Articles | Volume 11, issue 2
https://doi.org/10.5194/jbji-11-161-2026
© Author(s) 2026. 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-11-161-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Original full-length article
| 
12 Mar 2026
Original full-length article |
| 12 Mar 2026
| 12 Mar 2026
Combined analysis of host immune response, biofilm genes, and 16S rRNA detection in fracture-related infection: an observational cohort study
Melissa Depypere
CORRESPONDING AUTHOR
Department of laboratory medicine, University Hospitals Leuven, 3000, Leuven, Belgium
Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium
Jonathan Sliepen
Department of Trauma Surgery, University Medical Center Groningen, Groningen, the Netherlands
Jolien Onsea
Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
Department of Development and Regeneration, KU Leuven – University of Leuven, 3000 Leuven, Belgium
Yves Debaveye
Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
T. Fintan Moriarty
AO Research Institute Davos, Davos, Switzerland
Elena Della Bella
AO Research Institute Davos, Davos, Switzerland
Emmanuel André
Department of laboratory medicine, University Hospitals Leuven, 3000, Leuven, Belgium
Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium
Johan Van Weyenbergh
Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
Willem-Jan Metsemakers
Department of Trauma Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
Department of Development and Regeneration, KU Leuven – University of Leuven, 3000 Leuven, Belgium
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When infection around an artificial hip or knee is suspected, joint fluid sampling is essential but often unsuccessful. We performed a systematic review to evaluate whether rinsing the joint with sterile salt water after an unsuccessful attempt improves diagnosis. Our findings show that this approach is safe, yields testable fluid in nearly all cases, and identifies infection in about one in five patients that would otherwise be missed.
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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.
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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.
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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.
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When infection around an artificial hip or knee is suspected, joint fluid sampling is essential but often unsuccessful. We performed a systematic review to evaluate whether rinsing the joint with sterile salt water after an unsuccessful attempt improves diagnosis. Our findings show that this approach is safe, yields testable fluid in nearly all cases, and identifies infection in about one in five patients that would otherwise be missed.
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Segmental bone loss remains a major challenge, often worsened by fracture-related infection (FRI). Surgical debridement and tissue cultures are key initial steps. Bone transport, utilizing distraction osteogenesis, remains a key therapeutic strategy. Innovations like integrated fixation and motorized nails reduce patient morbidity. Management relies on a multidisciplinary approach. This review explores current and emerging concepts in the field of bone transport, focusing on FRI.
Niels Vanvelk, Esther M. M. Van Lieshout, Leendert H. T. Nugteren, A. Cornelis Plaisier, Rosalya Van der Pot, Corine Bethlehem, Willem-Jan Metsemakers, William T. Obremskey, and Michael H. J. Verhofstad
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Although local antibiotic administration is used to prevent and treat fracture-related infections, concerns remain about systemic absorption and potential renal toxicity. This study assessed serum levels and renal function after local gentamicin or vancomycin use. Gentamicin exceeded the lower limit of quantification in 17% of cases but remained below toxic levels. Vancomycin was undetectable. These findings suggest that local antibiotic administration does not harm renal function.
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J. Bone Joint Infect., 11, 65–76, https://doi.org/10.5194/jbji-11-65-2026, https://doi.org/10.5194/jbji-11-65-2026, 2026
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In this study, we tested whether very high doses and prolonged exposure of gentamicin, alone or with rifampin, can eliminate mature Staphylococcus aureus biofilm – one of the main causes of implant-associated infections. None of the regimes tested eradicated all bacteria. Adding rifampin gave no benefit. This suggests that aminoglycosides are not optimal for local antibiotic therapy.
Laura Bessems, Jolien Onsea, Baixing Chen, Marjan Wouthuyzen-Bakker, Irene K. Sigmund, Tristan Ferry, Richard Kuehl, Martin Clauss, Alex Soriano, Ricardo Sousa, Annette Schuermans, and Willem-Jan Metsemakers
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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
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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
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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.
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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
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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.
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
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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.
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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.
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
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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
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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.
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Short summary
The aim of this proof-of-concept study was to investigate host immune gene expression through transcriptome profiling in patients with fracture-related infection and to explore the feasibility of detecting 16S rRNA and biofilm-associated genes, an approach not previously applied using this method. This technique revealed distinct immune activation patterns in fracture-related infection (FRI) and enabled the identification of pathogens that were missed by conventional culture techniques.
The aim of this proof-of-concept study was to investigate host immune gene expression through...
