Abstract：
OBJECTIVE: The literature presents a wide range of success rates for a single surgical intervention of bacterial-septic-arthritis, and there is a lack of clear criteria for identifying treatment failure and making decisions about reintervention. This Delphi study aims to establish a consensus among an international panel of experts regarding the definition of treatment failure and the criteria for reintervention in case of bacterial arthritis.
METHODS: The conducting and reporting Delphi studies (CREDES) criteria were used. Data from a systematic review was provided as the basis for the study. A list of 100 potential experts were identified. The study was designed and conducted as follows: (I) identification and invitation of an expert panel, (II) informing the participating expert panel on the research question and subject, and (III) conducting two or three Delphi rounds to reach consensus on explicit research items. Potential criteria were rated on a five-point Likert scale.
RESULTS: Sixty orthopaedic experts from nine countries participated in this Delphi study, with 55 completing all three rounds. The mean experience as an orthopaedic surgeon was 15 years (SD ± 9). Strong (96%) consensus was reached on the definition of treatment failure: the persistence of physical signs of arthritis (e.g., pain and swelling) and/or systemic inflammation (e.g., fever and no improvement in CRP) despite surgical and antibiotic treatment. Furthermore, consensus (>80%) was reached on six criteria influencing the decision for reintervention; pain (81%), sepsis (98%), fever (88%), serum CRP (93%), blood culture (82%), and synovial fluid culture (84%).
CONCLUSIONS: The definition of treatment failure for bacterial arthritis after a single surgical intervention was established through a three-round Delphi study. Additionally, consensus was reached on six criteria that are helpful for determining the need for reintervention. This definition and these criteria may help in the development of clinical guidelines, and will empower physicians to make more precise and consistent decisions regarding reintervention for patients, ultimately aiming to reduce over- and undertreatment and improve patient outcomes.
METHODS: Level V.
METHODS: The conducting and reporting Delphi studies (CREDES) criteria were used. Data from a systematic review was provided as the basis for the study. A list of 100 potential experts were identified. The study was designed and conducted as follows: (I) identification and invitation of an expert panel, (II) informing the participating expert panel on the research question and subject, and (III) conducting two or three Delphi rounds to reach consensus on explicit research items. Potential criteria were rated on a five-point Likert scale.
RESULTS: Sixty orthopaedic experts from nine countries participated in this Delphi study, with 55 completing all three rounds. The mean experience as an orthopaedic surgeon was 15 years (SD ± 9). Strong (96%) consensus was reached on the definition of treatment failure: the persistence of physical signs of arthritis (e.g., pain and swelling) and/or systemic inflammation (e.g., fever and no improvement in CRP) despite surgical and antibiotic treatment. Furthermore, consensus (>80%) was reached on six criteria influencing the decision for reintervention; pain (81%), sepsis (98%), fever (88%), serum CRP (93%), blood culture (82%), and synovial fluid culture (84%).
CONCLUSIONS: The definition of treatment failure for bacterial arthritis after a single surgical intervention was established through a three-round Delphi study. Additionally, consensus was reached on six criteria that are helpful for determining the need for reintervention. This definition and these criteria may help in the development of clinical guidelines, and will empower physicians to make more precise and consistent decisions regarding reintervention for patients, ultimately aiming to reduce over- and undertreatment and improve patient outcomes.
METHODS: Level V.
摘要：
目的：文献显示了细菌性脓毒性关节炎的单一手术干预的广泛成功率，缺乏明确的标准来识别治疗失败和做出再干预的决定。这项Delphi研究旨在在国际专家小组中就治疗失败的定义和细菌性关节炎的再干预标准达成共识。
方法：使用进行和报告德尔菲研究（CREDES）标准。提供了系统评价的数据作为研究的基础。确定了100名潜在专家的名单。该研究的设计和进行如下：（I）确定和邀请专家小组，(二)将研究问题和课题通知与会专家组，(III)进行两到三次德尔菲回合，就明确的研究项目达成共识。潜在标准以5点Likert量表进行评估。
结果：来自9个国家的60名骨科专家参与了这项德尔菲研究，55人完成了所有三轮比赛。整形外科医生的平均经验为15年（SD±9）。在治疗失败的定义上达成了强烈的共识（96％）：关节炎的身体体征的持久性（例如，疼痛和肿胀)和/或全身性炎症(例如，尽管进行了手术和抗生素治疗，但发热和CRP没有改善）。此外，在影响再干预决策的六个标准上达成共识(>80%)；疼痛(81%)，脓毒症（98%），发烧（88%），血清CRP（93%），血培养（82%），和滑液培养（84%）。
结论：通过三轮Delphi研究确定了单次手术干预后细菌性关节炎治疗失败的定义。此外,就有助于确定是否需要再干预的六项标准达成了共识。这个定义和这些标准可能有助于临床指南的发展。并将使医生能够就患者的再干预做出更精确和一致的决定，最终旨在减少过度治疗和治疗不足，并改善患者预后。
方法：V级
方法：使用进行和报告德尔菲研究（CREDES）标准。提供了系统评价的数据作为研究的基础。确定了100名潜在专家的名单。该研究的设计和进行如下：（I）确定和邀请专家小组，(二)将研究问题和课题通知与会专家组，(III)进行两到三次德尔菲回合，就明确的研究项目达成共识。潜在标准以5点Likert量表进行评估。
结果：来自9个国家的60名骨科专家参与了这项德尔菲研究，55人完成了所有三轮比赛。整形外科医生的平均经验为15年（SD±9）。在治疗失败的定义上达成了强烈的共识（96％）：关节炎的身体体征的持久性（例如，疼痛和肿胀)和/或全身性炎症(例如，尽管进行了手术和抗生素治疗，但发热和CRP没有改善）。此外，在影响再干预决策的六个标准上达成共识(>80%)；疼痛(81%)，脓毒症（98%），发烧（88%），血清CRP（93%），血培养（82%），和滑液培养（84%）。
结论：通过三轮Delphi研究确定了单次手术干预后细菌性关节炎治疗失败的定义。此外,就有助于确定是否需要再干预的六项标准达成了共识。这个定义和这些标准可能有助于临床指南的发展。并将使医生能够就患者的再干预做出更精确和一致的决定，最终旨在减少过度治疗和治疗不足，并改善患者预后。
方法：V级
