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A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (31 July 2025) | Viewed by 8752

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Dr. Éric Bonnet

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Guest Editor

Purpan University Hospital, 31300 Toulouse, France
Interests: orthopedic infections; cardio-vascular infections; new antimicrobials; antimicrobial prophylaxis; antimicrobial Stewardship

Special Issue Information

Dear Colleagues,

Orthopedic infections remain challenging to treat and sometimes difficult to diagnose. Their management requires a multidisciplinary approach. They include post-surgical osteomyelitis, prosthetic joint infections, and various infections, such as septic arthritis after ligament reconstructions. This Special Issue will focus on these infections and describe the epidemiology, including infection rates, risk factors, and microbiology. Then, we will discuss antimicrobial treatment, focusing on probabilistic treatment options, therapy of documented infections, when to use anti-biofilm antibiotics, particularly rifampicin, when to use a combination of antibiotics, the total duration of treatment and duration of IV (if needed) treatment, the place of local antimicrobial agents and new systemic antibiotics.

Dr. Éric Bonnet
Guest Editor

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Keywords

chronic osteomyelitis
prosthetic joint infections
epidemiology
microbiology
antimicrobial treatment
treatment duration
local antibiotics

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Published Papers (5 papers)

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Research

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14 pages, 1014 KB

Open AccessArticle

Microbiological Profiles of Patients with Acute Periprosthetic Joint Infection Undergoing Debridement, Antibiotics, Irrigation and Implant Retention (DAIR)

by Alberto Alfieri Zellner, Niclas Watzlawik, Jonas Roos, Gunnar Thorben Rembert Hischebeth, Ernst Molitor, Alexander Franz and Frank Sebastian Fröschen

Antibiotics 2025, 14(9), 873; https://doi.org/10.3390/antibiotics14090873 (registering DOI) - 30 Aug 2025

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Abstract

Background: Periprosthetic joint infection (PJI) is one of the most serious complications following total joint arthroplasty. The debridement, antibiotics, irrigation, and implant retention (DAIR) procedure is commonly employed to treat acute, early-stage infections, but its success is highly variable, influenced by factors such as pathogen virulence and antibiotic susceptibility profiles. This study aimed to evaluate the impact of pathogens responsible for these infections on the outcome of DAIR. Methods: This retrospective, single-center study analyzed the microbiological profiles of 116 patients (66 hips and 50 knees) treated for acute periprosthetic joint infections (PJIs) with DAIR between 2018 and 2022. Acute PJI was defined as a duration of symptom less than three weeks, according to the criteria established by the Tsukayama and Izakovicova classification. Preoperative joint aspirations, intraoperatively collected tissue samples, and sonication of the exchanged mobile parts were analyzed for each case. We differentiated between monomicrobial PJI, polymicrobial PJI (defined as the identification of more than one microorganism from preoperative joint fluid aspiration or intraoperative samples), and difficult-to-treat (DTT) pathogens. Results: In this cohort, the following pathogen profiles were identified: culture-negative cases accounted for 11.1% of infections, while 64.2% were attributed to Gram-positive bacteria, 19.8% to Gram-negative bacteria, and 4.9% to fungal pathogens. Among the identified microorganisms, coagulase-negative staphylococci (CNS) were the most frequently detected, exhibiting a notable oxacillin resistance rate of 52.9% and rifampicin resistance rate of 28.7%. Additionally, no significant difference in revision-free implant survival was found between patients with DTT pathogens and/or polymicrobial PJI and those without such infections. Conclusions: This study highlights that pathogens in prosthetic joint infections (PJIs) do not solely determine outcomes, as patient-specific factors (comorbidities, implant type) may also play a key role. Regional variations in pathogens and antibiotic resistance patterns should guide empirical therapy. For instance, this study found a high reliance on vancomycin due to high oxacillin resistance in CNS, the most frequent causative pathogen. Full article

