Articles | Volume 10, issue 6
https://doi.org/10.5194/jbji-10-489-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-10-489-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Review
| 
28 Nov 2025
Review |
| 28 Nov 2025
| 28 Nov 2025
Re-evaluating patient isolation policies for musculoskeletal infections in orthopaedic practice: a scoping review
Laura Bessems
Department of Development and Regeneration, KU Leuven, Leuven, 3000, Belgium
Department of Trauma Surgery, University Hospitals Leuven, Leuven, 3000, Belgium
Jolien Onsea
Department of Development and Regeneration, KU Leuven, Leuven, 3000, Belgium
Department of Trauma Surgery, University Hospitals Leuven, Leuven, 3000, Belgium
Baixing Chen
Department of Development and Regeneration, KU Leuven, Leuven, 3000, Belgium
Department of Trauma Surgery, University Hospitals Leuven, Leuven, 3000, Belgium
Marjan Wouthuyzen-Bakker
Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands
University of Groningen, Groningen, 9713 GZ, the Netherlands
Irene K. Sigmund
Department of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, 1090, Austria
Tristan Ferry
Infectious and Tropical Diseases Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, 69004, France
Richard Kuehl
Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, 4031, Switzerland
Department of Orthopaedics and Trauma Surgery, Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, 4031, Switzerland
Martin Clauss
Department of Orthopaedics and Trauma Surgery, Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, 4031, Switzerland
Alex Soriano
Hospital Clinic of Barcelona, Barcelona, 08036, Spain
IDIBAPS, Barcelona, 08036, Spain
CIBERNIF, CIBER in Infectious Diseases, ISCIII, Madrid, 28029, Spain
Ricardo Sousa
Orthopaedic Department, Porto Bone Infection Group (GRIP), ULS Santo António, Porto, 4099-001, Portugal
Annette Schuermans
Department of Infection Control and Epidemiology, University Hospitals Leuven, Leuven, 3000, Belgium
Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven, 3000, Belgium
Willem-Jan Metsemakers
CORRESPONDING AUTHOR
Department of Development and Regeneration, KU Leuven, Leuven, 3000, Belgium
Department of Trauma Surgery, University Hospitals Leuven, Leuven, 3000, Belgium
Related authors
Ann-Sophie Jacob, Jolien Onsea, Laura Bessems, Pauline Spoormans, Georges Vles, Willem-Jan Metsemakers, Sien Ombelet, and Melissa Depypere
J. Bone Joint Infect., 10, 317–326, https://doi.org/10.5194/jbji-10-317-2025, https://doi.org/10.5194/jbji-10-317-2025, 2025
Short summary
Short summary
Fracture-related infections (FRIs) and periprosthetic joint infections (PJIs) fail to recover pathogens, posing a diagnostic challenge and impacting treatment. This new method involves homogenising biopsies with beads to release bacteria, followed by inoculation in blood culture bottles using an automated system. This technique shows similar sensitivity to conventional methods, with improved specificity and faster pathogen detection. To date, no other studies have reported an optimized method for incubating biopsies from patients with FRIs.
Lukas Rabitsch, Markus Luger, Felix Lötsch, Peter Starzengruber, Florian Thalhammer, Reinhard Windhager, Birgit Willinger, and Irene Katharina Sigmund
J. Bone Joint Infect., 10, 437–446, https://doi.org/10.5194/jbji-10-437-2025, https://doi.org/10.5194/jbji-10-437-2025, 2025
Short summary
Short summary
The novel multiplex polymerase chain reaction (mPCR), BioFire® Joint Infection Panel (BF-JIP; bioMérieux, Marcy-l’Étoile, France), demonstrated similar diagnostic accuracy to conventional synovial fluid culture and can therefore serve as a valuable adjunct in diagnosing septic arthritis in adults, particularly in patients with prior antimicrobial therapy.
Joana Contente, Carlos Ferreira, Mário Silva, Guilherme Madeira, Ana Ribau, and Ricardo Sousa
J. Bone Joint Infect., 10, 403–410, https://doi.org/10.5194/jbji-10-403-2025, https://doi.org/10.5194/jbji-10-403-2025, 2025
Short summary
Short summary
We assessed whether two debated scoring tools, KLIC and CRIME-80, could predict the failure of a treatment called debridement, antibiotics, and implant retention (DAIR) in prosthetic joint infections. We reviewed data from 102 patients. Neither score reliably predicted failure, even when the treatment was repeated. Our results highlight the limited clinical utility of these scores and support the need for better tools to guide treatment decisions in joint infections.
Laura K. Certain and Irene K. Sigmund
J. Bone Joint Infect., 10, 397–402, https://doi.org/10.5194/jbji-10-397-2025, https://doi.org/10.5194/jbji-10-397-2025, 2025
Short summary
Short summary
The Musculoskeletal Infection Society (MSIS) and the European Bone and Joint Infection Society (EBJIS) are comprised of experts in preventing, diagnosing, and managing orthopedic infections. In 2023, MSIS and EBJIS surveyed their membership about their approach to various clinical aspects of these challenging conditions. The results indicate that, even among experts, there remains substantial variability of practice. This variability reflects open questions in the field.
Irene K. Sigmund, Matthew J. Dietz, Marta Sabater-Martos, Antony J. R. Palmer, Nicolas Cortés-Penfield, and the “Serum Marker Workgroup” for the Unified PJI Definition Taskforce
J. Bone Joint Infect., 10, 363–376, https://doi.org/10.5194/jbji-10-363-2025, https://doi.org/10.5194/jbji-10-363-2025, 2025
Short summary
Short summary
Serum C-reactive protein, fibrinogen, and interleukin-6 show the best performance among serum markers for diagnosing periprosthetic joint infection (PJI), but they lack sufficient accuracy to confirm or exclude infection reliably. These markers should be re-evaluated in future PJI definitions, as they are not suitable as stand-alone tests. Given their limitations and the superior diagnostic performance of synovial markers, the role of serum markers in PJI diagnosis should be reconsidered.
