Abstract
Aim
Bone and joint infections (BJI) are associated with a heavy morbidity and high health costs. Comorbidities, device associated infections and complicated journeys are associated with increased mortality, treatment failures and costs. For this reason, 24 referral centers (RC) have been created in 2009 in order to advise about management of “complex” BJI in weekly multidisciplinary meetings (MM). Since end of 2012, data from these meetings are gathered in a national database. We aimed to describe the data from this French registry of BJI and determine factors associated with the definition of “complex” BJI.
Method
Demographic, clinical, microbiologic and therapeutic characteristics of patients are systematically recorded in the database. Data from the first presentation in RC for each adult patients are presented. Complexity of BJI is recorded after each meeting according to 4 criteria (first failure, complex antibiotic therapy, precarious underlying conditions or complex surgical procedure). Part of unavailable data have been completed by pattern extraction from text-encoded commentaries. Factors associated with complexity were determined by multivariate logistic regression.
Results
From 2012 to 2016, 17.527 patients were included corresponding to 30.300 presentations in MM. Median age was 64 years (IQR 50–76) with masculine predominance (61.8%). Comorbidity was present in 50.3%, with at least 2 comorbidities in 26%. Prosthetic joint infection represented 41.4% of patients, followed by chronic osteitis with/without foreign material (24%). Definite microbiologic documentation was available in 68.8% of cases, mostly Staphylococcus aureus (43.9%) followed by Coagulase negative Staphylococci (28.6%) and enterobacteriaceae (23.1%), with 27.4% of polybacterial infections. Antibiotic treatment was proposed in 81.6% and surgery in 70% of cases. BJI were defined as complex in 55.4%, mostly because underlying conditions (50%), and in 57.6% with at least 2 complexity criteria. Factors positively associated with definition of complexity in MM were: background: number of comorbidities, immunodeficiency, neoplasia, liver or kidney failure, intra-cardiac device; microbiology: Mycobacteria, Fungus, MRSA, MSSA, MR-CoNS, MDR enterobacteria, non-fermentative BGN, and atypical pathogens (actinomycetes, nocardia, intra-cellular …); infection characteristics: prosthetic joint infection, osteitis, foreign material infection, arthritis and number of infected sites; surgical procedures: surgical flap, 2 stages prosthesis exchange, spacer, arthrodesis, and joint removal. Simple debridement was negatively associated with complex definition.
Conclusions
This registry is the first national prospective database about management of BJI in France and provide many information about epidemiology and management of BJI in France, as well as a more precise definition of complexity.
