Bone and Joint Infection Referral Systems in Europe: A Survey of Organization, Centralization, and Multidisciplinary Care

Introduction: Bone and joint infections (BJI), including periprosthetic joint infections, fracture-related infections, diabetic foot syndrome, and pressure ulcers, are complex conditions associated with substantial morbidity, prolonged treatment, and high healthcare costs. Their management requires multidisciplinary expertise, advanced surgical reconstruction, and individualized antimicrobial strategies. However, the organization of referral pathways for BJI remains poorly characterized internationally. Methods: We conducted an international cross-sectional survey within the European Bone and Joint Infection Society (EBJIS) network to evaluate the organization of BJI care across healthcare systems. Clinicians with expertise in musculoskeletal infection from 15 countries completed a structured questionnaire assessing healthcare organization, referral pathways, centralization, and specialized “high-volume” centres. Analyses were descriptive. Results: Marked heterogeneity in BJI care organization was observed, ranging from centralized national models to regionalized or mixed systems. The number of “high-volume” centres managing >30 BJI patients annually varied substantially, from 2 in Portugal to >10 in France, Germany, Italy, Spain, England, Turkey, and the Netherlands. In most countries, all hospitals were permitted to manage BJI, with complex cases referred mainly through informal professional networks. France had the most structured model, with a nationwide CRIOAc network providing coordinated referral pathways and multidisciplinary assessment for patients with complex BJI. Spain and England had partially structured systems, whereas most countries lacked formally designated infection centres. Conclusions: BJI care organization varies considerably between countries, with formal referral systems remaining uncommon. Standardized referral criteria, clear definitions of case complexity, and coordinated specialized referral networks may facilitate timely access to multidisciplinary expertise and more equitable care for patients with complex BJI.