Osteoarticular infections

1. To participate as members of a multidisciplinary team to provide compassionate, evidence-based care to patients with diabetic foot infections
2. To provide compassionate, evidence-based care to patients with prosthetic joint infections
3. To promote clinical research on optimizing diagnosis, treatment and prevention of osteoarticular infections

People who are hospitalized at Yale New Haven with bone and joint infections are managed by the infectious disease teams on all three campuses. The inpatient service at the St. Raphael Campus (SRC) of Yale New Haven Hospital has a dedicated musculoskeletal service which is run primarily by an attending physician, PA and podiatry resident. In addition, these services are provided by Yale faculty to the Veterans at the VA CT Healthcare System.

The Yale academic outpatient ID clinic practice also welcomes a high volume of referral patients who have possible or confirmed osteomyelitis for ongoing diagnostic workup and multidisciplinary management.

Quality Improvement and Patient Safety

Patients who require prolonged antibacterials are followed after discharge in the outpatient ID clinics. Patients who are discharged on parenteral antibiotics are enrolled in our outpatient antimicrobial therapy (OPAT) program which allows for monitoring of laboratory results, ensures appropriate follow up and tracks adverse events.

There has been tremendous effort invested in shortening length of stay for patients with diabetic foot infections with systems in place for expedited outpatient imaging and vascular evaluation, discharge with pathology and cultures pending and rapid follow up of patients in the outpatient ID clinic. In order to maximize medical care, patients with diabetic foot infections are co-managed with hospitalist medicine teams.

Yale Faculty are involved in the clinical consensus groups for development of Yale Health hospital network care signature pathways, including vertebral osteomyelitis (Matthew Grant), septic arthritis (Anne Spichler, Joe Canterino) and diabetic foot infection (Marjie Golden, Joe Canterino).

Infectious diseases faculty partner with joint replacement surgery colleagues to optimize care related to diagnosis, treatment and prevention of prosthetic joint infection (PJI). Existing projects include optimal management of S. aureus PJI, appropriate duration of antibiotic suppression for patients with retained hardware components, value of sonicate cultures of explanted hardware to augment diagnostic yield, and the yield of routine AFB cultures on synovial fluid. Yale undergraduates in the biomedical engineering program are actively seeking clinical mentors, including ID fellows, for collaboration on research projects with device development. Yale faculty are also involved in material science research including covalently bound disinfectants applied to metallic surfaces which are highly active against MRSA infection.

Research is ongoing and we are developing a protocol for use of phage in treatment of prosthetic joint infections