Szanowni Państwo,
mamy przyjemność poinformować, że dr hab. n. med. Ireneusz Babiak wystąpił do kolegów z Otwocka z prośbą o pomoc w przygotowaniu oferty na organizację Kongresu EBJIS w Warszawie w 2019. W ubiegłym roku, pomimo przedłożenia polskiej kandydatury na kongresie EBJIS w Oxford do organizacji tego kongresu w 2018 roku, wygrała oferta z Helsinek, mocnego ośrodka naukowo-badawczego i klinicznego w dziedzinie infekcji kostno-stawowych. Mamy nadzieję, że w 2019 roku to Polska stanie się gospodarzem tego ważnego wydarzenia.
 
Mała ludnościowo Finlandia ma swój produkt do leczenia infekcji w ortopedii (Bonalive), podobnie jak Szwecja (Cerament G), czy GB (Stimulan), Niemcy (Herafil, cementy z ATB, Perossal), czy Austria ( walidowane przeszczepy kości z ATB). Tym niemniej kandydatura Warszawy jako miejsca organizacji kolejnego kongresu - w 2019 wzbudziła duże zainteresowanie kolegów z innych krajów, zwłaszcza z Niemiec i Austrii. 

Zachęcamy również do zapoznania się z pismem dotyczącym wdrożenia wytycznych EBJIS w zakresie prewencji zakażeń złamań.

EBJIS Short Guide 2017
Fracture-related Infection


Open wounds, co-morbidities and associated local soft tissue injury, all increase the vulnerability to infection of patients with fractures. The consequences of infection can be serious for the patient and expensive for healthcare providers.  Systems for the effective prevention, detection and management of infection are a central component in a surgical service.

This guidance is relevant for all adult patients with surgically managed fractures of the axial skeleton. 

Prevention
  • A hospital should be able to demonstrate that it has agreed standards for the prevention of infection in all fracture patients (1). This will include theatre protocols, preoperative patient preparation, prophylactic antibiotic protocols, colonisation screening and …
  • For open fractures also refer to BOAST 4 (2) and the NICE complex fracture guideline (3).

Suspected infection 
There must be readily available guidance for primary carers and patients on how to respond in the event of a suspected fracture related infection. This should be included in discharge documentation.

Suspected early fracture related infection:
  • A patient who has signs of systemic sepsis must have a medical assessment immediately (4). Blood cultures must be taken rapidly and parenteral antibiotic treatment must not be delayed in an acutely septic patient.  
  • A patient who is not systemically unwell should be seen in a clinic within 24 hours. Antibiotic treatment should not be commenced before discussion with the responsible fracture surgeon.  

Suspected late fracture related infection (e.g. infected non-unions, infected healed fractures):
  • A patient who has signs of systemic sepsis should have a medical assessment immediately (4).   Blood cultures should be taken. Parenteral antibiotic treatment should not be delayed in an acutely septic patient.  
  • A well patient should be seen at a specialist bone infection combined clinic (ref. service specification).

Diagnosis of suspected fracture-related infection
A diagnostic work up should be performed for all potentially infected cases. This should include:
  • Blood cultures in all febrile and/or systemically septic patients.
  • Plain radiology for implant loosening, periosteal reaction and bone lysis. 
  • Ultrasonography guided aspiration of possible collections for microbiological culture. 
  • Intra-operative sampling. This should include 4-6 samples taken from around the fracture site using separate sterile instruments for each sample and processed in an accredited laboratory. 
  • For stable patients, the optimum antibiotic free duration before sampling should be discussed with microbiology. In non-acute infections, this should be a minimum of 2 weeks. 
Management
Co-morbidities should be optimised and sepsis treated. This may require an urgent general medical review. In well patients, treatment of the infection may be delayed until co-morbidities are addressed.

  • There is no place for empiric antibiotics without a diagnostic work up. 
  • Early infections should be managed in the acute trauma unit with microbiological and plastic surgery support. Management must be delivered by a senior surgeon and must include 
o diagnostic sampling
o debridement 
o assessment of fracture stability 
o provision of definitive soft tissue cover 

  • An MDT¥ focused on infection management should manage all;
o late or recurrent infections. 
o infected non-unions 
o infected fractures with major bone and soft tissue defects. 

  • Broad-spectrum antibiotics should be started after sampling.  Hospitals must have a relevant antibiotic policy. Antibiotics must be reviewed after 48 hours with preliminary culture results. 
  • Antimicrobial therapy should be narrowed and be culture specific as soon as possible. Hospitals must provide 24 hour telephone or bedside Microbiology advice for drug choice, monitoring and duration. 
Monitoring and follow up
  • A senior clinician should see the patient at each visit.
  • Failure of response to treatment needs a re-evaluation though the MDT. Antibiotics should not be simply prolonged. 
  • Significant adverse effects from antimicrobial therapy are common and expert advice should be sought. 

