Purpose of the study: Management of bone and joint infections is a recognised public health concern recently labellised by the establishment of Reference Centres and associated Reference Centres. Among other objectives, these Centres are designed to develop pluridisciplinary expertise in the form of recommended clinical practices (French Health Ministry directive DHOS, May 2008).

Material and methods: In response to this tender, a weekly pluridisciplinary meeting was instituted in March 2008 with an orthopaedic surgeon, an infectious disease specialist, an anaesthetist, a pharmacist, microbiologists, a rheumatologist and a diabetologist. The activity and impact on antibiotic consumption in the functional unit of septic surgery was evaluated over a one-year period.

Results: From March 2008 to March 200, 35 pluridisciplinary meetings were held and analysed 243 files concerning 133 patients. This consensual approach led to a decrease in the antibiotic consumption in the functional unit. This consumption was 1222 DDJ/1000 days hospitalisation during the last semester of 2007 and 1069 DDJ/1000 days during the last semester of 2008 (p=0.005). During this same period, the activity in the unit increased from 37 patients with infected material (CIM 10 T 84) in 200 to 58 in 2008 and from 27 patients with septic arthritis (codeM00) to 42 in 2008. Similarly the number of indexed pathological conditions in this unit increased from 447 to 548 in 2008 with a fall in the mean duration of the hospital stay from 11 days in 2007 to 9.6 in 2008. The improvements provided by the process of intraoperative sampling provided bacteriological documents in 85% of cases. The analysis of antibiotics prescribed in the functional unit showed a decline in the consumption of antibiotics with week or unknown distribution in bone (amoxicillin + clavulanic acid: −13%; pristinamycin: −72%) and an increase in the prescription (before adaptation to documented bacteriological results) of the association cefotaxime+fosfomycin (5-fole increase in one year).

Discussion: This study clearly shows how important regular pluridisciplinary discussion is needed to optimise the management of bone and joint infections and that this approach improves the antibiotic prescription and shortens the hospital stay.

Conclusion: This experience proves the pertinence of the Reference Centres and the associated Reference Centres, both economically and medically.

Aims: The diagnosis of a prosthetic joint infection is difþcult, but crucial for appropriate treatment. Scintigraphy with speciþc markers for infection (labeled white cells or immunoglobulin-G) has been reported as a more reliable diagnostic tool than clinical assessment (fever, þstula), laboratory studies [polynuclear neutrophils blood count (PNC), erythrocyte rate sedimentation (ESR), and C-reactive protein (CRP)], and preoperative aspiration. Methods: In the þrst part of this study, we retrospectively reviewed 230 patients admitted with a suspected prosthetic joint infection and compared the validity of these different diagnostic tools. 209 patients had an infection. Results: Pain, fever, ESR, and PNC are unreliable for identifying occult infection. The presence of a þstula is inconstant, but when present is very reliable to detect infection. Our study revealed sensitivity, speciþcity, positive and negative predictive value as follows: CRP: 97%, 81%, 98%, 71% respectively; aspiration: 82%, 94%, 99%, 43% respectively, and labelled scintigraphy 74%, 76%, 91%, 44% respectively. In the second part, we reviewed 23 articles which included 1,722 prosthetic joints with preoperative evaluation of infection. Conclusions: Both our study and the literature review indicate that CRP and joint aspiration are the best tools to diagnose prosthetic joint infection.