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Antibiotics
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Single-Stage Management of Musculo-Skeletal Infections: Local Antibacterial Protection, Antibiotics, and...
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Single-Stage Management of Musculo-Skeletal Infections: Local Antibacterial Protection, Antibiotics, and Surgical Treatments

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 9120

Special Issue Editor

Dr. Carlo L. Romanò

E-Mail Website
Guest Editor
Romano Institute ShPK, Tirana, Albania
Interests: knee arthroplasty; hip arthroplasty; bone and joint infection

Special Issue Information

Dear Colleagues,

We are delighted to invite authors and experts in the fields of orthopedics and arthroplasty to contribute valuable insights to this upcoming Special Issue, "Single-Stage Management of Musculo-Skeletal Infections: Local Antibacterial Protection, Antibiotics, and Surgical Treatments".

This Special Issue aims to serve as a comprehensive platform for the exchange of cutting-edge research and innovative approaches related to the single-stage treatment of bone and joint infections. With the increasing prevalence of prosthetic joint infections, the integration of local antibacterial implant protection techniques, coupled with advancements in antibiotic and surgical treatments, has become paramount to ensuring successful outcomes for patients undergoing single-stage surgical treatment of musculo-skeletal infections.

We welcome the submission of original research articles, reviews, case studies, and perspectives that examine the latest developments, challenges, and breakthroughs in the field. By contributing to this Special Issue, authors will have the opportunity to shape the discourse around the best practices, novel strategies, and emerging technologies in the context of single-stage treatment of bone and joint infections. The published contributions will undoubtedly enrich the collective knowledge base, fostering advancements that directly impact patient care and outcomes.

We look forward to receiving your submissions.

Best regards,

Dr. Carlo L. Romanò
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Publisher’s Notice

Prof. Dr. Guillem Bori, a member of the original Guest Editor team for the Special Issue “Single-Stage Management of Musculo-Skeletal Infections: Local Antibacterial Protection, Antibiotics, and Surgical Treatments”, will no longer be involved in the editorial handling of the Special Issue as of 27 March 2026. This change has been agreed upon by the remaining Guest Editor and the Editorial Office, and the Special Issue website has been updated accordingly. The Special Issue will continue to be handled by the remaining Guest Editor in accordance with MDPI’s Special Issue and editorial policies.

Keywords

  • knee arthroplasty
  • hip arthroplasty
  • shoulder arthroplasty
  • antibiotic treatment
  • one-stage revision arthroplasty
  • antibacterial coating

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

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13 pages, 991 KB  
Article
The Accuracy of Empirical Antibiotic Treatment for Periprosthetic Joint Infections in Total Shoulder and Knee Arthroplasties
by Katrin Freller, Hannah Punz, Clemens Schopper, Tobias Gotterbarm, Antonio Klasan and Stella Stevoska
Antibiotics 2025, 14(5), 447; https://doi.org/10.3390/antibiotics14050447 - 28 Apr 2025
Viewed by 1917
Abstract
Introduction: Periprosthetic joint infections (PJIs) remain a major challenge in orthopedic and trauma surgeries. The microbial resistance profiles and the optimal choice of empirical antibiotic therapy in shoulder arthroplasty revision are less well characterized compared to those in knee or hip arthroplasty revision. [...] Read more.
Introduction: Periprosthetic joint infections (PJIs) remain a major challenge in orthopedic and trauma surgeries. The microbial resistance profiles and the optimal choice of empirical antibiotic therapy in shoulder arthroplasty revision are less well characterized compared to those in knee or hip arthroplasty revision. Materials and Methods: This retrospective study constitutes a novel comparative analysis, providing valuable insights into the presence of joint-specific pathogen resistance and the empirical treatment accuracy of shoulder and knee arthroplasties. A review of all the revision cases following primary shoulder and knee arthroplasties conducted between January 2012 and December 2023 was performed. Cases that required revision because of PJIs were identified, and microbial cultures were analyzed to determine the presence of pathogens and their resistance profiles. Results: The most administered postoperative empirical antibiotics were cefuroxime and amoxicillin–sulbactam. A statistically significant difference in the prevalence of anerobic pathogens was observed between total shoulder arthroplasty and knee arthroplasty. Furthermore, a statistically significant difference was observed in the sensitivities of pathogens to metronidazole (p < 0.001) and erythromycin (p = 0.014). Conclusions: This study demonstrates microbiological and antimicrobial resistance differences between PJI TSA and TKA cases. Full article
(This article belongs to the Special Issue Single-Stage Management of Musculo-Skeletal Infections: Local Antibacterial Protection, Antibiotics, and Surgical Treatments)
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Review

