors de l'implantation la bactériologie était toujours positive. Les concentrations locales d'antibiotiques étaient largement supérieures à celles nécessaires (Cmax/CMI > 1500 pour la gentamicine et ASC/CMI ∼16000 pour la vancomycine) et les concentrations sanguines pendant 48 h étaient indétectables. L'administration locale des antibiotiques a permis de retrouver des paramètres pharmacologiques témoignant d'une « resensibilisation » du S. epidermidis à la gentamicine et la vancomycine grâce à l'administration locale. La cicatrisation était obtenue en moins de 10 jours. Chez les 3 patients dont la flore était sensible à l'antibiotique, il n'y a pas eu de récidive de l'infection (> 18 mois de recul). Chez un patient il y a eu un changement radical de flore entre les derniers prélèvements réalisés et l'implantation, avec un passage de totalement sensible à complètement résistant à la gentamicine. Le DM a dû être retiré après 19 mois, mais les tissus cicatriciels ont permis de ne pas remettre de matériel. L'utilisation de cette céramique chargée en antibiotique permet de reconstruire la cage thoracique et de protéger son implantation. Le relargage local permet d'obtenir des concentrations locales efficaces qui complètent le débridement, protègent le DM d'une infection bactérienne et diminue le risque de toxicité systémique. Cela permet d'optimiser les concentrations locales et de récupérer des résistances « pharmacologiques ».

BACKGROUND:After its destruction during refractory deep sternal wound infection (DSWI), current sternum reconstructions mainly rely on muscle flaps technique, but such technique have pitfalls and limits. To tackle the limited possibilities to use device implantation because of the risk of infection, we developed a self-protected device allowing its implantation in an infected area.METHODS:We used gentamicin alone or in combination with vancomycin loaded in a porous ceramic sternum to replace sternums destroyed during DSWI. The aim was to mechanically replace the sternum and to secure the implantation by killing the remaining bacteria in the wound thanks to the loaded antibiotic.RESULTS:This device was implanted in four infected patients during DWSI with sternal dehiscence. No complication occurred during surgeries, and wound healing was obtained quickly. Local antibiotic concentrations largely exceeded the ones needed for their efficacy while no antibiotic was found in the blood. All patients are well-being. However previously unknown gentamicin resistant bacteria, present in the surgical wound at the time of positioning, required sternal implant removal for one patient after 19 months. For all patients, pulmonary function tests (PFT) improved after implantation.CONCLUSIONS:The ceramic sternum played its role consolidating the thoracic cage without stiffening. The antibiotic loaded in the sternum allowed a secure implantation, killing bacteria before the colonization of the implant even in this infected area. These four implantations are promising for patients with sternal destruction after DSWI.

Antibiotic efficacy against a given pathogenic bacterium is anticipated, among other things, by comparing its predicted blood concentrations with the MIC [[1]Mouton J.W. Muller A.E. Canton R. Giske C.G. Kahlmeter G. Turnidge J. MIC-based dose adjustment: facts and fables.J Antimicrob Chemother. 2018; 73: 564-568https://doi.org/10.1093/jac/dkx427Crossref PubMed Scopus (183) Google Scholar]. On this basis, a pathogenic agent is considered resistant if the blood concentrations do not reach a set threshold. However, this governing dogma does not always take into account the concentrations of the antibiotic at the site during a localized infection. However, the local concentration in these cases must be a central element in our interpretation of antibiotic susceptibility testing (AST). AST recommendations are based on blood concentrations which are used to extrapolate tissue concentrations. However, due to narrow therapeutic indexes, dosages of some antibiotics that have poor tissue diffusion, such as vancomycin or aminoglycosides, can not be increased and are thus considered as non-efficient and not usable. However, if local doses can be increased by a direct local delivery with an optimized exposure at the site of the infection and without generating toxicity, the breakpoint used for systemic interpretation of AST will no longer be considered as a cut-off to determine resistance. Consequently, the use of these antibiotics should be possible and effective. In the context of resistance related to low antibiotic concentrations, this optimization could allow the use of antibiotics that can not be efficient using usual routes. We applied this hypothesis for the treatment of a man who presented a mediastinitis with, among other bacteria, a methicillin resistant Staphylococcus epidermidis (MRSE) resistant to both gentamicin (MIC: 384 μg/mL) and vancomycin (MIC: 8 μg/mL). This mediastinitis, associated with an osteomyelitis destroying his sternum, was a complication of an aortic and coronary surgery (Bentall procedure). Despite classical care (debridement surgeries, Vacuum Assisted Closure therapy and several systemic