Tristan Ferry1, Piseth Seng2, Didier Mainard3, Jean-Yves Jenny4, Frédéric Laurent5, Eric Senneville6, Marion Grare7, Anne Jolivet-Gougeon8, Louis Bernard9, Simon Marmor10. 1. Service de maladies infectieuses, CRIOAc de Lyon, hôpital de la Croix-rousse, hospices civils de Lyon, 93, grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: tristan.ferry@univ-lyon1.fr. 2. Pôle MIT, IHU Méditerranée infection, CRIOAc de Marseille, AP-HM La Timone, 21, avenue Jean-Moulin, 13385 Marseille cedex 05, France. 3. Centre chirurgical Emile Gallé, CRIOAc de Nancy, 49, rue Hermite, 54000 Nancy, France. 4. CRIOAc de Strasbourg, hôpitaux universitaires de Strasbourg, 10, avenue Achille-Baumann, 67400 Illkirch, France. 5. Service de maladies infectieuses, CRIOAc de Lyon, hôpital de la Croix-rousse, hospices civils de Lyon, 93, grande rue de la Croix-Rousse, 69004 Lyon, France. 6. CRIOAc de Lille-Tourcoing, CHU de Lille, place de Verdun, 59037 Lille, France; Centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59200 Tourcoing, France. 7. CRIOAc de Toulouse, hôpital Purpan, CHU de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex 9, France. 8. CRIOAc de Rennes, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex, France. 9. CRIOAc de Tours, hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France. 10. CRIOAc de Paris, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
Abstract
BACKGROUND: Bone and joint infections (BJIs) have a major clinical and economic impact in industrialized countries. Its management requires a multidisciplinary approach, and a great experience for the most complicated cases to limit treatment failure, motor disability and amputation risk. To our best knowledge there is not currently national specific organization dedicated to manage BJI. Is it possible to build at a national level, a network involving orthopaedic surgeons, infectiologists and microbiologists performing locally multidisciplinary meetings to facilitate the recruitment and the management of patients with complex bone and joint infection in regional centers? HYPOTHESIS: A national healthcare network with regional labeled centers creates a dynamic that improves the recruitment, the management, the education, and the clinical research in the field of complex BJI. PATIENTS AND METHODS: We describe the history of this unique national healthcare network and how it works, specify the missions confided to the CRIOAcs, evaluate the activity of the network over the first decade, and finally discuss perspectives. RESULTS: The labelling of 24 centers in the CRIOAc network allowed for a meshing of the territory, with the possibility of management of complex BJI in each region of France. A dedicated secure national online information system was designed and used to facilitate decision-making during multidisciplinary consultation meetings. Since October 2012 to June 2017, 4553 multidisciplinary consultation meetings have been performed in the structures belonging to the network, with 34,607 cases discussed in 19,961 individual. Prosthetic joint infections represented 38% (7585/19,961) of all BJIs. Among all the cases discussed, the rate of complexity was of 61% (21,110/34,607) (related to antibiotic resistance, infection recurrence, patient co morbidities). A national scientific meeting was created and a national postgraduate diploma in the field of BJI was launched in 2014. The promotion of education, clinical research and interactivity between each academic discipline and between each labeled centers across the country has synergized the strengths and have greatly facilitated the management of patients with BJI. DISCUSSION: The setting up of the CRIOAc network in France took time, and has a cost for the French Ministry of Health. However, this network has greatly facilitated the management of BJI in France, and allowed to concentrate the management of complex BJI in centers that have significantly gained skills. There is, to our knowledge, no other exemple of such nationwide network in the field of BJI. LEVEL OF EVIDENCE: IV, case series without control group.
BACKGROUND: Bone and joint infections (BJIs) have a major clinical and economic impact in industrialized countries. Its management requires a multidisciplinary approach, and a great experience for the most complicated cases to limit treatment failure, motor disability and amputation risk. To our best knowledge there is not currently national specific organization dedicated to manage BJI. Is it possible to build at a national level, a network involving orthopaedic surgeons, infectiologists and microbiologists performing locally multidisciplinary meetings to facilitate the recruitment and the management of patients with complex bone and joint infection in regional centers? HYPOTHESIS: A national healthcare network with regional labeled centers creates a dynamic that improves the recruitment, the management, the education, and the clinical research in the field of complex BJI. PATIENTS AND METHODS: We describe the history of this unique national healthcare network and how it works, specify the missions confided to the CRIOAcs, evaluate the activity of the network over the first decade, and finally discuss perspectives. RESULTS: The labelling of 24 centers in the CRIOAc network allowed for a meshing of the territory, with the possibility of management of complex BJI in each region of France. A dedicated secure national online information system was designed and used to facilitate decision-making during multidisciplinary consultation meetings. Since October 2012 to June 2017, 4553 multidisciplinary consultation meetings have been performed in the structures belonging to the network, with 34,607 cases discussed in 19,961 individual. Prosthetic joint infections represented 38% (7585/19,961) of all BJIs. Among all the cases discussed, the rate of complexity was of 61% (21,110/34,607) (related to antibiotic resistance, infection recurrence, patient co morbidities). A national scientific meeting was created and a national postgraduate diploma in the field of BJI was launched in 2014. The promotion of education, clinical research and interactivity between each academic discipline and between each labeled centers across the country has synergized the strengths and have greatly facilitated the management of patients with BJI. DISCUSSION: The setting up of the CRIOAc network in France took time, and has a cost for the French Ministry of Health. However, this network has greatly facilitated the management of BJI in France, and allowed to concentrate the management of complex BJI in centers that have significantly gained skills. There is, to our knowledge, no other exemple of such nationwide network in the field of BJI. LEVEL OF EVIDENCE: IV, case series without control group.
Authors: Adrien Lemaignen; Leslie Grammatico-Guillon; Pascal Astagneau; Simon Marmor; Tristan Ferry; Anne Jolivet-Gougeon; Eric Senneville; Louis Bernard Journal: Bone Joint Res Date: 2020-10-10 Impact factor: 5.853
Authors: Marie Titécat; Caroline Loïez; François Demaeght; Jean-Thomas Leclerc; Théo Martin; Hervé Dezèque; Henri Migaud; Eric Senneville Journal: Front Med (Lausanne) Date: 2021-05-17