https://jbji.copernicus.org/articles/ Recent articles of the journal Journal of Bone and Joint Infection en https://doi.org/10.5194/jbji-11-229-2026 Empirical antibiotic therapy in acute orthopaedic infections: differences in antimicrobial susceptibility across anatomical sites Yoni Lodewijk-van den Brink, Jon H. M. Goosen, Denise S. C. Telgt, Marrigje Nabuurs-Franssen, and Karin C. M. Veerman J. Bone Joint Infect., 11, 229–235, https://doi.org/10.5194/jbji-11-229-2026, 2026 Early postoperative orthopaedic infections require rapid empirical antibiotic treatment, but the optimal regimen may differ by anatomical site. In this retrospective cohort study, empirical coverage was evaluated across anatomical sites. Vancomycin combined with ceftriaxone provided high coverage for most sites, while foot and ankle infections showed higher rates of resistant Gram-negative bacteria. These findings support an anatomy-specific approach to treatment. Wed, 15 Apr 2026 18:05:41 +0200 https://doi.org/10.5194/jbji-11-219-2026 Twenty common errors in the prevention, diagnosis, and treatment of fracture-related infection (FRI) Goran Georgievski, Nike Walter, Ronald Man Yeung Wong, Irene Katharina Sigmund, Ashok Kanuri, Christian Heiss, and Markus Rupp J. Bone Joint Infect., 11, 219–228, https://doi.org/10.5194/jbji-11-219-2026, 2026 This article outlines 20 common errors in the prevention, diagnosis, and management of fracture-related infection (FRI), highlighting their clinical consequences and providing practical recommendations for avoiding them. By addressing typical pitfalls and emphasizing standardized procedures and interdisciplinary collaboration, the article aims to improve patient safety and treatment outcomes. Mon, 13 Apr 2026 18:05:41 +0200 https://doi.org/10.5194/jbji-11-207-2026 Is there a role for lavage aspiration after a dry tap in the work-up for potential periprosthetic joint infection? A systematic review Sander Bruyninckx, Stijn Ghijselings, Melissa Depypere, Alex Soriano, Willem-Jan Metsemakers, and Georges Vles J. Bone Joint Infect., 11, 207–217, https://doi.org/10.5194/jbji-11-207-2026, 2026 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. Thu, 09 Apr 2026 18:05:41 +0200 https://doi.org/10.5194/jbji-11-191-2026 Bone transport in the management of fracture-related infection: current concepts and innovations Willem-Jan Metsemakers, Austin T. Fragomen, Mario Morgenstern, Steffen B. Rosslenbroich, Stephen M. Quinnan, Pablo S. Corona, Mitchell Bernstein, and Kevin Tetsworth J. Bone Joint Infect., 11, 191–206, https://doi.org/10.5194/jbji-11-191-2026, 2026 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. Wed, 01 Apr 2026 18:05:41 +0200 https://doi.org/10.5194/jbji-11-185-2026 A hidden threat: a case of relapsed disseminated Mycobacterium abscessus infection and its therapeutic challenges Katherine Grace Egan, Lisa Duffy, Catherine Fleming, Padraig McGettrick, Eavan G. Muldoon, Christine Kelly, James Woo, Emer Kilbride, Joseph Butler, Richard Storey, Christine Quinlan, Edward McDermott, Jonathan Hunter, and Carlos Mejia-Chew J. Bone Joint Infect., 11, 185–189, https://doi.org/10.5194/jbji-11-185-2026, 2026 Disseminated Mycobacterium abscessus infection is a rare clinical presentation that is challenging to treat due to the limited number of therapeutic options available. This complex case involved multi-speciality input across two hospitals. In the absence of guidelines for the management of extra-pulmonary and disseminated disease, our case  highlights which pharmacological agents were used and how surgery was utilised to achieve source control. Mon, 30 Mar 2026 18:05:41 +0200 https://doi.org/10.5194/jbji-11-175-2026 Diagnostic parameters in native joint septic arthritis and development of a new evaluation score Lorenz Huber, Hasan S. Aguicenoglu, Susanne Baertl, Julia Elisabeth Lenz, Kristina Gerhardinger, Frank Hanses, Florian Zeman, Nike Walter, Volker Alt, and Markus Rupp J. Bone Joint Infect., 11, 175–183, https://doi.org/10.5194/jbji-11-175-2026, 2026 Septic arthritis is a dangerous joint infection that requires rapid treatment. We analysed patient data to test common blood and synovial fluid markers and a newly developed composite score combining these markers. The score demonstrated higher sensitivity than individual tests alone within this dataset. Prospective validation in larger cohorts is required before clinical application. Mon, 23 Mar 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-161-2026 Combined analysis of host immune response, biofilm genes, and 16S rRNA detection in fracture-related infection: an observational cohort study Melissa Depypere, Jonathan Sliepen, Jolien Onsea, Yves Debaveye, T. Fintan Moriarty, Elena Della Bella, Emmanuel André, Johan Van Weyenbergh, and Willem-Jan Metsemakers J. Bone Joint Infect., 11, 161–173, https://doi.org/10.5194/jbji-11-161-2026, 2026 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.  