The Value of Ortho-ID Teams in Treating Bone and Joint Infections

Vasoo, Shawn; Chan, Mónica; Sendi, Parham; Berbari, Elie F.

doi:10.7150/jbji.41663

Cited by 20 publications

(12 citation statements)

References 23 publications

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“…Fourth, the absence of infectious diseases specialists in the author list suggests lack of an interdisciplinary team approach to the management of PJI, which is another important factor determining the treatment success of PJI [57,58]. After discharge, adequate intake or administration of antibiotics, patient compliance and modification in case of intolerance should be ensured.…”

Section: Critical Appraisal Of a Randomized Controlled Trial (Rct) Shmentioning

confidence: 99%

Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified?

2021

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Rifampin is a potent antibiotic against staphylococcal implant-associated infections. In the absence of implants, current data suggest against the use of rifampin combinations. In the past decades, abundant preclinical and clinical evidence has accumulated supporting its role in biofilm-related infections.In the present article, experimental data from animal models of foreign-body infections and clinical trials are reviewed. The risk for emergence of rifampin resistance and multiple drug interactions are emphasized. A recent randomized controlled trial (RCT) showing no beneficial effect of rifampin in patients with acute staphylococcal periprosthetic joint infection treated with prosthesis retention is critically reviewed and data interpreted. Given the existing strong evidence demonstrating the benefit of rifampin, the conduction of an adequately powered RCT with appropriate definitions and interventions would probably not comply with ethical standards.

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Section: Critical Appraisal Of a Randomized Controlled Trial (Rct) Shmentioning

confidence: 99%

Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified?

2021

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“…Successful management of osteomyelitis requires delivery of several interdependent elements of treatment. It is clear that the use of multidisciplinary clinics, pre-operative planning based on appropriate cross-sectional imaging, the availability of regular orthoplastic operating lists, the avoidance of negative pressure vacuum dressings (Yusef et al, 2013;Birke-Sorensen et al, 2011) and the management of osseous dead space using bioabsorbable local antimicrobial delivery all facilitate the delivery of single-stage surgery with all the resultant benefits described. This combination provides a "care bundle" which has proved successful in this condition.…”

Section: Discussionmentioning

confidence: 99%

“…Early involvement of multidisciplinary teams (MDT) is recognised as being important in preventing complications and improving outcomes in those with osteomyelitis and fracture-related infection (FRI) (Grammatico-Guillon et al, 2012;Olesen et al, 2017;Ferguson et al, 2018;Vasoo et al, 2019;Metsemakers et al, 2020). Teams should include orthopaedic surgery, infectious diseases, plastic surgery, radiology, and in some instances also vascular surgery (Lew and Waldvogel, 2004).…”

Section: Introductionmentioning

confidence: 99%

A retrospective cohort study comparing clinical outcomes and healthcare resource utilisation in patients undergoing surgery for osteomyelitis in England: a case for reorganising orthopaedic infection services

