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Volume 29, Number 6—June 2023
CME ACTIVITY - Synopsis

Case Studies and Literature Review of Francisella tularensis–Related Prosthetic Joint Infection

Léa Ponderand, Thomas Guimard, Estibaliz Lazaro, Henry Dupuy, Olivia Peuchant, Nathalie Roch, Philippe Deroche, Tristan Ferry, Max Maurin, Aurélie Hennebique, Sandrine Boisset, Isabelle Pelloux, and Yvan CasparComments to Author 
Author affiliations: Grenoble Alpes University Hospital Center, Grenoble, France (L. Ponderand, M. Maurin, A. Hennebique, S. Boisset, I. Pelloux, Y. Caspar); Univ. Grenoble Alpes, CNRS, CEA, IBS, Grenoble, France (L. Ponderand, S. Boisset, Y. Caspar); Departmental Hospital Center of Vendée, La Roche sur Yon, France (T. Guimard); University Hospital Center of Haut-Lévêque, Pessac, France (E. Lazaro, H. Dupuy); University Hospital Center of Bordeaux, Bordeaux, France (O. Peuchant); William Morey Hospital Center, Chalon-sur-Saône, France (N. Roch); Dracy-le-Fort Orthopedic Center, Dracy-le-Fort, France (P. Deroche); Claude Bernard University Lyon 1, CNRS ENS Lyon, INSERM, Lyon, France (T. Ferry); Croix-Rousse University Hospital Center, Hospices Civils de Lyon, Lyon (T. Ferry); Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble (M. Maurin, A. Hennebique)

Main Article

Table 2

Surgery, antibiotic treatment, and follow-up of patients with Francisella tularensis-related prosthesis joint infection

Characteristic
 Case
1
 2
 3
 4 (10)
 5 (11)
 6 (11)
 7 (12)
 8 (13)
Surgery
 1-stage revision joint replacement
 1-stage revision joint replacement
 1-stage revision with partial joint replacement
 Repeated joint aspiration
 2-stage revision joint replacement
 Repeated joint aspiration
 DAIR
 2-stage revision joint replacement
Antibiotic treatment
Before surgery DOX 100 mg 2×/d until surgery OFX 200 mg 2×/d for 6 wk ND ND AMC AMC ND IV cloxacillin 2 g/6 h for 10 d, oral cloxacillin 500 mg 4×/d
After surgery
 CIP 750 mg 2×/d + DOX 100 mg x2 2×/d for 9 wk
 IV CIP 500 mg 2×/d + IV AMK 1,200 mg for 5 d, CIP 500 mg 2×/d for 6 wk
 CIP 750 mg 2×/d 3 mo, lifetime treatment by DOX 100 mg 2×/d
 DOX, dosage NA
 DOX 100 mg 2×/d for 6 wk
 DOX 100 mg 2×/d for 20 d + GEN 240 mg for 10 d, CIP 500 mg 2×/d for 20 d
 DOX 100 mg 2×/d for 12 mo
 IV CFZ 2g/8h 6 wk + RIF 300 mg 2×/d, CIP 500 mg 2×/d + RIF 300 mg 2×/d >6 mo
Progress at follow up
 No relapse, no biologic inflammatory limp, chronic joint pain
 Biologic surveillance, favorable evolution
 Favorable evolution with mild limp
 No relapse, persistence of knee swelling
 Favorable evolution
 Small pain-free effusion at 24 mo
 Resolution of pain and skin lesion
 Resolution of symptoms under treatment
Staff monitoring or prophylaxis Prophylactic DOX or CIP NA Clinical and serologic NA Serologic Prophylactic DOX NA NA

*AMC, amoxicillin/clavulanic acid; AMK, amikacin; CFZ, cefazolin; CIP, ciprofloxacin; DOX, doxycycline; DAIR, debridement, antibiotics, implant retention; GEN, gentamicin; IV, intravenous; NA, not available; ND, not done; OFX, ofloxacin; RIF, rifampin.

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