Thu, 12 Mar 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-149-2026 Advancing diagnostics in suspected periprosthetic joint infections using synthetic synovial fluid and microcalorimetry Amber De Bleeckere, Jeroen Neyt, Jasper Van Heuverswyn, Stien Vandendriessche, Hannelore Hamerlinck, Annelynn Wallaert, Christophe Pattyn, Bruno Verhasselt, Jerina Boelens, and Tom Coenye J. Bone Joint Infect., 11, 149–160, https://doi.org/10.5194/jbji-11-149-2026, 2026 Timely and accurate pathogen identification is essential for managing periprosthetic joint infections (PJIs), yet conventional culturing often yields false negatives and requires prolonged incubation. We evaluated an in-vivo-like synovial fluid medium and isothermal microcalorimetry. The combined use of these approaches improved detection rates and reduced time to diagnosis, offering valuable insights to advance PJI diagnostics and support better clinical decision-making. Wed, 11 Mar 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-139-2026 Malnutrition affects infection rates and quality of life in patients undergoing primary hip and knee arthroplasty: a retrospective study Domenico De Mauro, Chiara Comisi, Valeria Maccauro, Giovanni Balato, Sebastian Meller, Martina Di Martino, Fabiana Arduini, Giulio Maccauro, and Raffaele Vitiello J. Bone Joint Infect., 11, 139–147, https://doi.org/10.5194/jbji-11-139-2026, 2026 This retrospective study analyzed 682 patients who underwent primary total hip or knee arthroplasty to evaluate the impact of malnutrition on post-operative outcomes. Malnutrition, as defined by the Nutritional Risk Screening 2002 (NRS-2002) and controlling nutritional status (CONUT) scores, was significantly associated with higher rates of post-operative infection and poorer quality-of-life scores. Early nutritional assessment may improve post-operative recovery and reduce complication rates. Wed, 04 Mar 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-123-2026 Septic arthritis and prosthetic joint infections: microbial spectrum and evolving resistance patterns Merve Gürler, Füsun Kırca, and Bedia Dinç J. Bone Joint Infect., 11, 123–137, https://doi.org/10.5194/jbji-11-123-2026, 2026 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. Wed, 25 Feb 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-113-2026 Treatment of periprosthetic joint infection – outcomes following algorithm-guided treatment at a multidisciplinary referral centre Christian Merz, Jan Klaas, Rik Osinga, Parham Sendi, Richard Alexander Kuehl, Mario Morgenstern, and Martin Clauss J. Bone Joint Infect., 11, 113–121, https://doi.org/10.5194/jbji-11-113-2026, 2026 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. Thu, 12 Feb 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-83-2026 High failure rate in Pseudomonas aeruginosa-associated periprosthetic hip and knee joint infections Ece Akcicek, Jennyfer A. Mitterer, Veronika Achatz, Tamino Szirmay, Sujeesh Sebastian, and Jochen G. Hofstaetter J. Bone Joint Infect., 11, 83–94, https://doi.org/10.5194/jbji-11-83-2026, 2026 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. Tue, 10 Feb 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-95-2026 Safety of locally applied antibiotics in orthopaedic trauma surgery: descriptive results from a prospective cohort study 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, 2026 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. Tue, 10 Feb 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-105-2026 How much are we willing to do for the ones we love – impact on caregivers of patients suffering from periprosthetic joint infections: a qualitative study Franz-Joseph Dally, Franziska Prüßner, Frederic Bludau, Sascha Gravius, Ali Darwich, and Marcel Betsch J. Bone Joint Infect., 11, 105–112, https://doi.org/10.5194/jbji-11-105-2026, 2026 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. Tue, 10 Feb 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-77-2026 Lyme in the prosthetic joint: two cases and a review of the literature Hussam Tabaja, Matteo Passerini, Irene G. Sia, Elena Beam, and Gina A. Suh J. Bone Joint Infect., 11, 77–82, https://doi.org/10.5194/jbji-11-77-2026, 2026 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. Thu, 05 Feb 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-65-2026 Gentamicin fails to eradicate Staphylococcus aureus biofilm in vitro, even in combination with rifampin 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, 2026 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. Mon, 02 Feb 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-53-2026 Diagnosis and management of fracture-related infections in a low-income country: a prospective study comparing current practice to international consensus guidelines Loïc Fonkoué, Elizabeth K. Tissingh, Cilia Ngang, Olivier Kennedy Muluem, Jasmine Sibatcheu Simo, Richard Douvamai, Jean Bahebeck, Olivier Cornu, and Martin McNally J. Bone Joint Infect., 11, 53–63, https://doi.org/10.5194/jbji-11-53-2026, 2026 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. Thu, 29 Jan 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-43-2026 Osteomyelitis in peri-implant bone of hip prosthetic joint infection: prevalence and clinical impact Ernesto Muñoz-Mahamud, Melissa Rivera, Ana Belén Larque, Laura Morata, Andrés Combalia, Alfonso Alías, Jenaro Ángel Fernández-Valencia, and Álex Soriano J. Bone Joint Infect., 11, 43–52, https://doi.org/10.5194/jbji-11-43-2026, 2026 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. Thu, 15 Jan 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-31-2026 The proportion of chronic periprosthetic joint infection patients with Candida isolates Samuelson E. Osifo, Adrian Santana, Michael F. Shannon, Victoria R. Wong, Caroline F. Tyndall, Christian Cisneros, Niosha Parvizi, Brian A. Klatt, Johannes F. Plate, Nicolas S. Piuzzi, and Kenneth L. Urish J. Bone Joint Infect., 11, 31–41, https://doi.org/10.5194/jbji-11-31-2026, 2026 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. Tue, 13 Jan 2026 18:05:41 +0100 https://doi.org/10.5194/jbji-11-15-2026 Synovial fluid specific gravity as an inexpensive point-of-care test for diagnosing hip and knee periprosthetic joint infection Sujeesh Sebastian, Hibah A. Abusulaiman, Veronika Achatz, Matteo Spadini, Jennyfer A. Mitterer, Sebastian Simon, and Jochen G. Hofstaetter J. Bone Joint Infect., 11, 15–19, https://doi.org/10.5194/jbji-11-15-2026, 2026 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. Mon, 12 Jan 2026 18:05:41 +0100