Ferguson

Alexander²,

Bruce

et al. 2021

J. Bone Joint Infect.

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Abstract. Aims: An investigation of the impact of a multidisciplinary bone infection unit (BIU) undertaking osteomyelitis surgery with a single-stage protocol on clinical outcomes and healthcare utilisation compared to national outcomes in England. Patients and Methods: A tertiary referral multidisciplinary BIU was compared to the rest of England (ROE) and a subset of the 10 next busiest centres based on osteomyelitis treatment episode volume (Top Ten), using the Hospital Episodes Statistics database (HES). A total of 25 006 patients undergoing osteomyelitis surgery between April 2013 and March 2017 were included. Data on secondary healthcare resource utilisation and clinical indicators were extracted for 24 months before and after surgery. Results: Patients treated at the BIU had higher orthopaedic healthcare utilisation in the 2 years prior to their index procedure, with more admissions (p< 0.001) and a mean length of stay (LOS) over 4 times longer than other groups (10.99 d, compared to 2.79 d for Top Ten and 2.46 d for the ROE, p< 0.001). During the index inpatient period, the BIU had fewer mean theatre visits (1.25) compared to the TT (1.98, p< 0.001) and the ROE (1.64, p= 0.001). The index inpatient period was shorter in the BIU (11.84 d), 33.6 % less than the Top Ten (17.83 d, p< 0.001) and 29.9 % shorter than the ROE (16.88 d, p< 0.001). During follow-up, BIU patients underwent fewer osteomyelitis-related reoperations than Top Ten centres (p= 0.0139) and the ROE (p= 0.0137). Mortality was lower (4.71 %) compared to the Top Ten (20.06 %, p< 0.001) and the ROE (22.63 %, p< 0.001). The cumulative BIU total amputation rate was lower (6.47 %) compared to the Top Ten (15.96 %, p< 0.001) and the ROE (12.71 %, p< 0.001). Overall healthcare utilisation was lower in the BIU for all inpatient admissions, LOS, and Accident and Emergency (A&E) attendances. Conclusion: The benefits of managing osteomyelitis in a multi-disciplinary team (MDT) specialist setting included reduced hospital stays, lower reoperation rates for infection recurrence, improved survival, lower amputation rates, and lower overall healthcare utilisation. These results support the establishment of centrally funded multidisciplinary bone infection units that will improve patient outcomes and reduce healthcare utilisation.

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“…The combined multidisciplinary approach described herein is particularly important in patients with soft-tissue defects and extensor apparatus deficiency around the knee. We stress the importance of treating these patients in a specialized BJI unit to ensure the best possible outcome [3,24]. The interaction between various specialists as part of an orthoplastic treatment concept allows a simultaneous multidisciplinary approach while the patient is located in one institution.…”

Section: Discussionmentioning

confidence: 99%

Orthoplastics in Periprosthetic Joint Infection of the Knee: Treatment Concept for Composite Soft-tissue Defect with Extensor Apparatus Deficiency

Osinga

Eggimann

et al. 2020

J. Bone Joint Infect.

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Abstract. Introduction: Reconstruction of composite soft-tissue defects with extensor apparatus deficiency in patients with periprosthetic joint infection (PJI) of the knee is challenging. We present a single-centre multidisciplinary orthoplastic treatment concept based on a retrospective outcome analysis over 20 years.Methods and Results: One-hundred sixty patients had PJI after total knee arthroplasty. Plastic surgical reconstruction of a concomitant perigenicular soft-tissue defect was indicated in 47 patients. Of these, six presented with extensor apparatus deficiency. One patient underwent primary arthrodesis and five patients underwent reconstruction of the extensor apparatus. The principle to reconstruct missing tissue 'like with like' was thereby favoured: Two patients with a wide soft-tissue defect received a free anterolateral thigh flap with fascia lata; one patient with a smaller soft-tissue defect received a free sensate, extended lateral arm flap with triceps tendon; and two patients who did not qualify for free flap surgery received a pedicled medial sural artery perforator gastrocnemius flap. Despite good functional results 1 year later, long-term follow-up revealed that two patients had to undergo arthrodesis because of recurrent infection and one patient was lost to follow-up.Conclusion: These results show that PJI of the knee and extensor apparatus deficiency is a dreaded combination with a poor long-term outcome. Standardization of surgical techniques for a defined PJI problem and consensus on study variables may facilitate interinstitutional comparisons of outcome data, and hence, improvement of treatment concepts.

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The Value of Ortho-ID Teams in Treating Bone and Joint Infections

Cited by 20 publications

References 23 publications

Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified?

Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified?

A retrospective cohort study comparing clinical outcomes and healthcare resource utilisation in patients undergoing surgery for osteomyelitis in England: a case for reorganising orthopaedic infection services

Orthoplastics in Periprosthetic Joint Infection of the Knee: Treatment Concept for Composite Soft-tissue Defect with Extensor Apparatus Deficiency

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