antibiotic courses) the local infection worsened. After 10 months of evolution, chest wall stabilization was mandatory. Reconstruction was performed using a porous ceramic sternum loaded with vancomycin (250 mg) and gentamicin (320 mg) allowing (a) the reconstruction of the chest wall and (b) the local delivery of antibiotics (I.Ceram®, Limoges, France) [[2]Tricard J. Chermat A. Denes E. Bertin F. Antibiotic-loaded ceramic sternum for sternal replacement in a patient with deep sternal wound infection.Interact Cardiovasc Thorac Surg. 2019; 29: 973-975https://doi.org/10.1093/icvts/ivz182Crossref PubMed Scopus (1) Google Scholar]. Wound healing was obtained in less than 1 week. After 2 months of follow-up, there was no relapse of the infection. Local antibiotic concentrations obtained using drainage and blood concentrations are summarized in Table 1. Local pharmacodynamics parameters were as follows: for vancomycin, the ratio AUC24/MIC (AUC, area under the curve) was approximately equal to 16 000 and for gentamicin, the inhibitory quotient Cmax/MIC (Cmax, maximal concentration) was 17 allowing for efficiency where systemic administration would have failed. At the same time, no gentamicin or vancomycin were detectable in blood for 48 h.Table 1Local and blood antibiotics concentrations (concentrations are given in μg/mL)H+1H+6H+24VancomycinLocal39094.328.1Blood<1.1<1.1<1.1GentamicinLocal656084.14.7Blood<0.5<0.5<0.5 Open table in a new tab In some cases, obtaining adequate local antibiotic concentration is difficult. For example, even without infection, diffusion of antibiotic is poor in mediastinum and it is worse after coronary bypass when mammary arteries are used, due to a devascularization of the sternum. Thus, obtaining adequate antibiotic concentration is challenging even for susceptible bacteria. Local administration makes it possible to obtain efficient concentrations that can not be achieved with systemic administration. This is what was observed for this patient and for the other previously reported patient who also received an antibiotic loaded porous alumina ceramic [[2]Tricard J. Chermat A. Denes E. Bertin F. Antibiotic-loaded ceramic sternum for sternal replacement in a patient with deep sternal wound infection.Interact Cardiovasc Thorac Surg. 2019; 29: 973-975https://doi.org/10.1093/icvts/ivz182Crossref PubMed Scopus (1) Google Scholar,[3]Fiorenza F. Durox H. El Balkhi S. Denes E. Antibiotic-loaded porous alumina ceramic for one-stage surgery for chronic osteomyelitis.J Am Acad Orthop Surg Glob Res Rev. 2018; 2: e079https://doi.org/10.5435/JAAOSGlobal-D-18-00079Crossref PubMed Scopus (7) Google Scholar]. Interestingly, due to the increased rate of resistant bacteria and the decrease in the number of new antibiotics, this kind of approach is a current area of research [[4]Caplin J.D. García A.J. Implantable antimicrobial biomaterials for local drug delivery in bone infection models.Acta Biomater. 2019; 93: 2-11https://doi.org/10.1016/j.actbio.2019.01.015Crossref PubMed Scopus (62) Google Scholar]. The antibiotics used were not detectable in the blood of the patient which indicates that there is no risk of toxicity because the delivery was only local. Another advantage of these undetectable systemic concentrations is a decrease in the selective pressure on the patient's intestinal microbiota. In this case, the AUCs for vancomycin and Cmax for gentamicin largely exceeded those usually obtained with systemic administration. The inhibitory quotient has to be greater than 10-fold to predict an efficacy of gentamicin and AUC24/MIC must exceed 400 for efficacy of vancomycin [[5]Eyler R.F. Shvets K. Clinical pharmacology of antibiotics.Clin J Am Soc Nephrol. 2019; 14: 1080-1090https://doi.org/10.2215/CJN.08140718Crossref PubMed Scopus (39) Google Scholar]. These goals were largely surpassed, authorizing a local efficacy of antibiotics that would have not been efficient if given intravenously. It should be noted that the duration of release of this loaded device is short: approximately 3 days. Thus, it can only be considered as part of the treatment. Its role is to complete the debridement, to eradicate bacteria remaining in the wound and to avoid its colonization and infection. Thus, as during every complex bone infection, a systemic antibiotic treatment must be prescribed in addition to debridement. Even if we report only one case, this type of administration, optimizing pharmacokinetic/pharmacodynamic (PK/PD) modelling, seems to be interesting when resistances are due to poor diffusion of antibiotics at the site of infection. However, other reports are needed to confirm this first impression. E.D. is a member of the scientific committee of I.Ceram and an owner of shares; F.B. and S.E.B. are members of the scientific board of I.Ceram; O.B. has no conflicts of interset to declare. No funding was received for this study. E.D. conceived of the idea of loading the device, analysed data and wrote the manuscript. F.B. conceived of loading the device, performed the surgery and corrected the manuscript. S.E.B. analysed pharmacological data and corrected the manuscript. O.B. analysed bacteriological data and corrected the manuscript.

