title: Potential changes to French recommendations about peri-prosthetic infections based on the international consensus meeting (ICMPJI).
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.
  
  
  OBJECTIVE
  French consensus conference recommendations show no major differences with ICMPJI recommendations.
  
  
  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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: 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.
authors.forename: M
authors.initials: M
authors.lastname: Ollivier
authors.affiliation: 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.
authors.forename: E
authors.initials: E
authors.lastname: Senneville
authors.affiliation: 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.
authors.forename: M
authors.initials: M
authors.lastname: Drancourt
authors.affiliation: 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.
authors.forename: J N
authors.initials: JN
authors.lastname: Argenson
authors.affiliation: 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.
authors.forename: H
authors.initials: H
authors.lastname: Migaud
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D019643:Arthroplasty, Replacement; D003646:Debridement; D005602:France; D006801:Humans; D017053:Infection Control; D007595:Joint Prosthesis / Q000009:adverse effects*; D011300:Preoperative Care; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012086:Reoperation; D007507:Therapeutic Irrigation
chemical_list: D000900:Anti-Bacterial Agents
keywords: Infection; Periprothetic infection guidelines; Total joint replacement