Potential Changes to French Recommendations About Peri-Prosthetic Infections Based on the International Consensus Meeting (ICMPJI)

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

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.

Publication types

  • Consensus Development Conference
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis
  • Arthroplasty, Replacement*
  • Debridement
  • France
  • Humans
  • Infection Control
  • Joint Prosthesis / adverse effects*
  • Preoperative Care
  • Prosthesis-Related Infections / therapy*
  • Reoperation
  • Therapeutic Irrigation

Substances

  • Anti-Bacterial Agents