Infected of Hip or Kneeprosthesis Clinical Trial
Official title:
Use of Probabilist Broad-spectrum β-lactam for One-stage Replacement of Infected Hip / Knee Arthroplasties: Retrospective Analysis in a Center of Reference
According to the official recommendations, infected prosthesis can be surgically treated by
one or two-stage replacement. In Strasbourg, the investigators only perform one-stage
surgery, which means that the new materiel is put directly into an infected site. To prevent
re-infection, probabilist antibiotherapy has to be started the earlier as possible and to
have the larger specter as possible. Official recommendations don't specify the best choice
of antibiotherapy and let prescriptors make choice, according to the local epidemiology and
patient's history.
In Strasbourg, the investigators systematically start an antibiotic against cocci gram
positive: daptomycin. Sometimes, the investigators add tazocillin, a broad-spectrum β-lactam
against bacillus gram negative. To determine if the investigators use the second one, they
focalized on the presence of fistula or not. Indeed, enterobacteriae from gastro-intestinal
tractus are also found on the skin and can move to the peri-prosthetic site if a fistula is
created. The major disadvantage of this board-spectrum antibiotic is the selection and
creation of resistant bacteriae, which can be responsible of failure, re-infection, or just
spreading on the environnement.
The primary purpose is to evaluate retrospectively the prescription of tazocillin, judging
it's necessity thanks to antibiograms performed on samples taken during surgery. The aim is
to evaluate if the criteria " fistula or not " is a good one to guide the prescription of
board-spectrum β-lactam.
Secondary purposes are to find the etiology of failures ( bacteriological failure or
re-infection with a new pathogen), evaluate the apparition of multi-drug resistant bacteriae
and infections they are responsible for, looking for others criterias which could help the
investigators to choose the probablist antibiotherapy
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