Dear FOI contact,

I am writing to request your assistance with an open government request relating to your joint infection services according to the Freedom of Information Act 2000.

Please kindly complete the below questions.

Questions for clinical team(s):
1. In 2022/2023 (or for the last recorded year with data available), in your Trust/Health Board, how many of the following did you record?
a) Paediatric patients with suspected septic arthritis in native joints
b) Paediatric patients with suspected prosthetic joint infection (PJI)
c) Adult patients with suspected septic arthritis in native joints
d) Adult patients with suspected prosthetic joint infection (PJI)

2. Does your Trust/Health Board follow or have any locally developed/adapted guidelines for the diagnosis and treatment of septic arthritis in native joints and prosthetic joint infections in both adults and paediatric patients?
a) If yes, please state which guidelines have been adapted and please provide a copy of your local guidelines

3. When investigating suspected septic arthritis in native joints in both paediatric and adult patients, is a synovial fluid sample collected before or after antibiotics are administered and commenced?
a) Is joint aspirate collected in ED/triage, Assessment unit, inpatient ward, or theatre?
b) Who typically performs the procedure and collects the sample? (Please specify job role)
c) Does the above differ for suspected prosthetic joint infections? If yes, please clarify how this differs

4. What clinician would typically manage paediatric patients with suspected septic arthritis in native joints? (please select one or multiple)
I. Paediatric Consultant
II. Orthopaedic Consultant
III. Infectious Diseases Consultant
IV. Other (please specify)

5. Are patients discharged before culture results from synovial fluid aspirate are received? If yes, what requirements need to be met before patients are discharged?

Questions for lab/diagnostic team(s):

6. For adult and paediatric patients with suspected septic arthritis of native joints, what are the mean turnaround times (in hours, or if more appropriate, working days) for results on the following tests from receipt of specimen: (please provide an answer for each result)
a) Gram Stain
b) Culture
c) Blood culture
d) White blood cell count

7. Does your Trust/Health Board conduct PCR testing of bacteria from synovial fluid of patients who have suspected septic arthritis of native joints?
If yes:
a) Is this testing conducted on site?
b) At what point is testing requested – when the culture is negative or on request?
c) How long is the average turnaround time for results from receipt of specimen?
d) What organisms are routinely tested for?

8. Does your Trust/Health Board conduct 16S PCR testing of bacteria from synovial fluid of patients who have suspected septic arthritis of native joints?
If yes:
a) Is this testing conducted on site?
b) At what point is testing requested – when the culture is negative or on request?
c) How long is the average turnaround time for results from receipt of specimen?
d) What organisms are routinely tested for?

Joint question – input from both clinician and lab/diagnostic team:
9. For joint infections, in your Trust/Health Board, please confirm the following:
a) Which roles or stakeholders are involved in the design of diagnostic pathways and introducing change/pathway improvement?
b) Which team(s) hold the budget for investing and implementing in new technologies across the pathway (e.g. rapid diagnostic testing)?

Thank you for taking the time to supply this information. I am working for, and have submitted this request, on behalf of Mtech Access, a market access company based in the UK. We are currently investigating and gathering information on the diagnosis and treatment processes for patients with suspected septic arthritis of native joints and prosthetic joint infections in the NHS for a specific singular client project.

As part of this request, I am seeking to obtain your permission to re-use and share the information you have provided with our client (a biotechnology company). The information and data will not be published publicly and will only be for our client’s internal use and information.

Please let me know within your response to this request if you do not want us to share this information with our client.

Thank you.

Best wishes,
Kimrin Pannu