M Ollivier1, E Senneville2, M Drancourt3, J N Argenson4, H Migaud5. 1. Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Institut du Mouvement et de l'Appareil Locomoteur, Aix-Marseille Université, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Centre de référence pour le traitement des infections ostéo-articulaires Sud-Méditerranée, Aix-Marseille Université, Marseille, France. Electronic address: ollivier.mt@gmail.com. 2. Service universitaire de maladies infectieuses et du voyageur, Hôpital Dron, rue du Président-Coty, 59208 Tourcoing, France; Hôpital Salengro, CHRU de Lille, Centre de référence pour le traitement des infections ostéo-articulaires G4 Lille-Tourcoing, rue Emile-Laine, 59037 Lille, France; Université Lille-Nord de France, 59000 Lille, France. 3. Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Institut du Mouvement et de l'Appareil Locomoteur, Aix-Marseille Université, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Centre de référence pour le traitement des infections ostéo-articulaires Sud-Méditerranée, Aix-Marseille Université, Marseille, France; Laboratoire de Microbiologie, Hôpital Timone, CHU de Marseille et URMITE, Assistance Publique-Hôpitaux de Marseille, Faculté de Médecine, IHU Méditerranée Infection, Aix-Marseille Université, Marseille, France. 4. Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Institut du Mouvement et de l'Appareil Locomoteur, Aix-Marseille Université, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Centre de référence pour le traitement des infections ostéo-articulaires Sud-Méditerranée, Aix-Marseille Université, Marseille, France. 5. Hôpital Salengro, CHRU de Lille, Centre de référence pour le traitement des infections ostéo-articulaires G4 Lille-Tourcoing, rue Emile-Laine, 59037 Lille, France; Université Lille-Nord de France, 59000 Lille, France; Service d'Orthopédie C, CHRU de Lille, rue Emile-Laine, 59000 Lille, France.
Abstract
BACKGROUND: Despite the large volume of studies on the prevention, diagnosis, and treatment of peri-prosthetic infections, surgical practice often rests on limited scientific evidence in this field. The vast International Consensus Meeting on Peri-prosthetic Joint Infection (ICMPJI) held in 2013 produced robust recommendations. HYPOTHESIS: French consensus conference recommendations show no major differences with ICMPJI recommendations. MATERIALS AND METHODS: The 207 recommendations developed by 300 experts at the ICMPJI were translated, and the translation was then examined by four reviewers, including 2 having participated in the consensus conference. The reviewers looked for any differences with French practices and recommendations. RESULTS: Twenty-three major differences or innovations were identified compared to French recommendations and standard practice. Among them, pre-operative screening for nasal or urinary micro-organisms is performed routinely in France but should be reserved according to the ICMPJI for symptomatic patients and/or patients at high risk for infection. The ICMPJI emphasizes the role for the operating room environment as a vector for infection; more specifically, the operating lamp handle and suction cannula deserve close attention. A wound discharge persisting longer than 5-7 days requires irrigation and debridement. This procedure is effective only within the first 3 post-operative months and/or the first 3 weeks after symptom onset and must include exchange of all modular implants. The ICMPJI warns against both irrigation-debridement in fungal infections (suggesting two-stage prosthesis replacement) and one-stage replacement in patients with sinus tracts. The use of spacers (articulating at the knee) is recommended in the event of two-stage prosthesis replacement. DISCUSSION: The ICMPJI recommendations differed in many ways with French recommendations and standard practice. They can be expected to impact practices in France, although a point worth noting is that only 1 of the 207 recommendations received unanimous agreement by the conference experts (keeping operating room traffic to a minimum).
BACKGROUND: Despite the large volume of studies on the prevention, diagnosis, and treatment of peri-prosthetic infections, surgical practice often rests on limited scientific evidence in this field. The vast International Consensus Meeting on Peri-prosthetic Joint Infection (ICMPJI) held in 2013 produced robust recommendations. HYPOTHESIS: French consensus conference recommendations show no major differences with ICMPJI recommendations. MATERIALS AND METHODS: The 207 recommendations developed by 300 experts at the ICMPJI were translated, and the translation was then examined by four reviewers, including 2 having participated in the consensus conference. The reviewers looked for any differences with French practices and recommendations. RESULTS: Twenty-three major differences or innovations were identified compared to French recommendations and standard practice. Among them, pre-operative screening for nasal or urinary micro-organisms is performed routinely in France but should be reserved according to the ICMPJI for symptomatic patients and/or patients at high risk for infection. The ICMPJI emphasizes the role for the operating room environment as a vector for infection; more specifically, the operating lamp handle and suction cannula deserve close attention. A wound discharge persisting longer than 5-7 days requires irrigation and debridement. This procedure is effective only within the first 3 post-operative months and/or the first 3 weeks after symptom onset and must include exchange of all modular implants. The ICMPJI warns against both irrigation-debridement in fungal infections (suggesting two-stage prosthesis replacement) and one-stage replacement in patients with sinus tracts. The use of spacers (articulating at the knee) is recommended in the event of two-stage prosthesis replacement. DISCUSSION: The ICMPJI recommendations differed in many ways with French recommendations and standard practice. They can be expected to impact practices in France, although a point worth noting is that only 1 of the 207 recommendations received unanimous agreement by the conference experts (keeping operating room traffic to a minimum).
Authors: O Lesens; T Ferry; E Forestier; E Botelho-Nevers; P Pavese; E Piet; B Pereira; E Montbarbon; B Boyer; S Lustig; S Descamps Journal: Eur J Clin Microbiol Infect Dis Date: 2018-08-07 Impact factor: 3.267