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Le lambeau perforant épigastique inférieur profond (DIEP) est un lambeau fiable principalement utilisé dans les couvertures après une résection importante d'un sarcome ou dans les corrections de déformations de contour. Ce cas clinique original est à propos d'un lambeau pédiculé de type DIEP recouvrant la région trochantérienne chez une femme de 62 ans avec un IMC à 42 kg/m2 présentant une arthroplastie totale de hanche infectée avec un défect cutané. Le changement de la prothèse de hanche associée à des antibiotiques adaptés et une couverture efficace, bien vascularisée, par un lambeau de DIEP a permis le traitement de l'infection. Le membre est sauvé et la patiente peut à nouveau marcher. Le succès de cette chirurgie est la collaboration entre infectiologues, chirurgiens orthopédistes et chirurgiens plasticiens. The deep inferior epigastric perforator (DIEP) flap is a reliable flap mostly used in skin resurfacing after signifiant resection for sarcoma or correction contour deformities. This case is about a pedicled DIEP flap covering the trochanteric region after a total hip arthroplasty infection. A 62 years old woman with a BMI at 42 kg/m2 presents an infected total hip arthroplasty with a cutaneous defect. The hip prosthesis is changed and covered with a pedicled DIEP flap. This original case reports the used of pedicled DIEP flap in hip coverage. This local fasciocutaneous flap covered the hip osteoarticular infection. The limb is salved and the patient can walked again. The success of this surgery is the collaboration between infectious disease specialist, orthopedic surgeon and plastic surgeon. [ABSTRACT FROM AUTHOR]

Dans la prise en charge des infections chroniques de PTH/PTG avec changement de prothèse en un temps, aucune recommandation ne précise quand l'antibiothérapie probabiliste doit couvrir les BGN en plus des cocci à gram positif (CGP). L'objectif de notre travail est de définir des critères permettant de cibler les patients nécessitant une antibiothérapie active contre les BGN lors des changements en un temps pour infection chronique de PTH/PTG. L'étude β-SEPTIC était rétrospective et monocentrique, réalisé dans un CRIOAC où tous les changements pour infection chronique de PTH/PTG sont effectués en un temps. L'antibiothérapie probabiliste comporte, dans ce CRIOAC systématiquement la daptomycine contre les CGP et, selon les situations, la pipéracilline–tazobactam contre les BGN. Nous avons formalisé l'algorithme suivi quotidiennement par les infectiologues pour choisir l'antibiothérapie probabiliste. Nous avons analysé rétrospectivement toutes les antibiothérapies probabilistes prescrites durant l'année 2018 pour les classer selon cinq statuts : lorsque la pipéracilline–tazobactam était prescrite, elle pouvait être « indispensable », « inutile » ou « active en bithérapie » avec la daptomycine. Lorsque la pipéracilline–tazobactam n'était pas prescrite, le statut pouvait être soit « couvert » si la daptomycine suffisait pour couvrir les bactéries identifiées, soit « non couvert » si le spectre de la daptomycine ne couvrait pas toutes les bactéries incriminées dans l'infection. Selon ces statuts, nous avons évalué la pertinence de notre algorithme et envisagé, dans un second temps, des pistes d'amélioration. Du 01/01/2018 au 31/12/2018, nous avons inclus 82 patients, soit 46 PTH et 40 PTG. L'âge et l'indice de masse corporelle médians étaient respectivement de 72 ans et 30,1 kg/m2. Une fistule était retrouvée chez 39 patients. Des BGN étaient identifiés dans 13 cas (15,9 %) alors que 50 patients (61 %) avaient été traités par bêtalactamine à large spectre (BLLS), pour une durée médiane de quatre jours. Seulement 11 prescriptions de BLLS avaient le statut « indispensable » et deux patients sans BLLS appartenaient au groupe « non couvert ». Tous les patients pour lesquels la BLLS était indispensable avaient une fistule et/ou un BGN identifié en préopératoire. Nous proposons un nouvel algorithme décisionnel basé sur les deux critères suivants pour définir les patients à risque d'infection par des BGN : la présence d'une fistule et l'identification de BGN en préopératoire. Nous proposons un algorithme pour cibler les patients à risque d'infection par des BGN dans les infections chroniques de PTH/PTG afin de réduire les prescriptions de BLLS à l'échelle collective, sans augmenter le risque d'échec à l'échelle individuelle. Les deux critères essentiels dans la décision sont : la présence d'une fistule et l'identification de BGN en préopératoire. [ABSTRACT FROM AUTHOR]