(This article belongs to the Special Issue Orthopedic Infections: Epidemiology and Antimicrobial Treatment)

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10 pages, 551 KB

Open AccessArticle

Microbiological Profile of Instrumented Spinal Infections: 10-Year Study at a French Spine Center

by Sophie Reissier, Carine Couzigou, Romain Courseau, Elise Aubert, Alban Le Monnier, Eric Bonnet, Peter Upex, Pierre-Emmanuel Moreau, Guillaume Riouallon and Julie Lourtet-Hascoët

Antibiotics 2024, 13(9), 791; https://doi.org/10.3390/antibiotics13090791 - 23 Aug 2024

Cited by 1 | Viewed by 1060

Abstract

Objective: The objective was to compare the microbiological characteristics and treatment of early and late surgical site infections (SSIs) in instrumented spinal surgery. Methods: Those patients admitted for SSIs in a single center between January 2010 and December 2022 were included. The subjects were divided into early (eSSIs) and late (lSSIs) SSIs, and demographic, microbiological, treatment, and follow-up data were collected. Results: Instrumented spinal surgery was performed in 2136 patients. Ninety-six cases of infections were identified (prevalence = 4.5%), with 47.9% eSSIs and 52.1% lSSIs. In 58.7% of the cases, the eSSIs were monomicrobial: Staphylococcus aureus (37%) and Enterobacterales (33.3%) were the main bacteria involved. In 66% of the cases, the lSSIs, were monomicrobial: Cutibacterium acnes (30.3%) and staphylococci were predominant. Enterobacterales were isolated in more than 70% of the polymicrobial samples in both the eSSIs and lSSIs. The treatment of the eSSIs mostly consisted of lavage-debridement surgery associated with antibiotic treatment, while the treatment of the lSSIs combined hardware removal or replacement and long-duration antibiotic treatment. A negative outcome was observed in 17.1% of the eSSIs and 5.7% of the lSSIs. Enterobacterales were associated with negative outcomes of eSSIs. Conclusions: Enterobacterales were found in most of the polymicrobial infections regardless of the time of infection onset. Further large studies should be conducted to precisely determine the management and prevention regarding the increasing Gram-negative bacteria SSIs. Full article

(This article belongs to the Special Issue Orthopedic Infections: Epidemiology and Antimicrobial Treatment)

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14 pages, 1904 KB

Open AccessArticle

Local Antimicrobial Therapy with Combined Aminoglycoside and Vancomycin Compared to Aminoglycoside Monotherapy in the Surgical Management of Osteomyelitis and Fracture-Related Infection

by Annalise Unsworth, Bernadette Young, Jamie Ferguson, Matthew Scarborough and Martin McNally

Antibiotics 2024, 13(8), 703; https://doi.org/10.3390/antibiotics13080703 - 27 Jul 2024

Cited by 1 | Viewed by 2080

Abstract

We investigated the effect of combination aminoglycoside and vancomycin local antibiotic treatment compared to aminoglycoside alone in the surgical management of bone infection. Data including patient demographics, type of surgery, microbiological characteristics, BACH score, duration of antibiotic treatment and clinical outcomes were collected. Failure of therapy was a composite of recurrence of infection, continued or new antimicrobial therapy, or reoperation with suspected or confirmed infection at one year after index surgery. A total of 266 patients met the inclusion criteria. 252 patients reached the final follow-up and were included in the final analysis. 113 patients had treatment with aminoglycoside alone and 139 patients had combination aminoglycoside and vancomycin. There was no difference in the failure rate between groups; 10/113 (8.8%) in the aminoglycoside alone and 12/139 (8.6%) in the combination group, p = 0.934. Multivariate analysis showed that there was no added benefit of combination therapy (OR 1.54: 95% CI 0.59–4.04, p = 0.38). BACH score and low BMI were associated with increased risk of failure (BACH OR 3.49: 95% CI 1.13–10.76, p = 0.03; Low BMI OR 0.91: 95% CI 0.84–0.99, p = 0.037). The form of the carrier material (pellets or injectable paste) had no effect on failure rate (p = 0.163). The presence of aminoglycoside resistance had no effect on failure rate (OR 0.39: 95% CI 0.05–3.01, p = 0.37). Clinical outcome was not improved by the addition of vancomycin to aminoglycoside alone as local therapy for the management of bone infection. Full article

