Patient selection: fracture
Confirmatory criteria for FRI:
(1) fistula, sinus or wound breakdown communicating to the bone or implant
(2) purulent drainage from wound OR presence of pus seen during surgery
(3) >= 2 separate deep specimens positive for the phenotypically identical pathogen
(4) presence of micro-organisms in deep tissue confirmed by histology
Suggestive criteria:
(1) >= 1 clinical sign (pain, erythema, swelling, increased temperature, fever >= 38.3°C)
(2) >= 1 radiological sign (lytic bone at fracture site or around implant, implant loosening, sequestration, fracture non-union, periosteal bone formation)
(3) 1 deep specimen positive for a pathogenic organism
(4) elevated serum inflammatory markers (ESR, WBC, CRP)
(5) persistent or increasing or new-onset of wound drainage
(6) new-onset of effusion in adjacent joint, especially if a septic arthritis
Culture specimens:
(1) sterile puncture from joint effusion
(2) tissue biopsy, with >= 3 taken per site with sterile instruments
(3) NOT superficial or sinus tract swabs
(4) (not mentioned) collection of pus from wound site
