Tissingh Elizabeth K, Marais Leonard, Loro Antonio, Bose Deepa, Paner Nilo T, Ferguson Jamie, Morgensten Mario, McNally Martin
The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
King's Global Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK.
EFORT Open Rev. 2022 May 31;7(6):422-432. doi: 10.1530/EOR-22-0031.
The global burden of fracture-related infection (FRI) is likely to be found in countries with limited healthcare resources and strategies are needed to ensure the best available practice is context appropriate. This study has two main aims: (i) to assess the applicability of recently published expert guidance from the FRI consensus groups on the diagnosis and management of FRI to low- and middle-income countries (LMICs); (ii) to summarise the available evidence on FRI, with consideration for strategies applicable to low resource settings. Data related to the International Consensus Meeting Orthopaedic Trauma Work Group and the International Fracture Related Infection Consensus Group FRI guidelines were collected including panel membership, country of origin, language of publication, open access status and impact factor of the journal of publication. The recommendations and guidelines were then summarised with specific consideration for relevance and applicability to LMICs. Barriers to implementation were explored within a group of LMIC residents and experienced workers. The authorship, evidence base and reach of the FRI consensus guidelines lack representation from low resource settings. The majority of authors (78.5-100%) are based in high-income countries and there are no low-income country collaborators listed in any of the papers. All papers are in English. The FRI consensus guidelines give a clear set of principles for the optimum management of FRI. Many of these - including the approach to diagnosis, multidisciplinary team working and some elements of surgical management - are achievable in low resource settings. Current evidence suggests that it is important that a core set of principles is prioritised but robust evidence for this is lacking. There are major organisational and infrastructure obstacles in LMICs that will make any standardisation of FRI diagnosis or management challenging. The detail of how FRI consensus principles should be applied in low resource settings requires further work. The important work presented in the current FRI consensus guidelines is relevant to low resource settings. However, leadership, collaboration, creativity and innovation will be needed to implement these strategies for communities who need it the most.
骨折相关感染（FRI）的全球负担可能存在于医疗资源有限的国家，因此需要制定相应策略，以确保最佳可行做法适用于当地情况。本研究有两个主要目标：（i）评估FRI共识小组最近发布的关于FRI诊断和管理的专家指南在低收入和中等收入国家（LMICs）的适用性；（ii）总结关于FRI的现有证据，并考虑适用于资源匮乏地区的策略。收集了与国际骨科创伤工作组共识会议和国际骨折相关感染共识小组FRI指南相关的数据，包括专家组成员、国籍、出版语言、开放获取状态以及出版期刊的影响因子。然后对这些建议和指南进行了总结，并特别考虑了其与LMICs的相关性和适用性。在一组LMICs的住院医师和经验丰富的工作人员中探讨了实施的障碍。FRI共识指南的作者身份、证据基础和影响力缺乏资源匮乏地区的代表性。大多数作者（78.5%-100%）来自高收入国家，所有论文中均未列出低收入国家的合作者。所有论文均为英文。FRI共识指南为FRI的最佳管理提供了一套明确的原则。其中许多原则——包括诊断方法、多学科团队协作以及手术管理的一些要素——在资源匮乏地区是可以实现的。目前的证据表明，优先考虑一组核心原则很重要，但缺乏有力的证据支持。LMICs存在重大的组织和基础设施障碍，这将使FRI诊断或管理的任何标准化都具有挑战性。FRI共识原则在资源匮乏地区的具体应用细节还需要进一步研究。当前FRI共识指南中提出的重要工作与资源匮乏地区相关。然而，对于最需要这些策略的社区来说，实施这些策略需要领导力、协作、创造力和创新。
