This is a case report which follows a patient who received multiple false positive synovial alpha-defensin test results following a revision for total knee arthroplasty. The report looks at the importance of generalizability in diagnostic testing and how a lack thereof can extend the cost and duration of care.

Staphylococcus aureus bloodstream infection can cause serious complications such as bone and joint involvement. We reviewed 489 cases (2017–2022) at a Brussels tertiary hospital to identify risk factors. Prolonged bacteremia and community acquisition increased the risk, while active cancer and intensive-care stay reduced it. This study highlights the burden of bone and joint infections in Staphylococcus aureus bloodstream infection.

A simple, rapid, and low-cost test measuring synovial fluid specific gravity shows high accuracy and excellent specificity for diagnosing hip and knee periprosthetic joint infection. This method can quickly help rule in infections during revision surgeries, making it a practical point-of-care tool, especially in clinics or hospitals with limited resources. Its performance supports use alongside established lab markers for better patient outcomes.

Infections represent a serious complication following the implantation of osteoarticular devices. Rifampicin in combination with fluoroquinolone is the most prescribed antibiotic regimen. Nevertheless, fluoroquinolones are associated with significant adverse effects. We sought to evaluate whether oral tetracyclines could serve as an alternative therapeutic option. Our findings suggest that tetracyclines may constitute a suitable alternative in cases where fluoroquinolones are not usable.

Fungal organisms are conventionally estimated to account for 1 % –2 % of periprosthetic joint infection (PJI) cases, although diagnostic and reporting limitations may result in systematic underestimation. Using a quantitative missing-data sensitivity analysis across 23 studies encompassing 28 253 PJI cases, we estimated an adjusted Candida PJI proportion of approximately 5 %, increasing to nearly 10 % in chronic or refractory infections.

Several factors have been linked to failure in chronic prosthetic joint infection revisions. We hypothesize that osteomyelitis in septic hip revisions is underestimated and may significantly impact outcomes. In this series, 30.8 % of septic revisions exhibited bone samples consistent with osteitis, mainly associated with prolonged unsuccessful surgical and antibiotic treatments, the presence of a sinus tract, and subsequent failure after implant removal.

This study assessed whether the diagnosis and management of fracture-related infections (FRIs) in a low- and middle-income countries (LMICs) currently align with consensus guidelines. We found that two-thirds of cases are managed outside the international guidelines. While the consensus definition is applicable, diagnostic capacity remains limited and microbiological standards are often impractical. Our findings highlight the need to adapt guidelines to local realities and to strengthen capacity in LMICs.

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.

In Lyme-endemic regions, Lyme disease should be considered in culture-negative periprosthetic joint infection (PJI). Diagnosis relies on microbial DNA detection, particularly Borrelia-targeted polymerase chain reaction (PCR) on synovial fluid or tissue. We present 10 cases highlighting the value of PCR for early recognition of this pathogen, which is not detectable by conventional culture media. Surgical debridement remains the standard of care, though several cases were successfully treated medically, an observation that merits further investigation.

Pseudomonas aeruginosa is a common pathogen in Gram-negative periprosthetic joint infections (PJIs). It is resistant to many antibiotics and forms biofilm, making it difficult to treat. We analyzed 1286 patients who underwent 1640 surgeries; among them, 38 patients with 50 procedures had P. aeruginosa. Most infections were chronic, often in hip revisions, with a high failure rate and recurrence. Due to its clinical and microbiological features, P. aeruginosa-related PJIs remain challenging.

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.

Periprosthetic joint infection (PJI) patient care has both positive and negative impacts on caregivers: (1) conflicts regarding the hospital stay, (2) novel personal challenges, (3) nursing, (4) emotional and psychological consequences, and (5) effects on the relationship. To conclude, caregivers of PJI patients shoulder a relevant burden both physically and emotionally, which seems to be very similar to caregivers of cancer patients. An inclusion in established treatment algorithms for PJI should be considered.

Founded in 2019, the Center for Musculoskeletal Infections at University Hospital Basel was established to implement standardized, multidisciplinary care for orthopaedic and trauma-related infections. This retrospective analysis of hip and knee periprosthetic joint infections (2019–2022) illustrates the feasibility and effectiveness of this structured approach, with infection control achieved in the majority of patients despite case complexity.

This study examined thousands of joint fluid samples to understand which bacteria cause infections in natural and artificial joints. Staphylococci were the main culprits, and antibiotic resistance increased over time, especially in methicillin-resistant and beta-lactamase-producing strains. Testing joint fluids in blood culture bottles improved detection, helping doctors to choose more effective treatments and protect joint health.