Seng Piseth, Traore Madou, Lavigne Jean-Philippe, Maulin Laurence, Lagier Jean-Christophe, Thiery Jean-François, Levy Pierre-Yves, Roger Pierre-Marie, Bonnet Eric, Sotto Albert, Stein Andreas
, 19-21 Boulevard Jean Moulin, Marseille, 13005, France.
Service de Maladies Infectieuses Tropicales et Infections Chroniques (MITIC), IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.
Int Orthop. 2017 Jun;41(6):1085-1091. doi: 10.1007/s00264-017-3476-4. Epub 2017 Apr 12.
Cases of fracture-fixation device infection involving Staphylococcus lugdunensis are not frequent. The clinical characteristics and the choice of treatment strategies of these infections are not obviously known to date.
We performed a review of fracture-fixation device infection involving S. lugdunensis managed by our centres.
Among the 38 cases of fracture-fixation device infection involving S. lugdunensis, 53% were located in the tibia. Most of our cases (87%) were chronic infections. Purulent discharge, which occurred in 79% of cases, was the most frequent clinical symptom, followed by pain in 63%, local inflammation in 55%, and fever in 37%. Bacteremia and severe sepsis occurred in 10% and 18% of cases, respectively. Four cases (10%) were treated exclusively with antimicrobial treatment alone. Thirty-four cases (89%) were treated with a combination of surgery with antimicrobial therapy including surgical debridement, antibiotics and osteosynthesis device retention in six cases (16%), and osteosynthesis device removal in 27 cases (71%). The mean length of antibiotic treatment was 119 days. The relapse rate was high that was not related to selection of resistant strains. Polymicrobial infection had no impact on clinical outcome. A combination of surgery with antimicrobial therapy was identified as a significant prognostic factor associated with remission (p = 0.042).
S. lugdunensis is probably involved in more infections than has been reported. Using appropriate microbiological methods laboratories should routinely identify the species of all coagulase-negative Staphylococci isolates involved in fracture-fixation device infection to better achieve the treatment strategies of fracture-fixation device infection involving S. lugdunensis.
涉及路邓葡萄球菌的骨折固定装置感染病例并不常见。目前尚不清楚这些感染的临床特征及治疗策略的选择。
我们对本中心处理的涉及路邓葡萄球菌的骨折固定装置感染病例进行了回顾。
在38例涉及路邓葡萄球菌的骨折固定装置感染病例中，53%发生在胫骨。我们的大多数病例（87%）为慢性感染。79%的病例出现脓性分泌物，这是最常见的临床症状，其次是疼痛（63%）、局部炎症（55%）和发热（37%）。菌血症和严重脓毒症分别发生在10%和18%的病例中。4例（10%）仅接受抗菌治疗。34例（89%）接受了手术联合抗菌治疗，包括手术清创、抗生素治疗，6例（16%）保留骨固定装置，27例（71%）取出骨固定装置。抗生素治疗的平均时长为119天。复发率很高，且与耐药菌株的选择无关。多微生物感染对临床结果无影响。手术联合抗菌治疗被确定为与病情缓解相关的重要预后因素（p = 0.042）。
路邓葡萄球菌可能涉及的感染比已报道的更多。实验室应使用适当的微生物学方法，常规鉴定所有参与骨折固定装置感染的凝固酶阴性葡萄球菌菌株的种类，以更好地实现涉及路邓葡萄球菌的骨折固定装置感染的治疗策略。
