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Orthop Traumatol Surg Res. 2014 Oct;100(6):583-7. doi: 10.1016/j.otsr.2014.04.001. Epub 2014 Jul 16.

Potential changes to French recommendations about peri-prosthetic infections based on the international consensus meeting (ICMPJI).

Author information

1
Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Institut du Mouvement et de l'Appareil Locomoteur, Aix-Marseille Université, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Centre de référence pour le traitement des infections ostéo-articulaires Sud-Méditerranée, Aix-Marseille Université, Marseille, France. Electronic address: ollivier.mt@gmail.com.
2
Service universitaire de maladies infectieuses et du voyageur, Hôpital Dron, rue du Président-Coty, 59208 Tourcoing, France; Hôpital Salengro, CHRU de Lille, Centre de référence pour le traitement des infections ostéo-articulaires G4 Lille-Tourcoing, rue Emile-Laine, 59037 Lille, France; Université Lille-Nord de France, 59000 Lille, France.
3
Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Institut du Mouvement et de l'Appareil Locomoteur, Aix-Marseille Université, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Centre de référence pour le traitement des infections ostéo-articulaires Sud-Méditerranée, Aix-Marseille Université, Marseille, France; Laboratoire de Microbiologie, Hôpital Timone, CHU de Marseille et URMITE, Assistance Publique-Hôpitaux de Marseille, Faculté de Médecine, IHU Méditerranée Infection, Aix-Marseille Université, Marseille, France.
4
Service de chirurgie orthopédique, Hôpital Sainte-Marguerite, CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Institut du Mouvement et de l'Appareil Locomoteur, Aix-Marseille Université, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; CHU de Marseille, Assistance Publique-Hôpitaux de Marseille, Centre de référence pour le traitement des infections ostéo-articulaires Sud-Méditerranée, Aix-Marseille Université, Marseille, France.
5
Hôpital Salengro, CHRU de Lille, Centre de référence pour le traitement des infections ostéo-articulaires G4 Lille-Tourcoing, rue Emile-Laine, 59037 Lille, France; Université Lille-Nord de France, 59000 Lille, France; Service d'Orthopédie C, CHRU de Lille, rue Emile-Laine, 59000 Lille, France.

Abstract

BACKGROUND:

Despite the large volume of studies on the prevention, diagnosis, and treatment of peri-prosthetic infections, surgical practice often rests on limited scientific evidence in this field. The vast International Consensus Meeting on Peri-prosthetic Joint Infection (ICMPJI) held in 2013 produced robust recommendations.

HYPOTHESIS:

French consensus conference recommendations show no major differences with ICMPJI recommendations.

MATERIALS AND METHODS:

The 207 recommendations developed by 300 experts at the ICMPJI were translated, and the translation was then examined by four reviewers, including 2 having participated in the consensus conference. The reviewers looked for any differences with French practices and recommendations.

RESULTS:

Twenty-three major differences or innovations were identified compared to French recommendations and standard practice. Among them, pre-operative screening for nasal or urinary micro-organisms is performed routinely in France but should be reserved according to the ICMPJI for symptomatic patients and/or patients at high risk for infection. The ICMPJI emphasizes the role for the operating room environment as a vector for infection; more specifically, the operating lamp handle and suction cannula deserve close attention. A wound discharge persisting longer than 5-7 days requires irrigation and debridement. This procedure is effective only within the first 3 post-operative months and/or the first 3 weeks after symptom onset and must include exchange of all modular implants. The ICMPJI warns against both irrigation-debridement in fungal infections (suggesting two-stage prosthesis replacement) and one-stage replacement in patients with sinus tracts. The use of spacers (articulating at the knee) is recommended in the event of two-stage prosthesis replacement.

DISCUSSION:

The ICMPJI recommendations differed in many ways with French recommendations and standard practice. They can be expected to impact practices in France, although a point worth noting is that only 1 of the 207 recommendations received unanimous agreement by the conference experts (keeping operating room traffic to a minimum).

KEYWORDS:

Infection; Periprothetic infection guidelines; Total joint replacement

PMID:
25044048
DOI:
10.1016/j.otsr.2014.04.001
[Indexed for MEDLINE]
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