Jonathan Sliepen, Michelle A. S. Buijs, Jolien Onsea, Geertje A. M. Govaert, Frank F. A. IJpma, Jean-Paul P. M. de Vries, Bart C. H. Van der Wal, Charalampos Zalavras, and Willem-Jan Metsemakers
J. Bone Joint Infect., 10, 347–361, https://doi.org/10.5194/jbji-10-347-2025, https://doi.org/10.5194/jbji-10-347-2025, 2025
Short summary
Short summary
This review assessed the effectiveness of single- and two-stage procedures for treating long-bone fracture-related infections, focusing on unhealed fractures without critical-sized bone defects. A total of 35 studies with 985 patients showed bone-healing rates of 80% for single-stage procedures and 77% for two-stage procedures. Infection eradication rates were 87% for single-stage approaches and 81% for two-stage approaches. The current evidence is inconclusive and lacks sufficient data to favor either approach.
Ann-Sophie Jacob, Jolien Onsea, Laura Bessems, Pauline Spoormans, Georges Vles, Willem-Jan Metsemakers, Sien Ombelet, and Melissa Depypere
J. Bone Joint Infect., 10, 317–326, https://doi.org/10.5194/jbji-10-317-2025, https://doi.org/10.5194/jbji-10-317-2025, 2025
Short summary
Short summary
Fracture-related infections (FRIs) and periprosthetic joint infections (PJIs) fail to recover pathogens, posing a diagnostic challenge and impacting treatment. This new method involves homogenising biopsies with beads to release bacteria, followed by inoculation in blood culture bottles using an automated system. This technique shows similar sensitivity to conventional methods, with improved specificity and faster pathogen detection. To date, no other studies have reported an optimized method for incubating biopsies from patients with FRIs.
Marta Sabater-Martos, Laura Morata, Josep Maria Segur, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 10, 237–241, https://doi.org/10.5194/jbji-10-237-2025, https://doi.org/10.5194/jbji-10-237-2025, 2025
Short summary
Short summary
This study's aim was to analyse the healing and failure rates of one-stage knee replacement in patients with positive and negative preoperative cultures and sinus presence. We concluded that culture-negative infections or the presence of a sinus tract showed similar results compared to patients that had undergone the same procedure with positive cultures or spared soft tissue.
Hendrika M. Schenk, Marine Sebillotte, Jose Lomas, Adrian Taylor, Eva Benavent, Oscar Murillo, Marta Fernandez-Sampedro, Kaisa Huotari, Craig Aboltins, Rihard Trebse, Alex Soriano, Marjan Wouthuyzen-Bakker, and on behalf of the ESCMID Study Group on Implant Associated Infections (ESGIAI)
J. Bone Joint Infect., 10, 217–224, https://doi.org/10.5194/jbji-10-217-2025, https://doi.org/10.5194/jbji-10-217-2025, 2025
Short summary
Short summary
Patients with rheumatoid arthritis have a high treatment failure rate when faced with a late acute periprosthetic joint infection. Because of the rarity of the condition, we performed a multicenter case-control study. We identified predictors of treatment failure to ultimately improve the treatment outcome. Exchange of modular components seems important in this patient group, likely due to a higher rate of positive blood cultures compared to control patients.
Marta Sabater-Martos, Martin Clauss, Ana Ribau, Ricardo Sousa, and on behalf of the Leukocyte Count Synovial Fluid working group for the Unified PJI definition task force
J. Bone Joint Infect., 10, 165–184, https://doi.org/10.5194/jbji-10-165-2025, https://doi.org/10.5194/jbji-10-165-2025, 2025
Short summary
Short summary
This meta-analysis evaluates synovial fluid white blood cell count and polymorphonuclear neutrophil proportion in order to diagnose chronic peri-prosthetic joint infection. Based on 74 studies, it identifies optimal thresholds, with rule-in and rule-out thresholds enhancing diagnostic precision. Confounding factors such as fractures and inflammatory arthritis are addressed. The findings support standardized diagnostic frameworks in improving accuracy and clinical consistency.
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem-Jan Metsemakers, Martin Clauss, Alex Soriano, Rihard Trebse, and Ricardo Sousa
J. Bone Joint Infect., 10, 139–142, https://doi.org/10.5194/jbji-10-139-2025, https://doi.org/10.5194/jbji-10-139-2025, 2025
Short summary
Short summary
This is a summary of our position paper on debridement, antimicrobial therapy, and implant retention (DAIR) procedures as a curative treatment strategy for acute periprosthetic hip and knee infections. It includes the defined indications as well as the contraindications of DAIR procedures when eradication/cure is intended, based on the currently available literature.
Irene K. Sigmund, Tristan Ferry, Ricardo Sousa, Alex Soriano, Willem-Jan Metsemakers, Martin Clauss, Rihard Trebse, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 10, 101–138, https://doi.org/10.5194/jbji-10-101-2025, https://doi.org/10.5194/jbji-10-101-2025, 2025
Short summary
Short summary
In this paper, we discuss the most relevant factors influencing the outcome and define indications, contraindications, and risk factors of a DAIR procedure based on the currently available literature. Furthermore, we discuss the surgical technique in combination with systemic antimicrobial therapy in patients undergoing a DAIR procedure.
Sebastian Simon, Marjan Wouthuyzen-Bakker, Susana Gardete Hartmann, Jennyfer A. Mitterer, Sujeesh Sebastian, Stephanie Huber, Bernhard J. H. Frank, and Jochen G. Hofstaetter
J. Bone Joint Infect., 10, 51–59, https://doi.org/10.5194/jbji-10-51-2025, https://doi.org/10.5194/jbji-10-51-2025, 2025
Short summary
Short summary
We compared the re-revision rates in rTHA and rTKA (revison total hip and knee arthroplasty) with and without AB (antibiotic) treatment in patients with UPICs (unexpected positive intraoperative cultures). The re-revision rate between the AB group and the non-AB group was similar. Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPICs in presumed aseptic rTHA and rTKA. Patients with pathogens classified as a likely contaminant can be safely ignored.