(This article belongs to the Special Issue Orthopedic Infections: Epidemiology and Antimicrobial Treatment)

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10 pages, 795 KB

Open AccessArticle

What Place Is There for Long-Acting Antibiotics in the Management of Gram-Positive Infections? A Qualitative Cross-Sectional Study

by Aurélien Dinh, Guillaume Béraud, Johan Courjon, Yann Le Goff, Nicolas Kader Ettahar, Matthieu Grégoire and Eric Senneville

Antibiotics 2024, 13(7), 644; https://doi.org/10.3390/antibiotics13070644 - 12 Jul 2024

Cited by 1 | Viewed by 1933

Abstract

Objectives. To identify the current practices with long half-life lipoglycopeptides (LGPs) and potential use/position of oritavancin. Results. Despite their indication being limited to skin and soft tissue infections (SSTIs), long half-life lipoglycopeptides are mainly used off-label to treat bone and joint infections (BJIs) and infective endocarditis. Oritavancin and dalbavancin are both semisynthetic lipoglycopeptide antibiotics with activity against Gram-positive organisms. The game-changing property of these two antibiotics is their one-time dosing. Due to its shorter half-life, oritavancin might have an advantage over dalbavancin for a treatment duration of less than 2 weeks, as it could be used both in prolonged treatments of complicated patients in BJIs or administered as a single-dose treatment for Gram-positive cocci infections usually treated by a 5- to 10-day antibiotic course. These infections include urinary tract infections, bacteremias, catheter-related infections, etc. In addition to the possibility of being used as an end-of-treatment injection, oritavancin could be used as an empiric therapy treatment in the postoperative period in the context of device-associated especially prosthetic joint infections to allow for the early discharge of the patient. Methods. A qualitative survey was conducted in March 2022 including sixteen infectiologists, one internist, five hospital pharmacists, and one pharmacologist. Conclusion. Long half-life lipoglycopeptides contribute to changing the paradigm in the management of acute bacterial infections, as infectiologists now consider a range of indications and patient profiles for one single drug. Oritavancin strengthens the therapeutic arsenal in numerous infections from BJIs to urinary tract infections and could help to manage specific clinical situations, on top of providing potential benefits for the hospital’s budget. Full article

(This article belongs to the Special Issue Orthopedic Infections: Epidemiology and Antimicrobial Treatment)

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Review

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13 pages, 246 KB

Open AccessReview

Suppressive Antibiotic Therapy in Prosthetic Joint Infections: A Contemporary Overview

by Hajer Harrabi, Eloïse Meyer, Nathalie Dournon, Frédérique Bouchand, Christel Mamona Kilu, Véronique Perronne, Karim Jaffal, Emma d’Anglejan, Clara Duran and Aurélien Dinh

Antibiotics 2025, 14(3), 277; https://doi.org/10.3390/antibiotics14030277 - 7 Mar 2025

Cited by 1 | Viewed by 2795

Abstract

The management of prosthetic joint infections (PJIs) poses significant challenges, requiring a multidisciplinary approach involving surgical, microbiological, and pharmacological expertise. Suppressive antibiotic therapy (SAT) has emerged as a viable option in cases where curative interventions are deemed unfeasible. This review provides an updated synthesis of recent evidence on SAT, including its indications, efficacy, practical considerations, and associated challenges. We aim to highlight the nuances of this therapeutic approach, discuss the factors influencing its success, and offer future directions for research to optimize patient outcomes. Full article

(This article belongs to the Special Issue Orthopedic Infections: Epidemiology and Antimicrobial Treatment)

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