Service de Médecine Interne et Maladies Infectieuses, Hôpital Bretonneau, CHRU de Tours, 2, Boulevard Tonnellé, 37044 Tours CEDEX 9, France; Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France.
Service de Médecine Interne et Maladies Infectieuses, Hôpital Bretonneau, CHRU de Tours, 2, Boulevard Tonnellé, 37044 Tours CEDEX 9, France.
J Infect. 2021 Feb;82(2):199-206. doi: 10.1016/j.jinf.2020.12.010. Epub 2020 Dec 19.
In France, a network of reference centers for bone and joint infections (BJI) was created in 2008, focused on the management of complex BJI (previous failure, difficult-to-treat microorganisms, heavy comorbidities or surgical procedures). A national registry was implemented from 2012, collecting decisions advised in periodic multidisciplinary meetings. We present here an epidemiological overview.
All consecutive adult patients presented from 2014 to 2019 in 23/30 reference centers were included in this cohort. Characteristics of patients, BJI, and medico-surgical management advice were described.
27,483 individual patients were included, corresponding to 28,365 distinct infectious episodes, which 17,328 were complex. Median age was 65 years, with 62% of men, 1/3 patients presented more than 2 comorbidities. Prosthetic joint infections (PJI) represented 42% of all BJIs (11,812 episodes). Staphylococcus aureus, coagulase-negative staphylococci and polymicrobial PJI represented 26%, 25% and 16% respectively. DAIR (debridement, antibiotics and implant retention) was proposed for 3,157 (27%), whereas one-stage and two-stage revision for 3,683 (31%) and 1,764 (15%). An antibiotic treatment was advised in 10,493 episodes (87%), with combination therapy in 88%.
This national network allows an optimized management of complex BJIs. Its cohort is a unique opportunity to draw up a detailed epidemiological picture and to follow the trends of these infrequent infections.
法国于 2008 年成立了一个骨与关节感染（BJI）的参考中心网络，专注于复杂 BJI（先前的治疗失败、难以治疗的微生物、严重的合并症或手术）的管理。自 2012 年以来，实施了一项国家登记制度，收集定期多学科会议建议的决策。在此，我们介绍一个流行病学概况。
所有于 2014 年至 2019 年在 23/30 个参考中心就诊的连续成年患者均纳入本队列。描述了患者、BJI 和医源性管理建议的特征。
共纳入 27483 例患者，对应 28365 例不同的感染发作，其中 17328 例为复杂感染。中位年龄为 65 岁，男性占 62%，1/3 的患者有 2 种以上合并症。人工关节感染（PJI）占所有 BJI 的 42%（11812 例）。金黄色葡萄球菌、凝固酶阴性葡萄球菌和多微生物 PJI 分别占 26%、25%和 16%。3157 例（27%）建议采用清创术、抗生素和保留植入物（DAIR），3683 例（31%）和 1764 例（15%）建议采用一期和二期翻修。10493 例（87%）建议采用抗生素治疗，88%采用联合治疗。
该国家网络可优化复杂 BJI 的管理。其队列是详细绘制这些罕见感染的流行病学图谱并跟踪其趋势的独特机会。
