2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions

Abstract

Musculoskeletal infections (MSKI) remain the bane of orthopedic surgery, and result in grievous illness and inordinate costs that threaten healthcare systems. As prevention, diagnosis, and treatment has remained largely unchanged over the last 50 years, a 2nd International Consensus Meeting on Musculoskeletal Infection (ICM 2018, https://icmphilly.com) was completed. Questions pertaining to all areas of MSKI were extensively researched to prepare recommendations, which were discussed and voted on by the delegates using the Delphi methodology. The questions, including the General Assembly (GA) results, have been published (GA questions). However, as critical outcomes include: (i) incidence and cost data that substantiate the problems, and (ii) establishment of research priorities; an ICM 2018 research workgroup (RW) was assembled to accomplish these tasks. Here, we present the result of the RW consensus on the current and projected incidence of infection, and the costs per patient, for all orthopedic subspecialties, which range from 0.1% to 30%, and $17,000 to $150,000. The RW also identified the most important research questions. The Delphi methodology was utilized to initially derive four objective criteria to define a subset of the 164 GA questions that are high priority for future research. Thirty-eight questions (23% of all GA questions) achieved the requisite > 70% agreement vote, and are highlighted in this Consensus article within six thematic categories: acute versus chronic infection, host immunity, antibiotics, diagnosis, research caveats, and modifiable factors. Finally, the RW emphasizes that without appropriate funding to address these high priority research questions, a 3rd ICM on MSKI to address similar issues at greater cost is inevitable. ICM, International Consensus Meeting; MSKI, musculoskeletal infections; RW, research workgroup. * 2018 ICM RW consensus on the current and projected incidences of infection, and costs per patient, for all orthopedic subspecialties. These estimates, which were compiled from information were obtained from: (i) recent peer-reviewed publications, (ii) analysis of 2015 national administrative data using HCUPNet (https://hcupnet.ahrq.gov/#setup), and (iii) RW expertise. 998 SCHWARZ ET AL.

Investigation of biofilm production and its association with genetic and phenotypic characteristics of OM (osteomyelitis) and non-OM orthopedic Staphylococcus aureus

“…Staphylococcus aureus is a common and versatile grampositive pathogen in orthopedic patients [1,2]. The notorious bacterium attracts more and more attention because of its ability of producing various virulence factors and the worsening situation of drug resistance [3].…”

Biofilm Producing Staphylococcus epidermidis (RP62A Strain) Inhibits Osseous Integration Without Osteolysis and Histopathology in a Murine Septic Implant Model

“…Orthopaedic implant-related infections remain a devastating problem that threatens life, wellness, and our healthcare systems. 1 Staphylococci species are responsible for the majority of implant-associated osteomyelitis, and account for~80% of the cases. 1,2 Historically, Staphylococci were distinguished by their ability to produce coagulase; a virulent enzyme that causes fibrin to clot.…”

“…1 Staphylococci species are responsible for the majority of implant-associated osteomyelitis, and account for~80% of the cases. 1,2 Historically, Staphylococci were distinguished by their ability to produce coagulase; a virulent enzyme that causes fibrin to clot. 3 Examples of this are Staphylococcus epidermidis (S. epidermidis), which is a representative species of coagulase-negative Staphylococci (CNS), and Staphylococcus aureus (S. aureus), which is the most common coagulase-positive organism in implant-associated infection.…”

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

“…Prosthetic joint infection (PJI) is a devastating complication that results in substantial costs to society and patient morbidity 1 . Despite being the focus of research efforts for many years, treatment failure of PJI remains high with failures rates up to 50% 2–4 .…”