Marta Sabater-Martos, Oscar Garcia, Laia Boadas, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 10, 41–49, https://doi.org/10.5194/jbji-10-41-2025, https://doi.org/10.5194/jbji-10-41-2025, 2025
Short summary
Short summary
This is a retrospective diagnostic study in acute postoperative prosthetic joint infection in total knee arthroplasty that wants to determine diagnostic accuracy of synovial glucose and serum-to-synovial glucose ratio in acute postoperative infection. Both tests demonstrated good diagnostic potential. Notably, these biomarkers exhibited superior accuracy compared to the combination of C-reactive protein, synovial white blood cell count and polymorphonuclear percentage.
Baixing Chen, T. Fintan Moriarty, Hans Steenackers, Georges F. Vles, Jolien Onsea, Thijs Vackier, Isabel Spriet, Rob Lavigne, R. Geoff Richards, and Willem-Jan Metsemakers
J. Bone Joint Infect., 9, 249–260, https://doi.org/10.5194/jbji-9-249-2024, https://doi.org/10.5194/jbji-9-249-2024, 2024
Short summary
Short summary
Our research explores natural antimicrobials to combat orthopedic-device-related infections, a challenging issue due to antibiotic resistance. We reviewed agents from bacteria, fungi, viruses, animals, plants and minerals, evaluating their effectiveness and synergy with traditional antibiotics. Our findings suggest these natural alternatives could revolutionize infection management in orthopedic patients, offering new hope for reducing antibiotic resistance and improving treatment outcomes.
Laia Boadas-Gironès, Marta Sabater-Martos, Marc Ferrer-Banus, Àlex Soriano-Viladomiu, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 241–248, https://doi.org/10.5194/jbji-9-241-2024, https://doi.org/10.5194/jbji-9-241-2024, 2024
Short summary
Short summary
When acute soft tissue defects are present after knee arthroplasty, the infection risk is high. A gastrocnemius flap is used for anterior defects, and it is not usually combined with debridement surgery unless infection is clear. We examined the benefit of combining coverage treatment with debridement surgery, DAIR, comparing the isolated traditional coverage treatment. The results suggested a higher healing rate in the combined treatment, so we recommended it.
Seung-Jae Yoon, Paul C. Jutte, Alex Soriano, Ricardo Sousa, Wierd P. Zijlstra, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 9, 231–239, https://doi.org/10.5194/jbji-9-231-2024, https://doi.org/10.5194/jbji-9-231-2024, 2024
Short summary
Short summary
This study validated three models for predicting infection after hip and knee replacement surgery. By analyzing data from 2684 patients in the Netherlands, Portugal, and Spain, we found that the models developed by Tan, Del Toro, and Bülow effectively identified high-risk patients. These models can be used to enhance preoperative counseling and to tailor infection prevention measures individually, potentially improving outcomes and reducing healthcare costs.
Alexandra Wallimann, Yvonne Achermann, Ciara Ferris, Mario Morgenstern, Martin Clauss, Vincent Stadelmann, Hannes Andreas Rüdiger, Liam O'Mahony, and Thomas Fintan Moriarty
J. Bone Joint Infect., 9, 191–196, https://doi.org/10.5194/jbji-9-191-2024, https://doi.org/10.5194/jbji-9-191-2024, 2024
Short summary
Short summary
Skin commensal bacteria such as staphylococci are often the source of orthopaedic-device-related infections. Rifampicin is a widely used antibiotic in the treatment of these infections. The results of this study show that oral rifampicin therapy leads to a consistent and persistent induction of resistance in commensal staphylococci on the skin and in the nose for a prolonged time.
Noémie Reinert, Katinka Wetzel, Fabian Franzeck, Mario Morgenstern, Markus Aschwanden, Thomas Wolff, Martin Clauss, and Parham Sendi
J. Bone Joint Infect., 9, 183–190, https://doi.org/10.5194/jbji-9-183-2024, https://doi.org/10.5194/jbji-9-183-2024, 2024
Short summary
Short summary
We assessed concordance of in-house guidelines for diagnostic principles and antibiotic treatment duration (ABT) 2 years after their implementation. The goal was to standardize diagnostic and treatment principles: are we doing what we recommend? The adherence to recommendations in terms of biopsy sampling was good, moderate for histopathology and poor for anatomic labeling. In terms of ABT duration, the adherence was good, but further shortening for surgically cured cases is necessary.
Fred Ruythooren, Stijn Ghijselings, Melissa Depypere, Willem-Jan Metsemakers, Liesbet Henckaerts, Nathalie Noppe, and Georges Vles
J. Bone Joint Infect., 9, 167–171, https://doi.org/10.5194/jbji-9-167-2024, https://doi.org/10.5194/jbji-9-167-2024, 2024
Short summary
Short summary
The article examines a unique case of Ureaplasma urealyticum causing osteomyelitis in the greater trochanter of a 26-year-old male treated with ocrelizumab for multiple sclerosis. It emphasizes the necessity of a multidisciplinary approach and advanced PCR diagnostics to manage such rare opportunistic infections effectively, highlighting the challenges faced due to the immunosuppressive nature of monoclonal antibody therapies of this kind.