A 68-year-old man presented with destruction of his sternum after cardiac surgery. Classical management with multiple debridements, vacuum dressings and antibiotics failed. A replacement of his sternum was performed using an antibiotic-loaded porous alumina ceramic sternum. Despite the infected wound, the ceramic sternum did not get infected due to the high antibiotic concentration obtained locally. Two years after the surgery, no relapse occurred and the pulmonary function tests improved.

L’adhésion bactérienne est dépendante de la surface du matériau. Certains articles ont récemment montré que les couples de frottement céramique–céramique étaient moins sujets aux infections que d’autres couples. Nous avons testé l’hypothèse que l’adhésion bactérienne était moindre sur l’alumine poreuse. Étant donné que les hydroxyles (OH) de surface sont un des facteurs importants déterminants les propriétés de surface (adsorption, premières étapes non spécifique de l’adhésion bactérienne), nous avons fait l’hypothèse que l’alumine possédait une densité d’OH plus faible que d’autres matériaux. Nous nous sommes demandé (1) si l’adhésion bactérienne était plus faible sur l’alumine que sur un alliage de titane, sur l’acier inoxydable ou le polyéthylène et (2) si la densité des OH de surface était plus faible sur l’alumine. Nous avons effectué (1) des cultures bactériennes de Staphylococcus aureus et de Pseudomonas aeruginosa in vitro sur de l’alumine poreuse, un alliage de titane, de l’acier inoxydable et du polyéthylène. Les expérimentations ont été réalisées en triplicata sur chaque matériau et pour chaque souche. Les unités formant colonies étaient déterminées par cm2 (UFC/cm2), (2) une estimation de la densité des OH de surface grâce à du rouge neutre. Le dosage du rouge neutre par spectrophotométrie en UV visible a été effectué en duplicata pour chaque matériau et la densité exprimée en μg/cm2. Il y avait significativement moins d’adhésion de P. aeruginosa sur l’alumine poreuse (2,25 × 104 UFC/cm2) que sur le titane (4,27 × 105 UFC/cm2, p = 0,01), sur l’acier inoxydable (2,44 × 105 UFC/cm2, p = 0,02) et le polyéthylène (7,29 × 105 UFC/cm2, p < 0,001). Il y avait significativement moins d’adhésion de S. aureus sur l’alumine poreuse (3,22 × 105 UFC/cm2) que sur le polyéthylène (5,23 × 106 UFC/cm2, p = 0,01), mais il n’y avait pas de différence avec le titane (1,64 × 106 UFC/cm2, p = 0,08) et l’acier inoxydable (1,79 × 106 UFC/cm2, p = 0,1). La densité d’OH était significativement plus faible sur l’alumine poreuse (0,09 μg/cm2) que sur le titane (8,88 μg/cm2, p < 0,0001), l’acier inoxydable (39,8 μg/cm2, p = 0,002) et le polyéthylène (4,5 μg/cm2, p < 0,01). Cependant, nous n’avons pas trouvé de corrélation entre l’adhésion bactérienne et la densité des OH. L’adhésion bactérienne était plus faible sur l’alumine poreuse que sur les autres matériaux. Bien qu’il y ait une plus faible densité d’OH à la surface de l’alumine, nous n’avons pu démontrer la corrélation entre ce paramètre et l’adhésion bactérienne. IV, étude in vitro.