Publications

Background

Bone and joint infections (BJIs) have a major clinical and economic impact in industrializedcountries. Its management requires a multidisciplinary approach, and a great experience for the mostcomplicated cases to limit treatment failure, motor disability and amputation risk. To our best knowledgethere is not currently national specific organization dedicated to manage BJI. Is it possible to build at anational level, a network involving orthopaedic surgeons, infectiologists and microbiologists performinglocally multidisciplinary meetings to facilitate the recruitment and the management of patients withcomplex bone and joint infection in regional centers?

Hypothesis

A national healthcare network with regional labeled centers creates a dynamic that improvesthe recruitment, the management, the education, and the clinical research in the field of complex BJI.Patients and methods: We describe the history of this unique national healthcare network and how itworks, specify the missions confided to the CRIOAcs, evaluate the activity of the network over the firstdecade, and finally discuss perspectives.

Results

The labelling of 24 centers in the CRIOAc network allowed for a meshing of the territory, withthe possibility of management of complex BJI in each region of France. A dedicated secure national onlineinformation system was designed and used to facilitate decision-making during multidisciplinary con-sultation meetings. Since October 2012 to June 2017, 4553 multidisciplinary consultation meetings havebeen performed in the structures belonging to the network, with 34,607 cases discussed in 19,961 indi-vidual. Prosthetic joint infections represented 38% (7585/19,961) of all BJIs. Among all the cases discussed,the rate of complexity was of 61% (21,110/34,607) (related to antibiotic resistance, infection recurrence,patient co morbidities). A national scientific meeting was created and a national postgraduate diplomain the field of BJI was launched in 2014. The promotion of education, clinical research and interactivitybetween each academic discipline and between each labeled centers across the country has synergizedthe strengths and have greatly facilitated the management of patients with BJI.

Discussion

The setting up of the CRIOAc network in France took time, and has a cost for the FrenchMinistry of Health. However, this network has greatly facilitated the management of BJI in France, andallowed to concentrate the management of complex BJI in centers that have significantly gained skills.There is, to our knowledge, no other exemple of such nationwide network in the field of BJI.Level of evidence: IV, case series without control group.