Stéphanie Pascual, Brooklyn Noble, Nusreen Ahmad-Saeed, Catherine Aldridge, Simone Ambretti, Sharon Amit, Rachel Annett, Shaan Ashk O'Shea, Anna Maria Barbui, Gavin Barlow, Lucinda Barrett, Mario Berth, Alessandro Bondi, Nicola Boran, Sara E. Boyd, Catarina Chaves, Martin Clauss, Peter Davies, Ileana T. Dianzo-Delgado, Jaime Esteban, Stefan Fuchs, Lennart Friis-Hansen, Daniel Goldenberger, Andrej Kraševac Glaser, Juha O. Groonroos, Ines Hoffmann, Tomer Hoffmann, Harriet Hughes, Marina Ivanova, Peter Jezek, Gwennan Jones, Zeynep Ceren Karahan, Cornelia Lass-Flörl, Frédéric Laurent, Laura Leach, Matilde Lee Horsbøll Pedersen, Caroline Loiez, Maureen Lynch, Robert J. Maloney, Martin Marsh, Olivia Milburn, Shanine Mitchell, Luke S. P. Moore, Lynn Moffat, Marianna Murdjeva, Michael E. Murphy, Deepa Nayar, Giacomo Nigrisoli, Fionnuala O'Sullivan, Büşra Öz, Teresa Peach, Christina Petridou, Mojgan Prinz, Mitja Rak, Niamh Reidy, Gian Maria Rossolini, Anne-Laure Roux, Patricia Ruiz-Garbajosa, Kordo Saeed, Llanos Salar-Vidal, Carlos Salas Venero, Mathyruban Selvaratnam, Eric Senneville, Peter Starzengruber, Ben Talbot, Vanessa Taylor, Rihard Trebše, Deborah Wearmouth, Birgit Willinger, Marjan Wouthuyzen-Bakker, Brianne Couturier, and Florence Allantaz
J. Bone Joint Infect., 9, 87–97, https://doi.org/10.5194/jbji-9-87-2024, https://doi.org/10.5194/jbji-9-87-2024, 2024
Short summary
Short summary
This study conducted in multiple sites across Europe aimed to evaluate the BIOFIRE Joint Infection (JI) Panel, a new technology that uses multiplex PCR to detect microorganisms in synovial fluid of patients with suspicion of joint infections in 1 h, in comparison with synovial fluid culture. Results showed an overall agreement of 85 % to 88.4 % between the two methods. The JI Panel detected additional organisms, and the positive user experience highlights its clinical significance.
Céline Dupieux, Ghislaine Descours, Paul Verhoeven, Florence Grattard, Yvonne Benito, François Vandenesch, Céline Cazorla, Tristan Ferry, Sébastien Lustig, Bertrand Boyer, Sandrine Boisset, Anne Carricajo, Frédéric Laurent, and PIRLA investigator group
J. Bone Joint Infect., 9, 37–48, https://doi.org/10.5194/jbji-9-37-2024, https://doi.org/10.5194/jbji-9-37-2024, 2024
Short summary
Short summary
We define an algorithm to optimize bone and joint infection diagnosis in adults on synovial fluid samples. This prospective multi-center study included a large number of synovial fluids and compared the performance of classical culture on different media, inoculation of synovial fluid in blood culture bottles, and broad-range and specific PCR. We proposed an algorithm associating culture onto three solid media and into blood culture bottles and 16S, Staphylococcus, and Streptococcus PCR.
Jordi Cools, Stijn Ghijselings, Fred Ruythooren, Sander Jentjens, Nathalie Noppe, Willem-Jan Metsemakers, and Georges Vles
J. Bone Joint Infect., 9, 27–35, https://doi.org/10.5194/jbji-9-27-2024, https://doi.org/10.5194/jbji-9-27-2024, 2024
Short summary
Short summary
Septic arthritis (SA) of the native adult hip is a rare orthopaedic emergency. To date, the role of advanced imaging has been confined to supporting or opposing diagnosis; however, implications for surgical decision-making and outcomes have not yet been established. We found that extra-articular abscesses are present in two out of three patients and require varying anatomical approaches. Therefore, we recommend routinely performing advanced imaging in all adults with SA of the native hip joint.
Marta Sabater-Martos, Marc Ferrer, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 17–26, https://doi.org/10.5194/jbji-9-17-2024, https://doi.org/10.5194/jbji-9-17-2024, 2024
Short summary
Short summary
This is a meta-analysis of six studies describing the cutoff values of white blood cell count and polymorphonuclear percentage in synovial fluid for the diagnosis of acute postoperative peri-prosthetic joint infection (PJI).
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
Fred Ruythooren, Stijn Ghijselings, Jordi Cools, Melissa Depypere, Paul De Munter, Willem-Jan Metsemakers, and Georges Vles
J. Bone Joint Infect., 8, 209–218, https://doi.org/10.5194/jbji-8-209-2023, https://doi.org/10.5194/jbji-8-209-2023, 2023
Short summary
Short summary
A total of 41 patients who underwent surgical treatment for septic arthritis (SA) of the native hip were studied. We show that patients with SA of the native hip can be divided in three distinct clinical subgroups based on route of infection. Route of infection is directly related to the chance of femoral head preservation and should, therefore, be the basis for decision-making. Only patients with blood-borne infections in an undamaged hip had a reasonable chance of femoral head preservation.
Niels Vanvelk, Esther M. M. Van Lieshout, Jolien Onsea, Jonathan Sliepen, Geertje Govaert, Frank F. A. IJpma, Melissa Depypere, Jamie Ferguson, Martin McNally, William T. Obremskey, Charalampos Zalavras, Michael H. J. Verhofstad, and Willem-Jan Metsemakers
J. Bone Joint Infect., 8, 133–142, https://doi.org/10.5194/jbji-8-133-2023, https://doi.org/10.5194/jbji-8-133-2023, 2023
Short summary
Short summary
This international retrospective cohort study displays the diagnostic characteristics of 609 patients who were treated for fracture-related infection (FRI). Clinical confirmatory criteria were present in 77% of patients. In the remaining patients, the decision to operatively collect deep tissue cultures had to be based on a set of suggestive criteria. The combined use of these suggestive criteria should guide treating physicians in the management pathway of FRI.
Sara Elisa Diniz, Ana Ribau, André Vinha, José Carlos Oliveira, Miguel Araújo Abreu, and Ricardo Sousa
J. Bone Joint Infect., 8, 109–118, https://doi.org/10.5194/jbji-8-109-2023, https://doi.org/10.5194/jbji-8-109-2023, 2023
Short summary
Short summary
While there is no gold standard test to diagnose periprosthetic joint infection (PJI), we believe synovial fluid analysis, especially preoperatively, is a critical step in differentiating between infection and aseptic failure. Adding simple and inexpensive biomarkers such as synovial C-reactive protein (CRP) or adenosine deaminase (ADA) and combined interpretation can be helpful in the context of inconclusive results.
