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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.

This retrospective case-matched study evaluated males and females with staphylococcal PJI (periprosthetic joint infection) treated with two-stage exchange arthroplasty. We matched 156 males and females for age, type of staphylococcal infection, and joint involved. We compared clinical parameters related to presentation, treatment, and outcome. We did not find a statistically significant difference in outcome between males and females treated with the same surgical approach at our institution.

Long antibiotic courses, including IV and oral administrations, are utilized in prosthetic joint infection (PJI) treatment. Most researchers focus on a shorter duration of the overall antibiotic course for the treatment of PJI; however, this is the first systematic review and meta-analysis to emphasize the IV component of the antibiotic course. The focus on IV treatment only is due to the burden associated with it and its prolonged utilization within the US without much evidence of practice.

Orthopedic infections are complex, often requiring surgical intervention and prolonged antibiotic therapy, especially in the presence of a foreign body. In a rabbit model of implant-associated methicillin-resistant Staphylococcus aureus osteomyelitis, the lysins exebacase and CF-296 delivered locally with and without systemic daptomycin resulted in lower bacterial counts than those of control animals, showing a promising complement to conventional antibiotics in implant-associated infections.

Culture-negative (CN) prosthetic joint infections (PJIs) present significant challenges for clinicians. While previous retrospective analyses have been conducted, inconsistencies in inclusion criteria and treatment success measures limit the opportunity for direct comparisons and use in guiding clinical practice. We compared baseline characteristics and outcomes of CN with culture-positive (CP) cases in a large multicentre prospective cohort and demonstrated improved overall outcomes in CN PJI.

The stoma for transcutaneous osseointegration carries a permanent source of bacterial ingress and infection. The value and role of intraoperative cultures to detect latent bacterial contamination or infection with targeted postoperative antibiotics has not been previously investigated. We compared two cohorts, 8 patients with unexpected positive cultures and 22 patients with negative intraoperative cultures, and found positive cultures do not appear to portend future infectious events.

The relation between postoperative wound leakage and occurrence of a prosthetic joint infection (PJI) after arthroplasty has not been investigated in a prospective study. We performed a large cohort study in which 1019 patients, after arthroplasty, recorded their wound drainage status in a wound care app during 30 postoperative days. Risk factors for wound drainage were identified. Moderate to heavy wound leakage in the third postoperative week was strongly associated with the occurrence of PJI.

Treatments for prosthetic joint infections (PJIs) are often assessed using a success or failure endpoint. Yet, this can fail to capture important outcomes for patients. A desirability of outcome ranking (DOOR) is a way of evaluating treatments in a more patient-focused form. This study found an outcome ranking using joint function, infection cure and quality of life. This helps to answer what are we trying to achieve for patients with PJI and how we measure the effectiveness of PJI treatments.

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.

Patients who receive joint replacement surgery might suffer from infection, which usually requires another surgery to clean the prosthesis and remove infected tissue. This tissue is analysed for bacteria in order to start appropriate antibiotic therapy. Bacteria are not always found, calling the appropriateness of the second surgery into question. We compared the treatment outcome in a large group of culture-positive and culture-negative patients and noticed a better outcome in the latter group.

Despite a growing interest in oral therapy for native vertebral osteomyelitis, there is no evidence to recommend oral or parenteral therapy. From our single-center experience combined with a systematic review and a meta-analysis of the available literature, there is insufficient evidence to conclude that there is a difference in proportion of failure and relapse between an early switch to oral antibiotics and prolonged parenteral therapy. Further studies are needed to increase the evidence.

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.

This paper displays the microbiological differences between infected endoprostheses post tumour resection and infected primary knee arthroplasty. It emphasises the point that significant differences between the two groups, including higher rates of multidrug resistant organisms in the endoprosthetic group, point to the requirement for the pre-emptive use of broad-spectrum empirical antibiotics. Pre-surgical sampling or aspiration is also of particular importance in the endoprosthetic group.

Bone infection (osteomyelitis) due to Mycobacterium fortuitum, a human pathogen commonly found in soil and water, is a rare disease. Treatment includes antibiotics and surgical removal of infected bone, leaving a bony defect that must be repaired to prevent reinfection and the risk of fracture. Here, M. fortuitum osteomyelitis of the cuboid bone was treated with synthetic antibiotic-loaded cement, successfully resolving inflammation and bone defect filling as well as promoting bone regeneration.

This systematic review presents the results regarding the concordance rate between preoperative synovial fluid and intraoperative tissue culturing in patients with a prosthetic joint infection (PJI). The included studies had heterogeneous results and were at a high risk of bias. Higher-quality future research may help to better understand the true concordance between these cultures. This may result in better guidance for orthopedic surgeons regarding the treatment of patients with PJI.

Every year the incidence of prosthetic joint infection (PJI) continues to increase. Therefore, it required a way to reduce complications, one of them coating methods. However, the best preventive strategy is still debatable. Through various review processes, it was finally discovered that coating methods using antibiotics were an effective method to prevent the occurrence of PJI, while coating with non-antibiotic materials such as silver and iodine is significant in preventing incidence of PJI.

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.

This paper describes five cases of prosthetic joint infection (PJI) caused by Mycobacterium avium complex (MAC). Infections occurred in both immune competent and immunosuppressed patients. Interestingly, using the Musculoskeletal Infection Society diagnostic criteria for PJI may miss some cases of MAC PJI. Treatment courses and outcomes are described.

