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Antibiotics
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Periprosthetic Joint Infection: Understanding the Epidemiology, Pathogenesis, Diagnosis and Treatment...
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Periprosthetic Joint Infection: Understanding the Epidemiology, Pathogenesis, Diagnosis and Treatment Options

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

Deadline for manuscript submissions: 31 May 2026 | Viewed by 5609

Special Issue Editors

Dr. Saad Tarabichi

E-Mail Website
Guest Editor
Mayo Clinic Orthopaedics, Scottsdale, AZ, USA
Interests: periprosthetic joint infection
Dr. Mark J. Spangehl

E-Mail Website
Guest Editor
Mayo Clinic Orthopaedics, Scottsdale, AZ, USA
Interests: postoperative pain management; periprosthetic joint infection
Dr. Joshua S. Bingham

E-Mail Website
Guest Editor
Mayo Clinic Orthopaedics, Scottsdale, AZ, USA
Interests: hip preservation surgery; primary and revision hip and knee arthroplasty

Special Issue Information

Dear Colleagues,

As you are all aware, periprosthetic joint infection (PJI) is a devastating complication and one of the leading causes of implant failure following primary and revision total-joint arthroplasty (TJA). Concurrently, the economic burden of this disease process exceeds $2 billion per annum in the United States alone. Notwithstanding this, our understanding of PJI epidemiology, pathogenesis, diagnosis, and treatment options remains limited.

We are excited to be collaborating with Antibiotics to bring you this Special Issue on PJI. All articles related to the epidemiology, pathogenesis, diagnosis, and treatment of PJI will be considered for publication, including clinical research, fundamental scientific research, and systematic reviews. In order to be considered for publication in this Special Issue, all articles must be submitted by the deadline date of 31 May 2026.

We look forward to working with you.

Dr. Saad Tarabichi
Dr. Mark J. Spangehl
Dr. Joshua S. Bingham
Guest Editors

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.

Keywords

  • periprosthetic joint infection
  • diagnosis
  • epidemiology
  • pathogenesis
  • treatment

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Published Papers (4 papers)

