MANAGING FRACTURE-RELATED INFECTION IN AFRICA: INSIGHTS FROM CLINICIAN SURVEYS AND GUIDELINE DEVELOPMENT

Aim The aim of this study was to describe current bone and joint infection (BJI) practice in Africa, and understand clinicians views regarding the challenges and opportunities in the development of guidelines. Method A survey on fracture related infection (FRI) practice was developed by an international group, building on an initial survey to understand BJI in Africa in March 2024. The survey had two 34 item questionnaires with a section on practice and a section on guideline recommendations and was administered via MS Forms in November 2024. These surveys were supplemented by live polls at the South African Orthopaedic Association (SAOA) conference in Cape Town (September 2024) and the College of Surgeons of East Central and Southern Africa (COSECSA) in Harare (December 2024) to better understand clinician views. Results The FRI practice survey had 82 responses from across 25 countries, mostly representing those who work in specialist units. Most respondents were working with multidisciplinary teams but the make up of the teams was heterogenous. Only 66% (54) respondents had access to blood culture bottles. Only 59 (48%) had access to local antibiotics. There were 40 responses during the live polls at SAOA and 59 at COSECSA. The descriptors given in the live polls for FRI were negative with the two most common adjectives in South Africa being ‘devastation’ and ‘amputation’ and in Zimbabwe ‘bone infection’ and ‘challenging’. The most common words used to answer the question ‘How do you prevent FRI?’ included: asepsis, antibiotics, soft tissue management and protocols. The main challenges to guideline development included: time, standardization, lack of data and not enough research support. Conclusions These results highlight the current challenges and opportunities in BJI practice in Africa. They present detailed findings from a broad spectrum of clinicians working in BJI in Africa and provide useful findings utilized in the development of context appropriate guidelines and will inform ongoing work to improve practice in low resource settings.