title: Prosthetic joint infection: A pluridisciplinary multi-center audit bridging quality of care and outcome.
abstract: BACKGROUND
  Care to patients with prosthetic joint infections (PJI) is provided after pluridisciplinary collaboration, in particular for complex presentations. Therefore, to carry out an audit in PJI justifies using pluridisciplinary criteria. We report an audit for hip or knee PJI, with emphasis on care homogeneity, length of hospital stay (LOS) and mortality.
  
  
  METHODS
  Fifteen criteria were chosen for quality of care: 5 diagnostic tools, 5 therapeutic aspects, and 5 pluridisciplinary criteria. Among these, 6 were chosen: surgical bacterial samples, surgical strategy, pluridisciplinary discussion, antibiotic treatment, monitoring of antibiotic toxicity, and prevention of thrombosis. They were scored on a scale to 20 points. We included PJI diagnosed between 2010 and 2012 from 6 different hospitals. PJI were defined as complex in case of severe comorbid conditions or multi-drug resistant bacteria, or the need for more than 1 surgery.
  
  
  RESULTS
  Eighty-two PJI were included, 70 of which were complex (85%); the median score was 15, with a significant difference among hospitals: from 9 to 17.5 points, P < 0.001. The median LOS was 17 days, and not related to the criterion score; 16% of the patients required intensive care and 13% died. The cure rate was 41%, lost to follow-up 33%, and therapeutic failure 13%. Cure was associated with a higher score than an unfavorable outcome in the univariate analysis (median [range]): 16 [9-18] vs 13 [4-18], P = 0.002.
  
  
  CONCLUSIONS
  Care to patients with PJI was heterogeneous, our quality criteria being correlated to the outcome.
authors.affiliation: Infectiologie, centre hospitalier universitaire de Nice, hôpital de l'Archet 1, université de Nice Sophia-Antipolis, BP 3079, 06202 Nice, France. Electronic address: roger.pm@chu-nice.fr.
authors.forename: P-M
authors.initials: PM
authors.lastname: Roger
authors.affiliation: Orthopédie-traumatologie, centre hospitalier de Cannes, Cannes, France.
authors.forename: J
authors.initials: J
authors.lastname: Tabutin
authors.affiliation: Bactériologie, centre hospitalier d'Antibes, Antibes, France.
authors.forename: V
authors.initials: V
authors.lastname: Blanc
authors.affiliation: Bactériologie, centre hospitalier de Grasse, Grasse, France.
authors.forename: S
authors.initials: S
authors.lastname: Léotard
authors.affiliation: Réanimation, bactériologie, orthopédie, centre hospitalier de Draguignan, Draguignan, France.
authors.forename: P
authors.initials: P
authors.lastname: Brofferio
authors.affiliation: Réanimation, bactériologie, orthopédie, centre hospitalier de Draguignan, Draguignan, France.
authors.forename: F
authors.initials: F
authors.lastname: Léculé
authors.affiliation: Orthopédie-traumatologie, clinique St-Michel, Toulon, France.
authors.forename: B
authors.initials: B
authors.lastname: Redréau
authors.affiliation: Infectiologie, centre hospitalier universitaire de Nice, hôpital de l'Archet 1, université de Nice Sophia-Antipolis, BP 3079, 06202 Nice, France.
authors.forename: E
authors.initials: E
authors.lastname: Bernard
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D003131:Combined Modality Therapy; D015897:Comorbidity; D003646:Debridement; D020878:Device Removal; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005602:France / Q000453:epidemiology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008511:Medicine; D008875:Middle Aged; D010348:Patient Care Team; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery; D011787:Quality of Health Care; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bone and joint infection; Infection ostéo-articulaire; Infection sur prothèse; Prosthetic joint infection