Impact of a multidisciplinary staff meeting on the quality of antibiotherapy prescription for bone and joint infections in orthopedic surgery

Bauer, Stefan; Bouldouyre, Marie‐Anne; Oufella, Arezki; Palmari, P.F.; Bakir, R; Fabreguettes, A.; Gros, Hélène

doi:10.1016/j.medmal.2012.09.005

Cited by 22 publications

(12 citation statements)

References 14 publications

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“…Since the age and underlying conditions of patients cannot be modified, these results stress the need to develop clinical trials aiming to reduce the treatment duration for these infections. Although our results failed to link the occurrence of SAE with an early referral to an infectious disease specialist, an early interaction between surgeons, microbiologists, and infectious disease clinicians might help reduce the incidence of antimicrobial-related SAE, in addition to being cost-efficient regarding the improvement of antibiotic therapy quality in BJI (21,22). For instance, Pestotnik et al (23) showed a decrease by 30% in the incidence of AE after the application of a computerassisted antimicrobial prescription support based on clinician recommendations.…”

Section: Resultsmentioning

confidence: 59%

Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

Valour

Karsenty

Bouaziz

et al. 2014

Antimicrob Agents Chemother

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Bone and joint infections (BJI), including septic arthritis, osteomyelitis, and orthopedic device-related infections (ODI), constitute difficult-to-treat clinical entities, as they chronically evolve and frequently cause a relapse in infection (1-4). Staphylococcus aureus is the leading cause of BJI, accounting for approximately 50% of cases, and it is particularly associated with treatment failure due to its various virulence factors, including its great ability to form biofilms (5-7). These concerns have led to the recommendation of a prolonged antimicrobial course in S. aureus BJI, frequently in combination to avoid the acquisition of drug resistance, with initial administration via the intravenous route and at a high dosage (8-10). It is well known that the prolonged use of antimicrobial combinations is associated with an increased toxicity risk (11), but only limited and conflicting data are found in the literature concerning the prevalence and predictive factors of antimicrobial-related adverse events (AE) occurring during the treatment of BJI. A recent meta-analysis concluded that the incidences of AE are 16.1% for mild AE and 7.7% for moderate and severe AE (12), but some studies found the incidence of AE can reach rates as high as 50% of the patients (13,14). We aimed to describe the occurrence of and risk factors for antimicrobial-related AE in a retrospective cohort study that included patients admitted to a regional reference center with methicillin-susceptible S. aureus (MSSA) BJI. MATERIALS AND METHODSEthics statements. This study received the approval of the French SouthEast ethics committee with the reference number CAL2011-021. In accordance with French legislation, written informed patient consent was not required for any part of the study.Inclusion criteria and data collection. All patients with MSSA BJI who followed up in our institution between 2001 and 2011 were enrolled in a retrospective cohort study. Patients with diabetic foot-and decubitus ulcer-related BJI were excluded because of the particular pathophysiology proceeded by contiguity with bone exposition and implicating diabetesassociated vascular disease and peripheral neuropathy, leading to a specific management of these infections. For each patient, data were collected from medical records, nursing charts, and biological software in an anonymous standardized case report form.Definitions. BJI diagnosis was based upon the existence of clinical and biological evidences of infection and at least one reliable bacteriological

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Section: Resultsmentioning

confidence: 59%

Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

Valour

Karsenty

Bouaziz

et al. 2014

Antimicrob Agents Chemother

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“…It is believed that MDTs improve decisionmaking and lead to superior outcomes for patients 6,[22][23][24] . The effectiveness of an MDT approach in orthopaedics has been reported in a limited number of cases [25][26][27] ; however, that approach is distinct from an MDT meeting composed of an expert panel.…”

Section: Discussionmentioning

confidence: 99%

A New Approach to Managing Patients with Problematic Metal Hip Implants

Berber

Pappas

Khoo

et al. 2015

The Journal of Bone and Joint Surgery

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Our iMDT approach to the metal-on-metal hip burden combines the tacit knowledge of an expert panel, regulatory guidance, and up-to-date evidence to improve decision-making among surgeons. The high level of concordance between the recommendation and the actual outcome, combined with the feasibility of the methods used, suggest that this method effectively reduces uncertainty among surgeons and may lead to improved patient outcomes.

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“…The impact of a referral to infectious disease specialist has been evaluated in several studies, which showed a benefit in terms of early adaptation of the initial empirical therapy after bacteriological results, and regarding dosages and duration of antimicrobials [4, 15]. However, these series failed to highlight an improvement of BJI outcome.…”

Section: Discussionmentioning

confidence: 99%

“…However, these series failed to highlight an improvement of BJI outcome. Nevertheless, Bauer and colleagues showed a decrease from 25 to 18% of treatment failure rate after the instauration of a weekly multidisciplinary staff meeting in their institution, even if this difference was not significant [15]. …”

Section: Discussionmentioning

confidence: 99%

Determinants of methicillin-susceptible Staphylococcus aureusnative bone and joint infection treatment failure: a retrospective cohort study

et al. 2014

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BackgroundAlthough methicillin-susceptible Staphylococcus aureus (MSSA) native bone and joint infection (BJI) constitutes the more frequent clinical entity of BJI, prognostic studies mostly focused on methicillin-resistant S. aureus prosthetic joint infection. We aimed to assess the determinants of native MSSA BJI outcomes.MethodsRetrospective cohort study (2001–2011) of patients admitted in a reference hospital centre for native MSSA BJI. Treatment failure determinants were assessed using Kaplan-Meier curves and binary logistic regression.ResultsSixty-six patients (42 males [63.6%]; median age 61.2 years; interquartile range [IQR] 45.9–71.9) presented an acute (n = 38; 57.6%) or chronic (n = 28; 42.4%) native MSSA arthritis (n = 15; 22.7%), osteomyelitis (n = 19; 28.8%) or spondylodiscitis (n = 32; 48.5%), considered as “difficult-to-treat” in 61 cases (92.4%). All received a prolonged (27.1 weeks; IQR, 16.9–36.1) combined antimicrobial therapy, after surgical management in 37 cases (56.1%). Sixteen treatment failures (24.2%) were observed during a median follow-up period of 63.3 weeks (IQR, 44.7–103.1), including 13 persisting infections, 1 relapse after treatment disruption, and 2 super-infections. Independent determinants of treatment failure were the existence of a sinus tract (odds ratio [OR], 5.300; 95% confidence interval [CI], 1.166–24.103) and a prolonged delay to infectious disease specialist referral (OR, 1.134; 95% CI 1.013–1.271).ConclusionsThe important treatment failure rate pinpointed the difficulty of cure encountered in complicated native MSSA BJI. An early infectious disease specialist referral is essential, especially in debilitated patients or in presence of sinus tract.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-443) contains supplementary material, which is available to authorized users.

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Impact of a multidisciplinary staff meeting on the quality of antibiotherapy prescription for bone and joint infections in orthopedic surgery

Cited by 22 publications

References 14 publications

Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

A New Approach to Managing Patients with Problematic Metal Hip Implants

Determinants of methicillin-susceptible Staphylococcus aureusnative bone and joint infection treatment failure: a retrospective cohort study

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