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Open AccessArticle

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

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Bacteriology-Hospital Hygiene Department, University Hospital of Poitiers, Poitiers Universiy, F-86000 Poitiers, France
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Bacteriology-Hospital Hygiene Department, University Hospital of Nantes, Nantes University, F-44000 Nantes, France
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Bacteriology-Hospital Hygiene Department, University Hospital of Tours, Tours University, F-37000 Tours, France
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Univ Rennes, INSERM, University Hospital of Rennes, NUMECAN Institute (Nutrition Metabolisms and Cancer), F-35000 Rennes, France
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Bacteriology-Hospital Hygiene Department, University Hospital of Brest, Brest University, F-29000 Brest, France
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Bacteriology-Hospital Hygiene Department, University Hospital of Angers, Angers University, F-49000 Angers, France
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Bacteriology-Hospital Hygiene Department, Hospital of Orléans, F-45000 Orléans, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(12), 2113; https://doi.org/10.3390/jcm8122113
Received: 18 October 2019 / Revised: 28 November 2019 / Accepted: 29 November 2019 / Published: 2 December 2019
Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation. View Full-Text
Keywords: prosthetic joint infection; bacterial growth time; time to positivity; empirical antimicrobial treatment; postoperative antibiotics prosthetic joint infection; bacterial growth time; time to positivity; empirical antimicrobial treatment; postoperative antibiotics
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Deroche, L.; Bémer, P.; Valentin, A.-S.; Jolivet-Gougeon, A.; Tandé, D.; Héry-Arnaud, G.; Lemarié, C.; Kempf, M.; Bret, L.; Burucoa, C.; Corvec, S.; Plouzeau, C. The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections. J. Clin. Med. 2019, 8, 2113.

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