New concepts for the management of musculoskeletal infections.

A musculoskeletal infection remains a serious complication after trauma surgery with a significant socio-economic impact. As this complication still poses an important diagnostic and therapeutic challenge, this thesis will be divided into three work packages, as described below. The Infectious Complications After musculoskeletal Trauma (ICAT) study was initiated at UZ Leuven to gain various insights into the diagnosis and treatment of MSI. The ICAT study consists of a retrospective and a prospective part. The retrospective part has already been completed. The prospective part forms the first work package of this thesis and aims to investigate disease progression, variations in treatment and consequent variations in outcome, as well as (risk) factors that correlate with a specific outcome and quality of life, as this information may improve current treatment and prevention strategies. In the second work package of this thesis, alternative treatment options will be examined for difficult-to-treat MSIs (e.g., because of antibiotic resistance or biofilm formation). The development of alternative therapeutic strategies, such as bacteriophage therapy, is necessary given the global increase in antimicrobial resistance. To date, few high-quality data are available on the pharmacokinetics, safety and efficacy of this alternative strategy. The PHAGEFORCE study (a prospective, observational, registry study) will attempt to obtain these data and further optimise bacteriophage therapy in MSI patients. Finally, the third work package focuses on infection prevention. The compliance to the hospital policy concerning the isolation of surgical patients who suffer from infectious complications will be investigated. Furthermore, the effect of the isolation of MSI patients on the prevalence of nosocomial infections will also be investigated.