Abstract
Musculoskeletal infections (MSKI) remain the bane of orthopedic surgery, and result in grievous illness and inordinate costs that threaten healthcare systems. As prevention, diagnosis, and treatment has remained largely unchanged over the last 50 years, a 2nd International Consensus Meeting on Musculoskeletal Infection (ICM 2018, https://icmphilly.com) was completed. Questions pertaining to all areas of MSKI were extensively researched to prepare recommendations, which were discussed and voted on by the delegates using the Delphi methodology. The questions, including the General Assembly (GA) results, have been published (GA questions). However, as critical outcomes include: (i) incidence and cost data that substantiate the problems, and (ii) establishment of research priorities; an ICM 2018 research workgroup (RW) was assembled to accomplish these tasks. Here, we present the result of the RW consensus on the current and projected incidence of infection, and the costs per patient, for all orthopedic subspecialties, which range from 0.1% to 30%, and $17,000 to $150,000. The RW also identified the most important research questions. The Delphi methodology was utilized to initially derive four objective criteria to define a subset of the 164 GA questions that are high priority for future research. Thirty-eight questions (23% of all GA questions) achieved the requisite > 70% agreement vote, and are highlighted in this Consensus article within six thematic categories: acute versus chronic infection, host immunity, antibiotics, diagnosis, research caveats, and modifiable factors. Finally, the RW emphasizes that without appropriate funding to address these high priority research questions, a 3rd ICM on MSKI to address similar issues at greater cost is inevitable.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 997-1006 |
| Number of pages | 10 |
| Journal | Journal of Orthopaedic Research |
| Volume | 37 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2019 |
Funding
1Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester, Rochester, New York, 2Department of Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, 3Department of Orthopaedic Surgery, Helios Endo Klinik Hamburg, Hamburg, Germany, 4Department of Orthopaedic Surgery, University of Miami/Miller School of Medicine, Miami, Florida, 5Department of Orthopaedics, Kaiser Permanente Vacaville Medical Center, Vacaville, California, 6Deparment of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, 7Department of Orthopedic Surgery, New York University, New York, New York, 8Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, 9Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada, 10Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, 11Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, 12Department of Orthopaedic Surgery, College of Medicine‐Phoenix, University of Arizona, Phoenix, Arizona, 13Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 14Department of Orthopedic Surgery, Vanderbilt Medical Center, Nashville, Tennessee, 15Department of Orthopaedics, University of Maryland, Baltimore, Maryland, 16Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, United Kingdom, 17Department of Microbiology, School of Medicine, University of Southampton, Southampton, United Kingdom, 18Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, 19Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
Keywords
- International Consensus Meeting
- costs
- incidence
- musculoskeletal infection
- research priorities
ASJC Scopus subject areas
- Orthopedics and Sports Medicine