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13 pages, 1669 KB  
Review
A One- or Two-Stage Revision of Fungal Prosthetic Joint Infection: A Review of Current Knowledge, Pitfalls and Recommendations
by Hazem Alkhawashki, Joseph Benevenia, Lorenzo Drago and Yazan Kadkoy
Antibiotics 2025, 14(7), 658; https://doi.org/10.3390/antibiotics14070658 - 30 Jun 2025
Cited by 5 | Viewed by 2849
Abstract
Fungal prosthetic joint infection (fPJI) is one of the orthopaedic pathologies where there is no clear evidence, guidelines or algorithm to guide the surgeon in its management. This is in addition to the difficulty with which these infections are diagnosed, isolated and treated. [...] Read more.
Fungal prosthetic joint infection (fPJI) is one of the orthopaedic pathologies where there is no clear evidence, guidelines or algorithm to guide the surgeon in its management. This is in addition to the difficulty with which these infections are diagnosed, isolated and treated. Fungi form notorious biofilms that are difficult to eradicate once formed and that display resistance to antimicrobial agents. These biofilms have been shown to act synergistically with biofilms of bacteria, further adding to medical treatment resistance. We have reviewed the literature for reports that describe the results of different methods in surgically treating fPJI. We found that surgical management with two stages remains the gold standard for treatment of fPJI, as is the case for bacterial PJI (bPJI). We have investigated medical treatment, debridement with implant retention (DAIR) and staged revisions and whether a reasonable recommendation can be made based on the best knowledge and practice available. From the data on bPJI, there exists a role for conservative management of acute PJI with debridement, antibiotics and implant retention (DAIR). While fPJI and bPJI both represent infections, the differences in our ability to detect these infections clinically, culture the pathogens and treat them with proper antimicrobial agents, along with the difference in the reported results of the surgical treatment, make us believe that these two types of infections should not be treated in the same manner. With all this in mind, we reviewed several reports in the literature on fPJI to determine the efficacy of current treatment modalities, including DAIR, which followed current guidelines for PJI. Data show an overall treatment success rate of 64.4% [range 17.4–100%]. Subgroup analysis revealed a success rate of 11.6% [range 0–28.7%] in patients treated with DAIR. There is no doubt that DAIR should not be encouraged as it consistently has a bad record. Although there are not enough studies or numbers of patients to show an evidence-based preference over one- or two-staged revisions, the two-stage revision of fPJI consistently shows better results and should be considered as the gold standard of management in cases of revision fPJI. This should also be coupled with proper expertise, follow-ups and recommended lengths of medical treatment, which should not be less than six months. From the review of these data, we have developed reasonable recommendations for the management of fPJI. These recommendations center on staged surgical debridement along with medical management. Medical treatment should be for at least 6 months under the guidance of an infectious disease team and based on intraoperative cultures. In the case of local antimicrobial treatment reported in the literature, many patients with fPJI were found to have a polymicrobial infection. As a result, it is our recommendation that antifungals as well as antibacterials should be incorporated into the cement spacer mix of these cases. Fungal PJI remains an exceedingly difficult pathology to treat and should be managed by experienced surgeons in a well-equipped institution. Full article
(This article belongs to the Special Issue Single-Stage Management of Musculo-Skeletal Infections: Local Antibacterial Protection, Antibiotics, and Surgical Treatments)
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11 pages, 651 KB  
Review
Enhancing Pathogen Detection in Implant-Related Infections through Chemical Antibiofilm Strategies: A Comprehensive Review
by Fabiana Giarritiello, Carlo Luca Romanò, Guenter Lob, Joseph Benevenia, Hiroyuki Tsuchiya, Emanuele Zappia and Lorenzo Drago
Antibiotics 2024, 13(7), 678; https://doi.org/10.3390/antibiotics13070678 - 22 Jul 2024
Cited by 4 | Viewed by 3446
Abstract
Implant-related infections (IRIs) represent a significant challenge to modern surgery. The occurrence of these infections is due to the ability of pathogens to aggregate and form biofilms, which presents a challenge to both the diagnosis and subsequent treatment of the infection. Biofilms provide [...] Read more.
Implant-related infections (IRIs) represent a significant challenge to modern surgery. The occurrence of these infections is due to the ability of pathogens to aggregate and form biofilms, which presents a challenge to both the diagnosis and subsequent treatment of the infection. Biofilms provide pathogens with protection from the host immune response and antibiotics, making detection difficult and complicating both single-stage and two-stage revision procedures. This narrative review examines advanced chemical antibiofilm techniques with the aim of improving the detection and identification of pathogens in IRIs. The articles included in this review were selected from databases such as PubMed, Scopus, MDPI and SpringerLink, which focus on recent studies evaluating the efficacy and enhanced accuracy of microbiological sampling and culture following the use of chemical antibiofilm. Although promising results have been achieved with the successful application of some antibiofilm chemical pre-treatment methods, mainly in orthopedics and in cardiovascular surgery, further research is required to optimize and expand their routine use in the clinical setting. This is necessary to ensure their safety, efficacy and integration into diagnostic protocols. Future studies should focus on standardizing these techniques and evaluating their effectiveness in large-scale clinical trials. This review emphasizes the importance of interdisciplinary collaboration in developing reliable diagnostic tools and highlights the need for innovative approaches to improve outcomes for patients undergoing both single-stage and two-stage revision surgery for implant-related infections. Full article
(This article belongs to the Special Issue Single-Stage Management of Musculo-Skeletal Infections: Local Antibacterial Protection, Antibiotics, and Surgical Treatments)
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