Impact of a multidisciplinary staff meeting on the quality of antibiotherapy prescription for bone and joint infections in orthopedic surgery.

INTRODUCTION: We studied the impact of a weekly multidisciplinary staff meeting (MSM) on the quality of antibiotherapy for bone and joint infections in orthopedic surgery, as part of professional practice assessment. MATERIALS AND METHODS: We retrospectively studied the file of patients hospitalized for bone and joint infection. We compared antibiotherapy compliance to good use (bacteriology, dose, length of treatment, length of adaptation to microbiology), and outcome at six months for patients with bone and joint infections, before (March 2007 to March 2009) and after (March 2009 to March 2011) implementation of the multidisciplinary staff meeting. We identified 28 patient files (32 infections) before MSM and 26 patient files (28 infections) after MSM. RESULTS: Antibiotherapy was adapted in 47% of cases before MSM, versus 96% after (P<0.0001). The dose was optimum in 72% of infections before MSM, versus 89% after (P=0.11) and the length of antibiotherapy complied with recommendations in 41% of infections before MSM, versus 86% after (P=0.0005). The average time of antibiotic adaptation to the antibiogram changed from 2 days before MSM to 1.7 days after (P=0.43). Forty seven per cent of patients were cured at six months before MSM, versus 57% after (P=0.45); the rate of treatment failure at six months decreased from 25% before MSM to 18% after (P=0.75). CONCLUSION: The effectiveness of antibiotherapy significantly improved concerning the spectrum and treatment duration (P ≤ 0.0005) after implementing MSMs in orthopedic surgery. But the clinical impact at six months was not significant due to the small population sample.

Osteomalacia revealing celiac disease and primary biliary cirrhosis-related Fanconi syndrome in a patient with systemic sclerosis.

Systemic sclerosis (SSc) may affect the gastrointestinal tract and cause very rarely malabsorption syndrome related to bacterial overgrowth. Malabsorption syndrome may be responsible for weight loss, diarrhea, osteomalacia, and iron and vitamins deficiency. We report the case of a SSc patient who developed osteomalacia caused by the combination of two exceptional conditions in the setting of SSc: celiac disease (CD) and primary biliary cirrhosis (PBC)-related Fanconi syndrome. Oral prednisone with angiotensin-converting enzyme inhibitors, was initiated because of active lesions of tubulitis, and led to the complete regression of bone pains, and by the improvement of renal function and regression of the features of proximal tubulopathy. Thus, in the presence of vitamin deficiencies in a patient with SSc, together with a search for malabsorption syndrome secondary to bacterial overgrowth, CD and/or PBC-associated Fanconi syndrome should be investigated.