Hôpital Ambroise-Paré

Septic nonunion of tibial plateau fractures is an exceptionally rare and severe complication for which long-term outcomes and the need for definitive salvage procedures are poorly documented. The juxta-articular location, limited bone stock, and frequent soft-tissue compromise make management particularly challenging, even in specialised centres. It was hypothesised that most patients with septic nonunion of the tibial plateau ultimately require non-reconstructive salvage procedures and experience poor long-term functional outcomes. A retrospective cohort study was conducted at a national referral centre for complex osteoarticular infections (CRIOAC). All adults treated for septic nonunion of the tibial plateau between 2002 and 2023 were included, with a minimum follow-up of two years. Septic nonunion was defined by absent healing after ≥6 months combined with microbiologically confirmed deep infection according to Fracture-Related Infection (FRI) criteria. Demographic data, fracture characteristics, microbiology, surgical management, and long-term outcomes were collected. The primary outcome was the rate and type of non-reconstructive salvage procedures (arthrodesis, transfemoral amputation, or delayed total knee arthroplasty). Functional outcomes (KSS, KOOS, VAS, range of motion) were assessed when applicable. Twenty-eight patients were included (mean age 45 ± 15 years; mean follow-up 8.1 ± 6.3 years). Only 5 of 28 patients (18%) achieved both union and infection remission without salvage surgery. Salvage procedures were required in 23 of 28 patients (82%), including total knee arthroplasty in 14 (50%), femorotibial arthrodesis in 4 (14%), and transfemoral amputation in 5 (18%). Persistent infection at final follow-up was recorded in 6 of 28 patients (21%). Functional outcomes were generally poor, with KSS 46.1 ± 12.2 and KOOS 41.4 ± 9.6 among patients retaining a mobile joint. Numerical trends suggested that diabetes, immunosuppression, open fractures, and polymicrobial infection may be associated with failure. Septic nonunion of the tibial plateau is associated with extremely limited reconstructive potential and a high likelihood of salvage procedures, even within a specialised multidisciplinary centre. These results provide essential data for prognosis assessment and transparent patient counselling in this complex clinical scenario. IV; retrospective cohort study.

To describe a series of doxycycline-induced fixed drug eruptions (FDE) observed in sexual health clinics, in a context of increasing doxycycline use for sexually transmitted infection (STI) management and prophylaxis in France. We conducted a retrospective case series, combined with a doxycycline prescription audit and a sexual health clinician survey. Thirteen male patients (mean age: 32.5 years) were diagnosed with doxycycline-induced FDE. Most were MSM (men who have sex with men, 84.6%) and received doxycycline for STI treatment (92.3%). Lesions were mainly genital (85%) and often misdiagnosed as ulcerative STIs. Doxycycline prescriptions increased by 345% between 2018 and 2024. When performed, allergy workups confirmed the diagnosis in 60% of cases. The sharp rise in doxycycline use for STI prophylaxis coincides with the identification of multiple FDE cases. Enhanced dermatological awareness is needed within antimicrobial stewardship programs to ensure safer implementation of doxycycline-based prevention strategies.

<h3>Background and Importance</h3> Oral antibiotic therapy for bone and joint infections (BJIs) is often prolonged and frequently associated with adverse events (AEs), which can compromise adherence and clinical outcomes. Pharmacist involvement during the hospital to home transition may enhance patient safety and treatment continuity. <h3>Aim and Objectives</h3> To assess, through a prospective randomised controlled trial, the impact of pharmacist–patient consultations (PCs) on AE management and patient knowledge during oral antibiotic therapy for BJIs. <h3>Material and Methods</h3> This prospective, randomised controlled trial (EFIRAD) included adults hospitalised for BJI, undergoing surgery, and discharged with a 4–12 week oral antibiotic prescription. Patients were randomised 1:1 to receive either a structured pharmacist–patient consultation (PC group) or standard discharge counselling (control). Telephone follow-ups were conducted at day 7 (D7) and day 14 (D14) to collect AEs and evaluate AE management, classified as optimal or non-optimal using a predefined decision tree. Patient knowledge was assessed using a validated 12-item questionnaire. <h3>Results</h3> Eighty-four patients were included (PC: n=41; control: n=43), with comparable baseline characteristics. At D7, 74% of patients reported ≥1 AE, mostly gastrointestinal (72%) and mild (grade I, 84%). Adverse event evolution between D7 and D14 was monitored, showing a decrease in overall AEs (74% vs 59%) and in gastrointestinal events (72% vs57%), but an increase in infectious AEs such as oral candidiasis and fungal infections (11.1% vs 3.5%). Optimal AE management was significantly higher in the PC group (95% vs 79%, p=0.03). Knowledge scores were greater in the PC group (p=0.0019), particularly regarding AE recognition, drug interactions, dosing, and appropriate responses. Non-optimal management in the PC group involved minor misuse of symptomatic treatment (n=1) or lack of medical consultation for hypersensitivity (n=1), while in controls it mainly included misuse or non-use of symptomatic treatments (n=7) and absence of medical contact (n=2). No AE required hospital readmission. <h3>Conclusion and Relevance</h3> This prospective randomised controlled trial demonstrates that pharmacist–patient consultations significantly improve AE management and patient knowledge during oral antibiotic therapy for BJIs. These results highlight the clinical relevance of pharmacist involvement in antimicrobial stewardship and support the integration of structured pharmacist-led interventions into post-hospital care pathways. <h3>Conflict of Interest</h3> No conflict of interest

