Articles | Volume 9, issue 5
https://doi.org/10.5194/jbji-9-249-2024
© Author(s) 2024. 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-9-249-2024
© Author(s) 2024. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Review
| 
31 Oct 2024
Review |
| 31 Oct 2024
| 31 Oct 2024
Exploring the potential of naturally occurring antimicrobials for managing orthopedic-device-related infections
Baixing Chen
Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
Department of Development and Regeneration, KU Leuven, Leuven, Belgium
T. Fintan Moriarty
AO Research Institute Davos, Davos, Switzerland
Hans Steenackers
Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Leuven, Belgium
Georges F. Vles
Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium
Jolien Onsea
Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
Department of Development and Regeneration, KU Leuven, Leuven, Belgium
Thijs Vackier
Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Leuven, Belgium
Isabel Spriet
Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
Rob Lavigne
Laboratory of Gene Technology, Department of Biosystems, KU Leuven, Leuven, Belgium
R. Geoff Richards
AO Research Institute Davos, Davos, Switzerland
Willem-Jan Metsemakers
CORRESPONDING AUTHOR
Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
Department of Development and Regeneration, KU Leuven, Leuven, Belgium
Related authors
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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
J. Bone Joint Infect., 11, 95–103, https://doi.org/10.5194/jbji-11-95-2026, https://doi.org/10.5194/jbji-11-95-2026, 2026
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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.
Willemijn Boot, Michel Schläppi, Virginia Post, T. Fintan Moriarty, and Peter Wahl
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
J. Bone Joint Infect., 10, 489–500, https://doi.org/10.5194/jbji-10-489-2025, https://doi.org/10.5194/jbji-10-489-2025, 2025
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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.
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
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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
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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.
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
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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
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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.
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
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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.
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
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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
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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
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.
Our research explores natural antimicrobials to combat orthopedic-device-related infections, a...
