dragnès meybeck, drolivierleroy# duacai2017# · overweight or obesity boderate renal chronic...
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Dr Agnès Meybeck, Dr Olivier Leroy DUACAI 2017
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Entre 1982 et 2002 à la Mayo clinique : 51 cas d’infecJon de prothèse vasculaire, dont 28 infecJons d’une prothèse aorJque; Etude cas-‐témoins: Facteurs de risque d’infecJon : abord du scarpa, complicaJon ou infecJon de la plaie opératoire.
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5 interrup*ons de la daptomicine pour effets secondaires: -‐ myalgies (n=1), -‐ augmentaJon des CPK (n=4)
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AnJbiothérapie probabiliste iniJale
Tableau clinique Pas d’allergie à la penicilline Allergie à la penicilline
IPV sans sepsis sévère ni ATCD de BMR
Piperacilline/tazobactam + vancomycine ou daptomycine +/-‐ gentamicine
Cefotaxime ou cefepime ou aztreonam+ metronidazole+ vancomycine ou daptomycine +/-‐gentamicine
IPV avec sepsis sévère et/ou ATCD de BMR
Imipénème ou meropénème ou doripénème+ vancomycine ou daptomycine +/-‐ gentamicine
Fosfomycine+métronidazole+vancomycine ou daptomycine +/-‐gentamicine
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AnJbiothérapie en cas d’IPV à Staphylocoques meJS
surgery
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AnJbiothérapie en cas d’IPV à Staphylocoques meJR
surgery
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AnJbiothérapie en cas d’IPV à entérobactéries
surgery
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Durée d’anJbiothérapie
• Durée proposée par le groupe d’expert : 6 semaines de traitement post-‐opératoire le plus souvent IV;
• En cas de traitement chirurgical subopJmal:
une anJbiothérapie suppressive sera discutée (molécules uJlisées : cyclines, trimethoprim-‐ sulfamethoxazole, fluoroquinolones)
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