Jorrit Willem Adriaan Schoenmakers, Rosanne de Boer, Lilli Gard, Greetje Anna Kampinga, Marleen van Oosten, Jan Maarten van Dijl, Paulus Christiaan Jutte, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 8, 45–50, https://doi.org/10.5194/jbji-8-45-2023, https://doi.org/10.5194/jbji-8-45-2023, 2023
Short summary
Short summary
In a first evaluation, the accuracy of a novel multiplex PCR (polymerase chain reaction) panel for rapid detection of pathogens in patients with a clinical suspicion of acute septic arthritis of native and prosthetic joints is assessed. Clear benefit is seen in patients with a suspected native septic arthritis and late acute prosthetic joint infection. This indicates that the panel allows for fast tailoring of antibiotics and may prompt the surgeon for surgical lavage in doubtful clinical cases.
Christen Ravn, Jeroen Neyt, Natividad Benito, Miguel Araújo Abreu, Yvonne Achermann, Svetlana Bozhkova, Liselotte Coorevits, Matteo Carlo Ferrari, Karianne Wiger Gammelsrud, Ulf-Joachim Gerlach, Efthymia Giannitsioti, Martin Gottliebsen, Nis Pedersen Jørgensen, Tomislav Madjarevic, Leonard Marais, Aditya Menon, Dirk Jan Moojen, Markus Pääkkönen, Marko Pokorn, Daniel Pérez-Prieto, Nora Renz, Jesús Saavedra-Lozano, Marta Sabater-Martos, Parham Sendi, Staffan Tevell, Charles Vogely, Alex Soriano, and the SANJO guideline group
J. Bone Joint Infect., 8, 29–37, https://doi.org/10.5194/jbji-8-29-2023, https://doi.org/10.5194/jbji-8-29-2023, 2023
Short summary
Short summary
Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of different specialties, experience levels, and at all hours of the day. The SANJO guideline group makes evidence-based recommendations for diagnosis, microbiological investigation, initial surgery, empirical antibiotic treatment, early mobilization, evaluation of outcomes, and treatment failure. Special considerations were made for children, tuberculosis, and SANJO after cruciate ligament reconstruction.
Efthymia Giannitsioti, Mauro José Salles, Andreas Mavrogenis, Dolors Rodriguez-Pardo, Ibai Los-Arcos, Alba Ribera, Javier Ariza, María Dolores del Toro, Sophie Nguyen, Eric Senneville, Eric Bonnet, Monica Chan, Maria Bruna Pasticci, Sabine Petersdorf, Natividad Benito, Nuala O' Connell, Antonio Blanco García, Gábor Skaliczki, Pierre Tattevin, Zeliha Kocak Tufan, Nikolaos Pantazis, Panayiotis D. Megaloikonomos, Panayiotis Papagelopoulos, Alejandro Soriano, Antonios Papadopoulos, and the ESGIAI collaborators study group
J. Bone Joint Infect., 7, 279–288, https://doi.org/10.5194/jbji-7-279-2022, https://doi.org/10.5194/jbji-7-279-2022, 2022
Short summary
Short summary
Our multicentre study on a lower-limb osteosynthesis-associated infection (OAI) cohort by multidrug (MDR) and extensively drug (XDR) resistant Gram-negative bacteria found the following: implant retention with debridement was mostly performed in early OAI; 50.9 % of patients achieved remission of infection; remission reached 50 % (MDR) vs. 25 % (XDR) in early OAI and 60 % (MDR) vs. 44.4 % (XDR) in late OAI; age (> 60) and multiple surgeries were independent factors influencing lack of remission.
Parham Sendi and Tristan Ferry
J. Bone Joint Infect., 7, 187–189, https://doi.org/10.5194/jbji-7-187-2022, https://doi.org/10.5194/jbji-7-187-2022, 2022
Clément Javaux, Clémentine Daveau, Clotilde Bettinger, Mathieu Daurade, Céline Dupieux-Chabert, Fabien Craighero, Carine Fuchsmann, Philippe Céruse, Arnaud Gleizal, Nicolas Sigaux, Tristan Ferry, Florent Valour, and the Lyon BJI study group
J. Bone Joint Infect., 7, 127–136, https://doi.org/10.5194/jbji-7-127-2022, https://doi.org/10.5194/jbji-7-127-2022, 2022
Short summary
Short summary
We describe 48 osteocutaneous-flap-related osteomyelitis cases, mostly presenting with early, local signs of infection and/or bone exposure. Main pathogens were Gram-negative bacilli, streptococci, S. aureus, enterococci, and anaerobes, justifying a broad-spectrum empirical antimicrobial therapy. Despite surgery and a 3-month antimicrobial therapy, a 50 % failure rate was recorded, associated with a delayed infectious disease specialist referral and advocating for multidisciplinary management.
Ernesto Muñoz-Mahamud, Eduard Tornero, José A. Estrada, Jenaro A. Fernández-Valencia, Juan C. Martínez-Pastor, and Álex Soriano
J. Bone Joint Infect., 7, 109–115, https://doi.org/10.5194/jbji-7-109-2022, https://doi.org/10.5194/jbji-7-109-2022, 2022
Short summary
Short summary
A patient with normal D-dimer value has a low risk of prosthetic joint infection, so serum D-dimer assessment should always be considered as a useful test to rule out chronic prosthetic joint infection (especially in those cases caused by low-virulence microorganisms in which conventional tests may lead to misdiagnosis). Conversely, the platelet count to mean platelet volume ratio may be of limited value for accurately diagnosing prosthetic joint infection.
Marjan Wouthuyzen-Bakker and Alexander L. Boerboom
J. Bone Joint Infect., 7, 33–34, https://doi.org/10.5194/jbji-7-33-2022, https://doi.org/10.5194/jbji-7-33-2022, 2022
Short summary
Short summary
This case illustrates the clinical picture of a worn-out elbow prosthesis resulting in severe metallosis and a subsequent periprosthetic joint infection.
Karsten D. Ottink, Stefan J. Gelderman, Marjan Wouthuyzen-Bakker, Joris J. W. Ploegmakers, Andor W. J. M. Glaudemans, and Paul C. Jutte
J. Bone Joint Infect., 7, 1–9, https://doi.org/10.5194/jbji-7-1-2022, https://doi.org/10.5194/jbji-7-1-2022, 2022
Short summary
Short summary
A low-grade periprosthetic joint infection (PJI) may be difficult to diagnose, and nuclear imaging could help in the diagnosis. However, its diagnostic value is unclear. We retrospectively evaluated this diagnostic value. We conclude that in patients presenting with nonspecific symptoms and a low a priori chance of PJI based on clinical evaluation, nuclear imaging is of no clear added value in diagnosing a PJI.