Evaluation of Outcomes 
• Hospitals must have a robust surgical site infection surveillance system5.
• There must be a clinical governance structure in place to review;
o primary outcome measures (re-operation rates, non-union, infection recurrence, amputation and death)
o access to care (turnaround times) 

Foot note
¥ MDT = multidisciplinary team which should include orthopaedic and plastic surgeons experienced in infection management, infection specialists and musculoskeletal radiologists. 

References
  1. NICE quality standard [QS61] Infection prevention and control, April 2014
  2. BOAST 4; from 2009 BOA/BAPRAS Standards for the Management of Open Lower Limb Fractures
  3. NICE fracture guidelines
  4. (NICE guideline: The recognition, diagnosis and management of sepsis, in development. Anticipated publication date: July 2016). 
  5.  https://www.gov.uk/government/collections/surgical-site-infection-ssi-guidance-data-and-analysis

Lista delegatów 
Country Delegate 

EUROPEAN BONE AND JOINT INFECTION SOCIETY

  • Mathias Glehr, Austria, mathias@glehr.com
  • Chingiz Alizada, Azerbaijan, ch.alizadehff@gmail.com
  • Jeroen Neyt, Belgium, jeroen.neyt@uzleuven.be, jgvneyt@yahoo.com
  • David Jahoda, Czech Republic, david.jahoda@post.cz
  • Christen Ravn, Denmark, christen.ravn@rsyd.dk
  • Kaisa, Huotari, Finland, kaisa.huotari@hus.fi
  • Gerard Giordano, France, ortho.giordano@gmail.com
  • Volker Alt, Germany, volker.alt@chiru.med.uni-giessen.de
  • Dieter Bettin, Germany, Praxis.bettin@gmx.de, dieter.bettin@ewetel.net
  • Kostas Malizos, Greece, kmalizos@otenet.gr
  • Adrian Taylor, UK, adrian.taylor@ouh.nhs.uk
  • Lorenzo Drago, Italy, lorenzo.drago@unimi.it
  • Martins Malzubris, Latvia, mmalzubris@inbox.lv
  • Danguole Vasznaisiene, Lithuania, danguole.simanaityte@gmail.com
  • Dirk Jan Moojen, Netherlands, dirkjan.moojen@gmail.com
  • Marianne Westberg, Norway, marianne.westberg@oslo-universitetssykehus.no
  • Muhammad Amin Chinoy, Pakistan, chinoy786@gmail.com
  • Ireneusz Babiak, Poland, irek63@poczta.onet.pl, ibabiak@wum.edu.pl
  • Ricardo Sousa, Portugal, ricardojgsousa@gmail.com
  • Rihard Trebse, Slovenija, Rihard.Trebse@ob-valdoltra.si
  • Guillem Bori, Spain, gbori@clinic.ub.es
  • Isidor Marchan, Spain, Isidor.marchan@gmail.com
  • Anna Stefánsdóttir, Sweden, anna.stefansdottir@med.lu.se
  • Martin Clauss, Switzerland, Martin.Clauss@ksli.ch
  • Rhidian Morgan-Jones, Wales, rhidianmj@hotmail.com

Zadania EBJIS

EBJIS Country delegates

To improve the promotion of the EBJIS in Europe, to reach interested colleagues in a more easy way and to appoint bone and joint infection centers in Europe.

Definition and nomination

1. The European Bone and Joint Infection Society Board may nominate, within members in good state, one or more “EBJIS Country Delegate (EBJIS CD)”.

2. Written candidature to become an EBJIS CD may be proposed by any EBJIS member or by any component of the EBJIS Board.

3. EBJIS Country Delegates are nominated by the arithmetical majority of the EBJIS Board members, stay in charge for the duration of the Board and may be renovated more than once.

4. One or more EBJIS CDs per Country / Region may be nominated, according to the local number of EBJIS members. 

5. A Region is made from various Countries. Preferably, different Countries are merged into one Region when less than < 10 members per Country are found, or on the basis of geographic proximity, or of the same/similar language, etc..


Duties and obligations

6. EBJIS CD acts as regional reference / local host, facilitating and advertising the European Bone and Joint Society initiatives, promoting educational and scientific activity and coordinating with the EBJIS Board.

7. EBJIS CD may be invited to participate to meetings and dedicated sessions to improve/organize EBJIS activity.

8. EBJIS CDs will have their name, address and short CV listed at the website of the Society and on official printed documents, when relevant. They may obtain a written certificate from the EBJIS Board concerning their role within the EBJIS.

9. At any time, the Board, with numerical majority, may decide to withdraw any EBJIS CD, due to misconduct or inadequate activity or lack of payment of membership dues after two consecutive written recalls.

10. The present regulation will take effect after ratification from the EBJIS General Assembly. Changes to the present regulation may be made, provided that they are voted by the numerical majority of the EBJIS Board and ratified by the General Assembly.