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., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Introduction: There is no consensus in the literature, or even within the same team, on the most appropriate treatment option for acute paronychia with abscess formation. The performance of an evaluation of professional practices (EPP) using a clinical audit measures the quality of our practices with the aim of standardizing them. Therefore, the primary objective of this study was to develop a clinical pathway for the management of acute paronychia with abscess formation. The secondary objectives were to evaluate our professional practices using a clinical audit before and after the dissemination of the clinical pathway and then recommend strategies for improving our management of acute paronychia with abscess formation., Materials and Methods: A working group was established that designed an audit grid comprised of 15 items. Thirty patients (Group 1) who had an acute paronychia with abscess formation were included and their health records were analyzed using this audit grid. The working group then developed a clinical pathway for the management of acute paronychia with abscess formation. Thirty new patients (Group 2) were included after the dissemination of this clinical pathway and their records were analyzed using the same audit grid., Results: Our clinical pathway for the management of acute paronychia was validated by the local infectious disease committee of our university hospital center. The difference between groups 1 and 2 was significant (p<0.05) for eight items. There was no significant difference in the rate of surgical revision between the two groups., Discussion: This EPP enabled us to develop a clinical pathway that detailed the processes for managing acute paronychia with abscess formation, and in particular it provided indications for antibiotic therapy and its limitations., Level of Evidence: IV, retrospective study., (Copyright © 2021. Published by Elsevier Masson SAS.)

Introduction: Surgical treatment for chronic infection of total elbow arthroplasty (TEA) generally involves 2-stage exchange. In the lower limb, 1-stage strategies are increasingly implemented, but few cases have been reported for the elbow. We present results in a preliminary series, with the aim of: (1) assessing control of infection in systematic 1-stage exchange for chronic TEA infection, (2) detailing clinical and radiological results, and (3) analyzing intra- and post-operative complications., Hypothesis: Systematic 1-stage exchange for chronic TEA prosthetic joint infection provides satisfactory control of infection., Material and Methods: Seven non-selected patients were operated on by 1-stage exchange for chronic infection of TEA during the study period. Two died before the minimum 2 years' follow-up, from causes unrelated to the infection. Thus 5 patients (4 women, 1 man; mean age at surgery, 61 years [range: 48-69 years]) were included for analysis. At a minimum 2 years' follow-up, all underwent clinical examination and elbow X-ray. Infection was monomicrobial in 4 cases and polymicrobial in 1. Isolates comprised Staphylococcus aureus in 40% of cases (2/5), Staphylococcus epidermidis in 60% (3/5) and Staphylococcus Warneri in 20% (1/5). Three patients showed fistula. Three were under immunosuppression/immunomodulation treatment., Results: At a mean 40 months' follow-up (range: 24-60 months), 4 patients (80%) were free of infection and 1 showed signs of persistent infection. Mean range of flexion-extension was 81° (range: 60-95°) and pronation-supination 128° (range: 80-160°). Mean Mayo Elbow Performance Score was 75 points (range: 65-90). There were 2 intraoperative fractures and 1 neurologic deficit with partial regression., Conclusion: One-stage exchange provided control of infection in 80% of cases, despite cutaneous fistulae or immunosuppression treatment. Clinical results and complications rate were similar to those reported for 2-stage exchange., Level of Evidence: IV; retrospective study without control group., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Competing Interests: Competing interests: None declared.