Simon Martin Heinrich, Parham Sendi, and Martin Clauss
J. Bone Joint Infect., 6, 423–424, https://doi.org/10.5194/jbji-6-423-2021, https://doi.org/10.5194/jbji-6-423-2021, 2021
Short summary
Short summary
We report on an 83-year-old woman who had an open removal of a baker's cyst several months after total knee arthroplasty. The following wound healing problem was first misinterpreted as being superficial. With an injection of methylene blue and a contrast medium, we showed the extent of the sinus tract, proving the periprosthetic joint infection.
Truong-Thanh Pham, Eugénie Mabrut, Philippe Cochard, Paul Chardon, Hassan Serrier, Florent Valour, Laure Huot, Michel Tod, Gilles Leboucher, Christian Chidiac, and Tristan Ferry
J. Bone Joint Infect., 6, 337–346, https://doi.org/10.5194/jbji-6-337-2021, https://doi.org/10.5194/jbji-6-337-2021, 2021
Short summary
Short summary
Costs related to off-label expensive antibiotics used to treat bone and joint infections (BJIs) in a referral centre in France were analysed in this cohort study. Despite the large increase in the number of patients treated with these antibiotics, the overall costs remained stable (approximately EUR 1 million) and were helped by the appearance of generic molecules at lower prices. Production of generic antibiotics at low cost is essential to limit the financial burden of the management of BJIs.
Karel-Jan Dag François Lensen, Rosa Escudero-Sanchez, Javier Cobo, Rihard Trebše, Camelia Gubavu, Sara Tedeschi, Jose M. Lomas, Cedric Arvieux, Dolors Rodriguez-Pardo, Massimo Fantoni, Maria Jose Garcia Pais, Francisco Jover, Mauro José Costa Salles, Ignacio Sancho, Marta Fernandez Sampedro, Alex Soriano, Marjan Wouthuyzen-Bakker, and ESCMID Study Group of Implant Associated Infections (ESGIAI)
J. Bone Joint Infect., 6, 313–319, https://doi.org/10.5194/jbji-6-313-2021, https://doi.org/10.5194/jbji-6-313-2021, 2021
Short summary
Short summary
Our data suggest that, in periprosthetic joint infection (PJI) patients with a draining sinus, suppressive antibiotic treatment (SAT) can be considered on an individual basis. SAT may reduce pain and favour the closure of the sinus tract in certain individuals, but the prescription of SAT does not appear to have any influence on the prevention of prosthetic loosening and other infectious complications.
André Dias Carvalho, Ana Ribau, Daniel Soares, Ana Claudia Santos, Miguel Abreu, and Ricardo Sousa
J. Bone Joint Infect., 6, 305–312, https://doi.org/10.5194/jbji-6-305-2021, https://doi.org/10.5194/jbji-6-305-2021, 2021
Short summary
Short summary
When we initiated this paper, there was no evidence on what kind of spacers we should use. Our work was to prove that we must use a broad spectrum of antibiotics at the spacers in two-stage revision procedures. We demonstrate that a large spectrum of antibiotics at the spacer results in a lower rate of positive cultures during preimplantation and, subsequently, better outcomes and lower rate of infection.
Ernesto Muñoz-Mahamud, Jenaro Ángel Fernández-Valencia, Andreu Combalia, Laura Morata, and Álex Soriano
J. Bone Joint Infect., 6, 85–90, https://doi.org/10.5194/jbji-6-85-2021, https://doi.org/10.5194/jbji-6-85-2021, 2021
Short summary
Short summary
A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. We present our initial experience in hip revision for chronic infection in which fluorescent tetracycline bone labeling was used as an additional aid to provide a visual index of surgical bone debridement. In the present series, the use of this technique successfully aided the surgeon to detect the presence of nonviable bone.
Cited articles
Allegranzi, B., Bischoff, P., de Jonge, S., Kubilay, N. Z., Zayed, B., Gomes, S. M., Abbas, M., Atema, J. J., Gans, S., van Rijen, M., Boermeester, M. A., Egger, M., Kluytmans, J., Pittet, D., and Solomkin, J. S.: New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective, Lancet Infect. Dis., 16, e276–e287, https://doi.org/10.1016/s1473-3099(16)30398-x, 2016.
Armstrong, D.: Health workforce issues and challenges in the post-pandemic era, Health Aff. Sch., 3, qxae168, https://doi.org/10.1093/haschl/qxae168, 2025.
Arruda, M. C., de Aguiar, R. S., Jardim, W. M., Melo, L. H., Mendonça, T., Cavalcanti, A. B., and de França, P. H. C.: Cohorting to prevent acquisition of multidrug-resistant bacteria: An interrupted time series study, Am. J. Infect. Control., 47, 180–185, https://doi.org/10.1016/j.ajic.2018.07.025, 2019.
Berríos-Torres, S. I., Umscheid, C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., Reinke, C. E., Morgan, S., Solomkin, J. S., Mazuski, J. E., Dellinger, E. P., Itani, K. M. F., Berbari, E. F., Segreti, J., Parvizi, J., Blanchard, J., Allen, G., Kluytmans, J., Donlan, R., and Schecter, W. P.: Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017, JAMA Surg., 152, 784–791, https://doi.org/10.1001/jamasurg.2017.0904, 2017.
Blane, B., Coll, F., Raven, K., Allen, O., Kappeler, A. R. M., Pai, S., Floto, R. A., Peacock, S. J., and Gouliouris, T.: Impact of a new hospital with close to 100 % single-occupancy rooms on environmental contamination and incidence of vancomycin-resistant Enterococcus faecium colonization or infection: a genomic surveillance study, J. Hosp. Infect., 139, 192–200, https://doi.org/10.1016/j.jhin.2023.06.025, 2023.