In this study, we prospectively enrolled patients with a suspected diagnosis of native vertebral osteomyelitis (NVO) undergoing image-guided needle aspiration of the intervertebral disc. Based on this pilot study, a high manual cell count or a high neutrophilic predominance from the disc aspirate was associated with the diagnosis of NVO.

A Madura foot caused by the fungus Madurella mycetomatis is a rare condition in non-endemic countries, but should be included in the differential diagnosis in case of soft tissue swellings of the foot in patients who have been in mycetomatis-endemic regions, more specifically in immunocompromised patients, who are at risk of developing a (more severe) mycetoma infection. Adequate treatment is needed to prevent the progression and recurrence of a Madura foot.

Pan-spine MRI is warranted in patients who require operative treatment for pyogenic spinal infection to evaluate for multifocal infection.

We present the first published case of bilateral extensor tenosynovitis caused by Coxiella burnetii. C. burnetii should be considered in patients with inflammatory osteoarticular disease, including tenosynovitis, when conventional cultures are negative especially in elderly, male, or immunocompromised patients with exposure to animals.

Currently, there is no method available to reload antibiotic carriers to treat late bone infections or to prevent bacterial attachment. We propose a novel method to load and protect a biphasic calcium sulfate/hydroxyapatite (CaS/HA) carrier material from bacterial re-population by systemically administering a clinical dose of HA-seeking antibiotic rifampicin (RIF). CaS/HA-based carriers could recruit HA-seeking RIF to locally exert an adequate antibacterial effect at the targeted tissue.

Tuberculosis is a serious public health problem. A retrospective study of a series of cases of patients with a diagnosis of osteoarticular tuberculosis was carried out from 2014 to 2019. A total of 30 patients were confirmed. The presence of sequelae was correlated with the presence of motor deficit at the beginning of treatment and the high value of C-reactive protein at the end of treatment. These results may contribute to a better understanding of this disease to reduce complications.

The scientific publication score (SPS) summarizes specific publication results. It is organized into five levels (1–5) based on evidence, data and statistical criteria. In risk factors for prosthetic joint infections, the highest scores were noted for anemia, malignancy and previous alloarthroplasty; for diagnosis methods, these were obtained for aspirate leucocyte count, neutrophils over 80 and interleukin-6 level. SPS is a promising new tool for automatic data mining and systematic reviews.

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.

Sometimes after surgery to repair an injured bone or joint, infection can cause the bone to heal improperly. Surgeons use calcium sulfate to prevent infections in joints after surgery. Calcium sulfate can be impregnated with antibiotics and placed inside the joint, where the bloodstream often cannot deliver intravenous or oral antibiotics effectively. We reviewed 20 years of studies of the effectiveness of calcium sulfate and found high rates of healing and infection eradication.

In a low-resource setting, we studied the risk factors for infection in 101 open fractures treated with the SIGN nail. We found that infection of fractures increased with fracture severity. The treatment-related factors found to have significant association with infection were also essentially the same as those known in advanced countries. We believe low-resource settings could affordably adopt management approaches of high-income countries to achieve good outcomes despite the scarce resources.

Forty years ago I made a radical professional choice: to dedicate a few years of practice to the African continent. Not surprisingly, a few years became many. This paper is dedicated to the children who are battling osteoarticular infections and to those who will be struggling with them in future.

Despite the success of total hip replacements, there is still a devastating complication that orthopedic surgeons must deal with: periprosthetic infection. We conducted a retrospective study on patients diagnosed with chronic periprosthetic hip infection treated with a two-stage revision using a gentamicin-impregnated articulating cement spacer. We observed a had a high overall success rate (above 90%) and that there were no significant differences between mono- and polymicrobial infections.

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.

Bone infections are challenging to treat and require new treatments. The current animal models for testing new therapies can be expensive and complex; therefore, we developed a cheap and reliable bone infection model in mice. Our new model features an infected hole created by a needle in the leg bone with a metal pin. This method achieved a consistent infection rate and demonstrates the importance of bacterial biofilm in bone infection.

Upper extremity abscesses frequently present to the acute care setting with inconclusive physical examination and imaging findings. This study sought to evaluate the diagnostic accuracy of various serum inflammatory markers that are commonly used in the diagnosis of other types of infections. Results demonstrated that C-reactive-protein, an acute phase inflammatory marker, is the most sensitive test, but it is the least specific.

Physicians have difficulties interpreting the isolation of Cutibacterium acnes in the spine tissue. Here we provide the experience of our center about this topic, adding data that can help physicians in their choices. Our results show that some clinical, radiological, and microbiological features can help distinguish patients to treat or not to treat. Moreover, treatment with parenteral beta-lactams appears to be effective, but targeted oral therapy could be a valid alternative.

Magnetic resonance imaging (MRI) is an imaging test that is often used in patients with a suspected bone infection in their foot. MRI findings may impact how these patients are treated; thus, it is important to understand the significance of various MRI findings. This study compared different patterns of MRI findings in these patients to their clinical outcomes. Patients with classic features of bone infection on MRI had the worst outcomes, whereas patients without them sometimes healed.

Our study showed that ultrasound-guided aspiration of a total hip arthroplasty was more commonly successful and resulted in fewer dry aspirations than fluoroscopy. Ultrasound-guided aspiration yielded a larger volume of fluid than fluoroscopy, even when excluding dry aspirations. Ultrasound was more sensitive than fluoroscopy in diagnosing prosthetic joint infection (PJI) using culture results only and 2018 Musculoskeletal Infection Society (MSIS) International Consensus Meeting (ICM) criteria.