BACKGROUNDEarly surgery for hip fractures in elderly patients is recommended to reduce morbidity and mortality. In patients treated with direct oral anticoagulants (DOACs), early surgical management raises pharmacological and safety concerns. Current guidelines recommend using plasma anticoagulant levels to guide perioperative management, but data describing the time course of DOAC plasma concentrations after the last dose in geriatric patients with hip fracture remain limited.OBJECTIVE(S)To describe the time course of DOAC plasma concentrations according to the estimated time since last intake in elderly patients admitted for hip fracture, and to compare residual concentrations at 24 h between patients with preserved and impaired renal function.DESIGNSingle-centre retrospective observational study.SETTINGSecondary care hospital; emergency admissions for hip fracture surgery. Study period: January 1st, 2022 to March 31st, 2025.PATIENTSPatients aged ≥65 years treated with DOACs and admitted for hip fracture following a low-energy traumatic event. Patients receiving inappropriate DOAC dosing or DOACs despite formal contraindications were excluded from the main analysis.INTERVENTION(S)None.MAIN OUTCOME MEASURESThe primary outcome was the proportion of patients with a plasma DOAC concentration ≥100 ng ml−1 at 24 h after the last estimated dose. Renal impairment was defined as estimated glomerular filtration rate (eGFR) <50 ml min−1.RESULTSData from 186 patients were analysed. Among patients with eGFR ≥50 ml min−1, 1 out of 49 (2.0%) had a plasma DOAC concentration ≥100 ng ml−1 at 24 h. In contrast, 11 patients (9.4%) with eGFR <50 ml min−1 had concentrations ≥100 ng ml−1 at 24 h. Inappropriate DOAC dosing was significantly associated with higher residual plasma concentrations (9 patients excluded).CONCLUSIONSMost elderly patients with preserved renal function had plasma DOAC concentrations below 100 ng ml−1 at 24 h. Although not powered to demonstrate definitive safety, these findings suggest that systematic plasma DOAC monitoring may be unnecessary in selected geriatric patients with hip fracture and preserved renal function. These results should be considered hypothesis-generating.TRIAL REGISTRATIONNot applicable (retrospective observational study).

BackgroundPatient-reported outcome measures (PROMs) are key elements of assessing the efficacy of perioperative pain management. Here, we aimed to capture the association of 10 individually reported aspects of patient's specific impression of change since surgery (PSIC) related to four outcome domains of a previously defined core outcome set, relative to the patient's global impression of change (PGIC). We further evaluated the influence of type of surgery, sex, preoperative baseline characteristics, and satisfaction with pain management on PGIC.MethodsThis exploratory analysis used the PROMPT NIT-1 study data (2661 patients, 18 sites, four surgery types: total knee arthroplasty, sternotomy, breast cancer surgery, or endometriosis surgery). Male and female adults were included. All PROMs were assessed on postoperative day 3. We used ordinal regression models with PGIC as a dependent variable and PSICs as independent variables.ResultsThe overall model achieved a pseudo-R2 of 0.55 (relative domain contributions: pain intensity 55%, self-efficacy 19%, adverse events 15%, and pain-related interference of physical functioning 10%). Pain-related worrying and depression had no association with the PGIC, whereas anxiety, preoperative pain, opioid intake, low satisfaction with and wish for more treatment, low treatment agency, and overall dissatisfaction were associated with less improvement after surgery. Receiving information about treatment was associated with greater improvement on the PGIC.ConclusionsAlthough all four domains contributed to PGIC after surgery, pain intensity was the most important. These findings highlight the importance of both managing postoperative pain and optimising patient experience by addressing self-efficacy, adverse events, and pain-related interference of physical functioning.Clinical trial registrationNCT 03834922