Carrier, M., Marchand, R., Auger, P., Hébert, Y., Pellerin, M., Perrault, L. P., Cartier, R., Bouchard, D., Poirier, N., and Pagé, P.: Methicillin-resistant Staphylococcus aureus infection in a cardiac surgical unit, J. Thorac. Cardiovasc. Surg., 123, 40–44, https://doi.org/10.1067/mtc.2002.118505, 2002.
Cepeda, J. A., Whitehouse, T., Cooper, B., Hails, J., Jones, K., Kwaku, F., Taylor, L., Hayman, S., Cookson, B., Shaw, S., Kibbler, C., Singer, M., Bellingan, G., and Wilson, A. P.: Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study, Lancet, 365, 295–304, https://doi.org/10.1016/s0140-6736(05)17783-6, 2005.
Chang, E., Im, D., Lee, H. Y., Lee, M., Lee, C. M., Kang, C. K., Park, W. B., Kim, N. J., Choe, P. G., and Oh, M.: Impact of discontinuing isolation in a private room for patients infected or colonized with vancomycin-resistant enterococci (VRE) on the incidence of healthcare-associated VRE bacteraemia in a hospital with a predominantly shared-room setting, J. Hosp. Infect., 132, 1–7, https://doi.org/10.1016/j.jhin.2022.11.017, 2023.
Cimen, C., Berends, M. S., Lokate, M., Glasner, C., Herrmann, J., Bathoorn, E., Hamprecht, A., and Voss, A.: Infection prevention and control without borders: comparison of guidelines on multidrug-resistant organisms in the northern Dutch-German cross-border region, Antimicrob. Resist. Infect. Control., 14, 11, https://doi.org/10.1186/s13756-025-01528-3, 2025.
Cooper, B. S., Stone, S. P., Kibbler, C. C., Cookson, B. D., Roberts, J. A., Medley, G. F., Duckworth, G. J., Lai, R., and Ebrahim, S.: Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling, Health Technol. Assess., 7, 1–194, https://doi.org/10.3310/hta7390, 2003.
Cooper, B. S., Stone, S. P., Kibbler, C. C., Cookson, B. D., Roberts, J. A., Medley, G. F., Duckworth, G., Lai, R., and Ebrahim, S.: Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature, Bmj, 329, 533, https://doi.org/10.1136/bmj.329.7465.533, 2004.
Curran, E. T., Hamilton, K., Monaghan, A., McGinlay, M., and Thakker, B.: Use of a temporary cohort ward as part of an intervention to reduce the incidence of meticillin-resistant Staphylococcus aureus in a vascular surgery ward, J. Hosp. Infect., 63, 374–379, https://doi.org/10.1016/j.jhin.2006.02.017, 2006.
Dancer, S. J.: The role of environmental cleaning in the control of hospital-acquired infection, J. Hosp. Infect., 73, 378–385, https://doi.org/10.1016/j.jhin.2009.03.030, 2009.
Deakin, M.: NHS workforce shortages and staff burnout are taking a toll, Bmj, 377, o945, https://doi.org/10.1136/bmj.o945, 2022.
Depypere, M., Morgenstern, M., Kuehl, R., Senneville, E., Moriarty, T. F., Obremskey, W. T., Zimmerli, W., Trampuz, A., Lagrou, K., and Metsemakers, W. J.: Pathogenesis and management of fracture-related infection, Clin. Microbiol. Infect., 26, 572–578, https://doi.org/10.1016/j.cmi.2019.08.006, 2020.
Garner, J. S.: Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee, Infect. Control. Hosp. Epidemiol., 17, 53–80, https://doi.org/10.1086/647190, 1996.
GBD 2021 Antimicrobial Resistance Collaborators: Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050, Lancet, 404, 1199–1226, https://doi.org/10.1016/s0140-6736(24)01867-1, 2024.
Glowicz, J. B., Landon, E., Sickbert-Bennett, E. E., Aiello, A. E., deKay, K., Hoffmann, K. K., Maragakis, L., Olmsted, R. N., Polgreen, P. M., Trexler, P. A., VanAmringe, M. A., Wood, A. R., Yokoe, D., and Ellingson, K. D.: SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update, Infect. Control. Hosp. Epidemiol., 44, 355–376, https://doi.org/10.1017/ice.2022.304, 2023.
Hartstein, A. I., Denny, M. A., Morthland, V. H., LeMonte, A. M., and Pfaller, M. A.: Control of methicillin-resistant Staphylococcus aureus in a hospital and an intensive care unit, Infect. Control. Hosp. Epidemiol., 16, 405–411, https://doi.org/10.1086/647138, 1995.
Haynes, A. and Khardori, N.: Current Practices for Infection Prevention in the Hospital Settings, Hospital Infection Prevention, 45–51, https://doi.org/10.1007/978-81-322-1608-7_3, 2013.
Ji, B. and Ye, W.: Prevention and control of hospital-acquired infections with multidrug-resistant organism: A review, Medicine (Baltimore), 103, e37018, https://doi.org/10.1097/md.0000000000037018, 2024.
Kang, J., Ji, E., Kim, J., Bae, H., Cho, E., Kim, E. S., Shin, M. J., and Kim, H. B.: Evaluation of Patients' Adverse Events During Contact Isolation for Vancomycin-Resistant Enterococci Using a Matched Cohort Study With Propensity Score, JAMA Netw. Open, 5, e221865, https://doi.org/10.1001/jamanetworkopen.2022.1865, 2022.
Kapur, B. P., Tonge, X., and Kumar, G.: Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee arthroplasty following eradication therapy, World J. Orthop., 12, 842–849, https://doi.org/10.5312/wjo.v12.i11.842, 2021.
Kempf, I., Sittler, M. A., Lecocq, L., and Klem, M.: Isolation Ward (Septic Ward) for Infected Patients, Springer, Berlin, Heidelberg, https://doi.org/10.1007/978-3-642-69833-0_31, 1985.
Kawamura, H., Matsumoto, K., Shigemi, A., Orita, M., Nakagawa, A., Nozima, S., Tominaga, H., Setoguchi, T., Komiya, S., Tokuda, K., and Nishi, J.: A bundle that includes active surveillance, contact precaution for carriers, and cefazolin-based antimicrobial prophylaxis prevents methicillin-resistant Staphylococcus aureus infections in clean orthopedic surgery, Am. J. Infect. Control., 44, 210–214, https://doi.org/10.1016/j.ajic.2015.09.014, 2016.