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Research

12 pages, 952 KB  
Article
Microbiological Patterns in Periprosthetic Knee Infections over a Decade: Analysis of Resistance Patterns, Temporal Trends, and Patient Residence
by Marcos González-Alonso, Alfonso Lajara-Heredia, Adrián Guerra-González, Vega Villar-Suárez and Jaime Antonio Sánchez-Lázaro
Antibiotics 2026, 15(5), 481; https://doi.org/10.3390/antibiotics15050481 - 9 May 2026
Viewed by 287
Abstract
Background: Infection following total knee arthroplasty (TKA) is a challenging complication. Optimal empirical antibiotic therapy and surgical management hinge on up-to-date knowledge of local pathogen distribution and resistance patterns. However, few studies have examined whether geographical factors, specifically rural versus urban residence, influence [...] Read more.
Background: Infection following total knee arthroplasty (TKA) is a challenging complication. Optimal empirical antibiotic therapy and surgical management hinge on up-to-date knowledge of local pathogen distribution and resistance patterns. However, few studies have examined whether geographical factors, specifically rural versus urban residence, influence the microbiology or clinical outcomes of periprosthetic joint infection (PJI) within integrated healthcare systems. The goal of this study was to assess the temporal evolution of bacterial species and antimicrobial resistance in knee PJI over an 11-year period. As a secondary objective, we wanted to evaluate the potential impact of patient residence on microbiological trends and treatment success. Methods: We conducted a retrospective analysis of all patients diagnosed with knee PJI who underwent surgical treatment between 2013 and 2023 at our center. Infections were classified as acute postoperative, acute hematogenous, or chronic. Patient residence was categorized as rural (<5000 inhabitants) or urban. Temporal trends were modeled using Poisson regression, and comparisons between subgroups were performed using Fisher’s exact test and Student’s t-test. Results: A total of 98 patients were analyzed, with 99 microorganisms identified. Gram-positive organisms predominated (72.3%), with Staphylococcus aureus (33.3%) and Coagulase-negative Staphylococci (CoNS) (29.3%) as the most frequent isolates. Resistance to vancomycin was not detected in S. aureus isolates. However, CoNS demonstrated high resistance to fluoroquinolones (55.2%) and rifampicin (20.7%). No significant annual shifts were observed for Gram-positive (IRR = 0.94; 95% CI: 0.86–1.03; p = 0.413) or Gram-negative cases (IRR = 0.75; 95% CI: 0.53–1.05; p = 0.086). Comparing rural versus urban populations, no differences were found in microbiological profiles (Fisher’s exact test, all p > 0.05). Furthermore, clinical treatment success rates were comparable (Rural 69.4% vs. Urban 63.0%, p = 0.500), despite a significantly higher prevalence of diabetes mellitus in rural patients (34.7% vs. 10.2%, p = 0.007). Conclusions: The microbiological landscape of knee PJI has remained stable, with no emergence of multidrug-resistant S. aureus. In our setting, standardized management protocols appeared to be equally effective regardless of patient residence. However, given the single-center nature and sample size of this study, broader multicenter validation is required before these findings can be generalized. Full article
(This article belongs to the Special Issue Periprosthetic Joint Infection: Understanding the Epidemiology, Pathogenesis, Diagnosis and Treatment Options)
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10 pages, 307 KB  
Article
Cutibacterium acnes Culture Isolation Following Total Hip and Total Knee Arthroplasty
by Benjamin Levy, Alton Daley, Tracy Borsinger, Paul Werth and Wayne Moschetti
Antibiotics 2026, 15(2), 165; https://doi.org/10.3390/antibiotics15020165 - 4 Feb 2026
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Abstract
Introduction: Cutibacterium acnes, a component of normal skin flora and a common commensal Gram-positive bacterium, presents a diagnostic challenge for arthroplasty surgeons. While Cutibacterium acnes (C. acnes) as a source of infection has been well characterized in shoulder surgery, its presentation and [...] Read more.
Introduction: Cutibacterium acnes, a component of normal skin flora and a common commensal Gram-positive bacterium, presents a diagnostic challenge for arthroplasty surgeons. While Cutibacterium acnes (C. acnes) as a source of infection has been well characterized in shoulder surgery, its presentation and clinical significance in total hip (THA) and total knee arthroplasty (TKA) remain less understood. Methods: A retrospective chart review identified patients with C. acnes culture positivity following THA or TKA. Demographics, laboratory values, and microbiologic data were collected. Statistical comparisons were performed using t-tests and chi-squared analysis. One-year outcomes were evaluated using the Musculoskeletal Infection Society Outcome Reporting Tool (MSIS ORT) criteria among patients undergoing further surgical intervention. Results: Twenty-nine patients with C. acnes-positive cultures were identified (21 THA, 8 TKA); 15 (52%) were polymicrobial. Ten THA patients (47.6%) and seven TKA patients (87.5%) met MSIS criteria for infection at the time of presentation. Mean time to culture positivity was similar between THA (6.8 days) and TKA (7.4 days; p = 0.57). Sonicated cultures were positive in 24% of THA and 12.5% of TKA cases. Mean ESR was 36.4 mm/h for THA and 51.5 mm/h for TKA (p = 0.21); mean C-reactive protein (CRP) was 35.2 and 36.8 mg/dL, respectively (p = 0.95). Mean synovial cell counts were 27,055 for THA and 22,194 for TKA, with polymorphonuclear cells (PMN) percentages of 68% and 73.9% (p = 0.72, 0.70). Monomicrobial infections demonstrated a mean cell count of 24,143 with 58.9% PMNs, compared to 25,903 and 78.8% in polymicrobial cases. At one year, 72% of patients undergoing subsequent surgery achieved successful outcomes. Higher ASA classification was the only significant predictor of failure (mean 3.0 vs. 2.75). Conclusions: C. acnes-associated THA and TKA infections often present with delayed culture growth, mild inflammatory markers, and frequent polymicrobial involvement. At one-year, patients with available follow-up who undergo surgical management experience favorable outcomes, with 72% achieving MSIS ORT success. Full article
