Impact of Three Probabilistic Antibiotic Therapy on Digestive Microbiota and Colonization With Multi-resistant Bacteria

Inclusion criteria

• Age ≥ 18 years
• Indication for prosthetic revision (PTG, PUC, PTH or hip hemiarthroplasty, PTE) or internal osteosynthesis with suspicion of IOAM following the opinion of a Réunion de concertation Pluridisciplinaire (RCP) on complex osteoarticular infections
• Normal CPK level according to laboratory standard
• Social security affiliation
• Signature of informed consent
• Negative pregnancy test for women of childbearing age.

Exclusion criteria

• Antibiotic therapy in the 3 months prior to inclusion
• Clinical or radiological signs making HAI highly probable: scar discharge and/or peri-scar cellulitis fistula or abscess, bacteremia
• positive bacterial culture from joint puncture or biopsy prior to revision
• Chronic inflammatory bowel disease.
• Previous surgical resection of small intestine or colon.
• Hypersensitivity to daptomycin or any of its excipients.
• Hypersensitivity to cefepime or any of its excipients or to other beta-lactamins.
• Hypersensitivity to piperacillin+tazobactam or to any of the excipients or to other beta-lactamines.
• Hypersensitivity to ceftobiprole or to any of the excipients or to other beta-lactamines.
• Renal insufficiency with GFR < 50ml/min/1.73 m2 (CKD-EPI).
• Treatment with bosentan.
• Treatment with probenecid.
• Pre-existing seizure disorder.
• Contraindication to L-arginine, acidosis, hyperkalemia that cannot be corrected.
• Treatment with HMG-CoA reductase inhibitors.
• Treatment with statins (pitavastin, pravastatin, rosuvastatin) or glyburide.
• Patients in a medical emergency.
• Pregnant or breast-feeding women.
• Patient participating in another ongoing trial.
• Mental state rendering the patient incapable of understanding this research.
• Patient deprived of liberty by administrative or judicial decision.