Computerized registry as a potential tool for surveillance and management of complex bone and joint infections in France: French registry of complex bone and joint infections

Efficacy and safety of co-trimoxazole in device-related bone and joint infections: a CRIOGO multicentre case-control study

OBJECTIVES

Co-trimoxazole could be an alternative antibiotic to treat device-related bone and joint infection (BJI) but there are few published data about its efficacy and safety in this complex scenario to treat infection. The objective was to compare the outcome of patients with device-related BJI treated with an antibiotic regimen including co-trimoxazole versus a regimen without co-trimoxazole.

METHODS

This multicentre case-control study included consecutive adult patients diagnosed with device-related BJI. Each patient receiving co-trimoxazole was included in the co-trimoxazole group and was matched with two control patients, with stratification on microbial aetiology and age. The primary outcome was composite and defined by death or treatment failure during the follow-up.

RESULTS

In this study, 150 patients were included, 50 in the co-trimoxazole group and 100 in the control group. The rate of reaching the primary endpoint was 18% in the co-trimoxazole group (9/50 cases) versus 21% in the control group (21/100) (P = 0.66). Co-trimoxazole use was not associated with an unfavourable outcome in the multivariate analysis (adjusted OR 0.8, 95% CI 0.31-2.06, P = 0.64). Although no significant difference was observed in premature discontinuation of treatment due to an adverse event between both groups (14 versus 12%, P = 0.73), treatment-related adverse events were significantly more frequently reported in patients of the co-trimoxazole group than the control group [34% (17/50) versus 18% (18/100), P = 0.03].

CONCLUSIONS

Co-trimoxazole appears to be an effective alternative for the treatment of BJI, even when it occurs on a device, but the safety profile requires close monitoring of adverse effects.

Teaching potential of interdisciplinary meetings on osteoarticular infections for orthopaedic residents: Insights from a French reference center (CRIOAC)

Objective

Management of osteoarticular infections (OAI) represents a major public health challenge. To deal with this, the French Ministry of Health created the Complex Osteoarticular Infections Referral Centers (CRIOAC) in 2008. CRIOAC functions as a national network of reference centers for OAI, with the aim of coordinating, providing expertise, offering training, and conducting research at the regional level. Through multidisciplinary team meetings (MTM-CRIOAC), experts discuss complex OAI cases and formulate optimal treatment decisions. This study aims to evaluate the perception of the teaching potential of MTM-CRIOAC among orthopedic residents and identify potential areas for improvement.

Methods

To conduct this cross-sectional study a validated questionnaire was distributed to orthopedic residents who participated in said meetings to evaluate their perceptions and benefit. Opinions were then collected using a Likert scale for further evaluation.

Results

Results showed that (75%) found MTM useful for training, and (71%) considered it appropriate for teaching. The majority (84%) reported acquiring valuable skills, with (78%) emphasizing knowledge about complex osteoarticular infections. Residents recommended integrating more classes, active engagement, and thorough case summaries for improvement. Notably, 94% recommended MTM participation for colleagues. The study highlights MTMs' potential in medical education, enhancing clinical skills and collaborative healthcare practices among orthopedic residents.

Conclusion

Previous studies have shown that MTM-CRIOACs have improved patient outcomes. However, the literature has not yet addressed the potential teaching opportunities that MTM-CRIOACs could provide to residents. The study shows that these meetings offer grounds for teaching, enrichment of clinical judgment, professionalism, and collaborative skills of orthopedic residents.

Clinical features and treatment outcomes of bone and joint nontuberculous mycobacterial infections according to immune status: a 9-year retrospective observational cohort

OBJECTIVES

Nontuberculous mycobacteria (NTM) bone and joint infections (BJIs) are uncommon. We evaluated the characteristics of BJIs and identified differences according to immune status.

METHODS

We performed a multicenter retrospective study in France involving patients with documented NTM BJI over a 9-year period. We collected the clinical and microbiological characteristics, management, and clinical outcomes of the patients.

