Implication of antibiotic referents in complex bone and joint infections

One of the main objectives of antibiotic referents in French hospitals is to promote the nationwide antibiotic stewardship program. National guidelines for complex bone and joint infection management (CBJI) issued in 2009, and expert and associated hospital centres were chosen. Our aim was to determine the role of antibiotic referents in CBJI treatment modalities, in 2012.

A questionnaire was proposed to participants at the seventh national meeting of antibiotic referent in June 2012.

Ninety-seven questionnaires were completed. Antibiotic referents were mainly infectious diseases doctors working in public hospitals with more than 300 hundreds beds. Twenty-eight units dedicated to CBJI were reported, as well as 35 multidisciplinary team meetings, 57% of which including physicians from both private and public hospitals. The 2009 national recommendations were the reference for 81% of responders, while referring to expert and associated centres was reported by 80%. Patient transfer to a reference center was rare, for both geographic reason and divergent medical and surgical habits. Most antibiotic referents suggested a 6-week course of antibiotic therapy and 12 months of follow-up. Twenty-two percent of the responders participated in morbidity and mortality audits.

The 2009 national guidelines were rapidly taken into account. Their implementation led to more homogeneous clinical practices as reported by antibiotic referents. Reference centres are used for advice but patient transfer to these centres is still rare.