Leaper, D. J. and Edmiston, C. E.: World Health Organization: global guidelines for the prevention of surgical site infection, J. Hosp. Infect., 95, 135–136, https://doi.org/10.1016/j.jhin.2016.12.016, 2017.
Loftus, R. W., Dexter, F., and Robinson, A. D. M.: Methicillin-resistant Staphylococcus aureus has greater risk of transmission in the operating room than methicillin-sensitive S aureus, Am. J. Infect. Control., 46, 520–525, https://doi.org/10.1016/j.ajic.2017.11.002, 2018.
Long, D. R., Bryson-Cahn, C., Waalkes, A., Holmes, E. A., Penewit, K., Tavolaro, C., Bellabarba, C., Zhang, F., Chan, J. D., Fang, F. C., Lynch, J. B., and Salipante, S. J.: Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery, Sci. Transl. Med., 16, eadk8222, https://doi.org/10.1126/scitranslmed.adk8222, 2024.
Maechler, F., Schwab, F., Hansen, S., Fankhauser, C., Harbarth, S., Huttner, B. D., Diaz-Agero, C., Lopez, N., Canton, R., Ruiz-Garbajosa, P., Blok, H., Bonten, M. J., Kloosterman, F., Schotsman, J., Cooper, B. S., Behnke, M., Golembus, J., Kola, A., and Gastmeier, P.: Contact isolation versus standard precautions to decrease acquisition of extended-spectrum β-lactamase-producing Enterobacterales in non-critical care wards: a cluster-randomised crossover trial, Lancet Infect. Dis., 20, 575–584, https://doi.org/10.1016/s1473-3099(19)30626-7, 2020.
Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., and Jarvis, W. R.: Guideline for Prevention of Surgical Site Infection, 1999, Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee, Am. J. Infect. Control, 27, 97–132, 1999.
Mastoraki, A., Kriaras, I., Douka, E., Mastoraki, S., Stravopodis, G., and Geroulanos, S.: Methicillin-resistant Staphylococcus aureus preventing strategy in cardiac surgery, Interact. Cardiovasc. Thorac. Surg., 7, 452–456, https://doi.org/10.1510/icvts.2008.176156, 2008.
Metsemakers, W. J., Onsea, J., Neutjens, E., Steffens, E., Schuermans, A., McNally, M., and Nijs, S.: Prevention of fracture-related infection: a multidisciplinary care package, Int. Orthop., 41, 2457–2469, https://doi.org/10.1007/s00264-017-3607-y, 2017.
Metsemakers, W. J., Kuehl, R., Moriarty, T. F., Richards, R. G., Verhofstad, M. H. J., Borens, O., Kates, S., and Morgenstern, M.: Infection after fracture fixation: Current surgical and microbiological concepts, Injury, 49, 511–522, https://doi.org/10.1016/j.injury.2016.09.019, 2018.
Ouzzani, M., Hammady, H., Fedorowicz, Z., and Elmagarmid, A.: Rayyan – a web and mobile app for systematic reviews, Syst. Rev., 5, 210, https://doi.org/10.1186/s13643-016-0384-4, 2016
Park, S., Bae, S., Kim, E. O., Chang, E., Kim, M. J., Chong, Y. P., Choi, S. H., Lee, S. O., Kim, Y. S., Jung, J., and Kim, S. H.: The impact of discontinuing single-room isolation of patients with vancomycin-resistant enterococci: a quasi-experimental single-centre study in South Korea, J. Hosp. Infect., 147, 77–82, https://doi.org/10.1016/j.jhin.2024.02.025, 2024.
Prevention CDC: Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007, https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html (last access: 2 July 2025).
Schelenz, S., Tucker, D., Georgeu, C., Daly, S., Hill, M., Roxburgh, J., and French, G. L.: Significant reduction of endemic MRSA acquisition and infection in cardiothoracic patients by means of an enhanced targeted infection control programme, J. Hosp. Infect., 60, 104–110, https://doi.org/10.1016/j.jhin.2004.11.020, 2005.
Shanson, D. C., Johnstone, D., and Midgley, J.: Control of a hospital outbreak of methicillin-resistant Staphylococcus aureus infections: value of an isolation unit, J. Hosp. Infect., 6, 285–292, 1985.
Stelfox, H. T., Bates, D. W., and Redelmeier, D. A.: Safety of patients isolated for infection control, Jama, 290, 1899–1905, https://doi.org/10.1001/jama.290.14.1899, 2003.
Talon, D., Vichard, P., Muller, A., Bertin, M., Jeunet, L., and Bertrand, X.: Modelling the usefulness of a dedicated cohort facility to prevent the dissemination of MRSA, J. Hosp. Infect., 54, 57–62, https://doi.org/10.1016/s0195-6701(03)00086-0, 2003.
Tande, A. J. and Patel, R.: Prosthetic joint infection, Clin. Microbiol. Rev., 27, 302–345, https://doi.org/10.1128/cmr.00111-13, 2014.
Tschudin-Sutter, S., Frei, R., Dangel, M., Stranden, A., and Widmer, A. F.: Rate of transmission of extended-spectrum beta-lactamase-producing enterobacteriaceae without contact isolation, Clin. Infect. Dis., 55, 1505–1511, https://doi.org/10.1093/cid/cis770, 2012.
Yavuz, S., Tarçın, O., Ada, S., Dinçer, F., Toraman, S., Birbudak, S., Eren, E., and Yekeler, I.: Incidence, aetiology, and control of sternal surgical site infections, J. Hosp. Infect., 85, 206–212, https://doi.org/10.1016/j.jhin.2013.07.010, 2013.
Short summary
Isolation of patients with musculoskeletal infections in orthopedic care is controversial. Evidence supports selective isolation for certain resistant pathogens but not for non-resistant pathogens, nor does it support the routine use of septic wards. Effective infection control depends on hospital-wide strategies and adherence to standard precautions, with specialized centres offering better care than dedicated isolation units.
Isolation of patients with musculoskeletal infections in orthopedic care is controversial....