RESULTS

Overall, 95 patients were included, of whom 50.5% (48/95) were immunosuppressed. Tenosynovitis was more frequent in the immunocompetent group, and native arthritis more common in the immunosuppressed group. Mycobacerium marinum and M. abscessus complex were significantly more frequent in the immunocompetent group, and M. avium and M. xenopi were significantly more frequent in the immunosuppressed group. The combination of antibiotherapy with surgery tended to be more frequent in the immunocompetent than the immunosuppressed group (63.8% (30/47) vs 47.8% (22/46), respectively); of the latter, 45.7% (21/46) received antimicrobial therapy alone, a higher frequency than in the immunocompetent group (23.4%, 11/47). The median duration of antimicrobial treatment was similar in the two groups (11 months). Mortality was significantly higher in the immunosuppressed group.

CONCLUSIONS

Although the clinical presentations and the NTM species involved in BJI differed according to immune status, most recovered completely after treatment.

A Review of Phage Therapy for Bone and Joint Infections

There is a strong rationale for using phages in patients with bone and joint infections (BJIs). Indeed, specific phages can infect and replicate in bacterial pathogens and have also demonstrated their activity in vitro against biofilm produced by different bacteria. However, there is a high variability of the different clinical forms of BJI, and their management is complex and frequently includes surgery followed by the administration of antibiotics. Regardless of the availability of active phages, optimal ways of phage administration in patients with BJIs are unknown. Otherwise, all BJIs are not relevant for phage therapy. Except for diabetic foot infection, a BJI with bone exposure is potentially not a relevant indication for phage therapy. On the counterpart, prosthetic joint infections in patients for whom a multidisciplinary expert team judges a conservative approach as the best option to keep the patient's function seem to be a relevant indication with the hypothesis that phage therapy could increase the rate of infection control. The ESCMID Study Group for Non-traditional Antibacterial Therapy (ESGNTA) was created in 2022. One century after the first use of phages as a therapy, the phage therapy 2.0 era, with the possibility to evaluate personalized phage therapy in modern medicine and orthopedic surgery, is just open.

Relevance of a bone and joint registry for fracture-related infections

The UK Bone and Joint Infection Registry (BAJIR) is a national project established in 2018 with the aim of collecting information about demographics, co-morbidities, pathogens, treatment strategies and outcomes on all patients who are diagnosed with, and treated for, a bone or joint infection in the UK with the objective of providing an understanding of the burden of disease. In time these data will be used to inform best practice, direct research and provide information for commissioners of healthcare. In this fracture-related infection special edition article, we discuss the registry's development, relevance and how we see it directing our practice in the future. Equally, we have highlighted some potential limitations and lessons learned.

Epidemiology of complex bone and joint infections in France using a national registry: The CRIOAc network

OBJECTIVES

In France, a network of reference centers for bone and joint infections (BJI) was created in 2008, focused on the management of complex BJI (previous failure, difficult-to-treat microorganisms, heavy comorbidities or surgical procedures). A national registry was implemented from 2012, collecting decisions advised in periodic multidisciplinary meetings. We present here an epidemiological overview.

METHODS

All consecutive adult patients presented from 2014 to 2019 in 23/30 reference centers were included in this cohort. Characteristics of patients, BJI, and medico-surgical management advice were described.

RESULTS

27,483 individual patients were included, corresponding to 28,365 distinct infectious episodes, which 17,328 were complex. Median age was 65 years, with 62% of men, 1/3 patients presented more than 2 comorbidities. Prosthetic joint infections (PJI) represented 42% of all BJIs (11,812 episodes). Staphylococcus aureus, coagulase-negative staphylococci and polymicrobial PJI represented 26%, 25% and 16% respectively. DAIR (debridement, antibiotics and implant retention) was proposed for 3,157 (27%), whereas one-stage and two-stage revision for 3,683 (31%) and 1,764 (15%). An antibiotic treatment was advised in 10,493 episodes (87%), with combination therapy in 88%.

CONCLUSION

This national network allows an optimized management of complex BJIs. Its cohort is a unique opportunity to draw up a detailed epidemiological picture and to follow the trends of these infrequent infections.