(This article belongs to the Special Issue Periprosthetic Joint Infection: Understanding the Epidemiology, Pathogenesis, Diagnosis and Treatment Options)
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10 pages, 332 KB  
Article
Rapid Nanopore Sequencing to Identify Bacteria Causing Prosthetic Joint Infections
by Hollie Wilkinson, Karina Wright, Helen S. McCarthy, Jade Perry, Charlotte Hulme, Niall Steele, Benjamin Burston, Rob Townsend and Paul Cool
Antibiotics 2025, 14(9), 879; https://doi.org/10.3390/antibiotics14090879 - 31 Aug 2025
Viewed by 1549
Abstract
Background/Objectives: The diagnosis of prosthetic joint infection remains difficult. Microbiological cultures frequently have false-positive and false-negative results. This study investigates whether rapid nanopore sequencing can be used to aid the identification of bacteria causing prosthetic joint infection for more timely identification and treatment. [...] Read more.
Background/Objectives: The diagnosis of prosthetic joint infection remains difficult. Microbiological cultures frequently have false-positive and false-negative results. This study investigates whether rapid nanopore sequencing can be used to aid the identification of bacteria causing prosthetic joint infection for more timely identification and treatment. Methods: Nineteen patients who had revision surgery following total joint arthroplasty were included in this study. Of these, 15 patients had an infected joint arthroplasty. All patients had joint fluid aspirated at the time of revision surgery. The DNA was extracted from these fluid aspirates, and rapid nanopore sequencing was performed using the MinION device from Oxford Nanopore Technologies. The sequencing data was trimmed to improve quality and filtered to remove human reads using bioinformatic tools. Genomic sequence classification was performed using the Basic Local Alignment Search Tool. The results were filtered by read length and sequence identity score. The European Bone and Joint Infection Society criteria were used as a standard to identify infected and not infected patients. Confusion tables were used to calculate accuracy and F1 score based on this criteria and the nanopore sequencing results. Results: Microbiological cultures and nanopore sequencing had an accuracy of 68% and 74%, respectively. However, combining both results predicted infection accurately in 94% of cases (F1 score 96%). Conclusions: Nanopore sequencing has the potential to aid identification of bacteria causing prosthetic joint infection and may be useful as a supplementary diagnostic tool. Full article
(This article belongs to the Special Issue Periprosthetic Joint Infection: Understanding the Epidemiology, Pathogenesis, Diagnosis and Treatment Options)
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8 pages, 213 KB  
Article
Periprosthetic Joint Infection in Unicompartmental vs. Total Knee Arthroplasty: Microbiological Spectrum and Management Outcomes
by Ali Said Nazlıgül, Şahan Güven, Yasin Erdoğan, Ahmet Fırat, Metin Doğan and Mustafa Akkaya
Antibiotics 2025, 14(6), 585; https://doi.org/10.3390/antibiotics14060585 - 6 Jun 2025
Cited by 2 | Viewed by 1600
Abstract
Background/Objectives: Periprosthetic joint infection (PJI) is a severe complication following both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). While the microbiological profile of TKA PJI has been well characterized, limited data exist regarding UKA PJIs. This study aimed to compare [...] Read more.
Background/Objectives: Periprosthetic joint infection (PJI) is a severe complication following both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). While the microbiological profile of TKA PJI has been well characterized, limited data exist regarding UKA PJIs. This study aimed to compare the causative microorganisms and surgical treatment outcomes in PJI cases following UKA and TKA. Methods: This retrospective cohort study included 82 patients (71 TKA and 11 UKA) who underwent surgical treatment for PJI between January 2017 and May 2024. PJI was diagnosed based on the Musculoskeletal Infection Society (MSIS) criteria. Treatment strategies included debridement, antibiotics, and implant retention (DAIR) or two-stage revision arthroplasty. Microbiological data were extracted from intraoperative cultures. Fisher’s exact test and the Mann–Whitney U test were used for statistical comparisons. Results: Gram-positive organisms, primarily Staphylococcus aureus and coagulase-negative staphylococci, were isolated in all UKA PJIs. In contrast, the TKA group demonstrated greater microbial diversity, including Gram-negative bacilli, polymicrobial infections, and a higher rate of culture-negative cases (33.8% vs. 18.2%). DAIR was performed more frequently in UKA cases (72.7% vs. 28.2%, p = 0.002). Recurrence rates following DAIR were similar in both groups (12.5% in UKA, 20.0% in TKA, p = 1.000). Two-stage revision resulted in no recurrence in UKA and a 9.8% recurrence rate in TKA patients. Conclusions: UKA PJIs appear to be microbiologically less complex than TKA PJI cases, with Gram-positive organisms predominating. Despite these differences, the outcomes of surgical treatment—both DAIR and two-stage revision—were comparable between groups. Standard PJI treatment principles may be applicable to both arthroplasty types; however, larger prospective studies are needed to confirm these findings. Full article
(This article belongs to the Special Issue Periprosthetic Joint Infection: Understanding the Epidemiology, Pathogenesis, Diagnosis and Treatment Options)
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