Algorithm to Diagnose Delayed and Late PJI: Role of Joint Aspiration.

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Abstract

[Indexed for MEDLINE] 14. Int Orthop. 2017 Dec;41(12):2457-2469. doi: 10.1007/s00264-017-3607-y. Epub 2017 Aug 22. Prevention of fracture-related infection: a multidisciplinary care package. Metsemakers WJ(1)(2), Onsea J(3)(4), Neutjens E(5), Steffens E(4), Schuermans A(4)(6), McNally M(7), Nijs S(3)(8). Author information: (1)Department of Trauma Surgery, University Hospital Leuven, Leuven, Belgium. willem-jan.metsemakers@uzleuven.be. (2)Department Development and Regeneration, KU Leuven - University of Leuven, B-3000, Leuven, Belgium. willem-jan.metsemakers@uzleuven.be. (3)Department of Trauma Surgery, University Hospital Leuven, Leuven, Belgium. (4)Department of Infection Control and Epidemiology, University Hospitals Leuven, Leuven, Belgium. (5)Department of Biomedical Sciences, Catholic University Leuven, Leuven, Belgium. (6)Department of Public Health and Primary Care, KU Leuven - University of Leuven, B-3000, Leuven, Belgium. (7)The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK. (8)Department Development and Regeneration, KU Leuven - University of Leuven, B-3000, Leuven, Belgium. Fracture-related infection (FRI) remains a challenging complication. It may result in permanent functional loss or even amputation in otherwise healthy patients. For these reasons, it is important to focus attention on prevention. In treatment algorithms for FRI, antibiotic stewardship programmes have already proved their use by means of a multidisciplinary collaboration between microbiologists, surgeons, pharmacists, infectious disease physicians and nursing staff. A similar approach, however, has not been described for infection prevention. As a first step towards achieving a multidisciplinary care package for infection prevention, this review summarises the most recent guidelines published by the World Health Organization (WHO) and US National Institutes of Health Centers for Disease Control and Prevention (CDC), primarily focusing on the musculoskeletal trauma patient. The implementation of these guidelines, together with close collaboration between infection control physicians, surgeons, anaesthesiologists and nursing staff, can potentially have a beneficial effect on the rate of FRI after musculoskeletal trauma surgery. It must be stated that most evidence presented here in support of these guidelines was not obtained from musculoskeletal trauma research. Although most preventive measures described in these studies can be generalised to the musculoskeletal trauma patient, there are still important differences with nontrauma patients that require further attention. Future research should therefore focus more on this very defined patient population and more specifically on FRI prevention. DOI: 10.1007/s00264-017-3607-y