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Antibiotics
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Diagnostics, Antibiotic Usage and Surgery Related Techniques in Prevention and...
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Diagnostics, Antibiotic Usage and Surgery Related Techniques in Prevention and Treatment of Prosthetic Joint and Implant Related Infections

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 June 2026 | Viewed by 12203

Special Issue Editors

Prof. Dr. Bernd Fink

E-Mail Website
Guest Editor
Department for Joint Replacement, Rheumatoid and General Orthopaedics, Orthopaedic Clinic Markgröningen, Markgröningen, Germany
Interests: primary and revision joint arthroplasty of hip and knee; diagnostics and therapy of bone and joint infections
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Steffen Ruchholtz

E-Mail Website
Guest Editor
Center for Orthopedics and Trauma Surgery, University Hospital of Marburg, Marburg, Germany
Interests: the care of severe injuries; orthopedics and trauma surgery; special trauma surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Prosthetic joint infections (PJIs) remain among the most serious and complex complications that can follow joint arthroplasty, particularly in hip and knee replacements. With the global increase in both primary and revision joint arthroplasty procedures, the incidence and clinical burden of PJIs are growing. These infections not only compromise patient outcomes but also pose substantial challenges to orthopedic surgeons and infectious disease specialists alike.

The accurate and timely diagnosis of PJIs is crucial. Advances in imaging, molecular diagnostics, and biomarker identification are improving our ability to detect infections early and implement targeted therapy. Still, there remains a need for standardized diagnostic criteria and personalized treatment strategies, especially in the setting of multidrug-resistant organisms and recurrent infections.

Antibiotic usage plays a pivotal role throughout the continuum of care—from prophylaxis during primary arthroplasty to salvage procedures in complex revision cases. While perioperative antibiotic prophylaxis has significantly reduced infection rates in primary procedures, managing infections in revision arthroplasty is markedly more complicated due to factors such as antibiotic resistance and the formation of biofilms on implants.

Equally critical are surgical techniques for preventing and treating PJI and FRI. Skin preparation, irrigation solutions, and debridement techniques are some examples of these.

This Special Issue focuses on antibiotic strategies in primary and revision joint arthroplasty and the evolving landscape of diagnostics and therapies for bone and joint infections. Original articles and meta-analyses in both clinical and basic research are welcome, as well as review articles that summarize the newest knowledge in the field.

Prof. Dr. Bernd Fink
Prof. Dr. Steffen Ruchholtz
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
  • implant-related infection
  • antibiotics
  • spacer
  • diagnosis
  • septic revision arthroplasty
  • irrigation
  • debridement

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Published Papers (5 papers)

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Research

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12 pages, 1350 KB  
Article
Additional Erythrocyte Field Is Helpful for Graphic Type Differentiation of Cell Count Determination Between Acute Periprosthetic Joint Infection and Hematoma
by Florian Hubert Sax, Marius Hoyka, Benedikt Paul Blersch, Elke Weissbarth, Philipp Schuster, Irina Berger, Hansjörg Baum and Bernd Fink
Antibiotics 2026, 15(2), 122; https://doi.org/10.3390/antibiotics15020122 - 26 Jan 2026
Viewed by 416
Abstract
Background/Objectives: This study was designed to verify the hypothesis that graphical cell differentiation of synovial cell count analysis is helpful for diagnosis of acute periprosthetic joint infection (PJI) and that the additional erythrocyte field has advantages to differentiate PJI from hematoma. Methods [...] Read more.
Background/Objectives: This study was designed to verify the hypothesis that graphical cell differentiation of synovial cell count analysis is helpful for diagnosis of acute periprosthetic joint infection (PJI) and that the additional erythrocyte field has advantages to differentiate PJI from hematoma. Methods: A total of 77 total knee arthroplasties and 31 total hip arthroplasties underwent aspiration within six weeks of primary implantation. The aspirate was analyzed with the cell counter Yumizen H500 and examined by cultivation. Serum CRP was also determined. A total of 43 patients underwent revision and microbiological and histological analysis of the periprosthetic tissue, according to Morowitz and Krenn, was performed. The ICM criteria for diagnosing PJI were used. Results: Thirty-two cases (29.6%) were classified as acute infection. The graphical type differentiation LMNE (leukocyte–monocyte–neutrophil–eosinophil) showed 28 cases with type II (infection type), 63 cases with type IV (indifferent type), 13 cases with type V (hematoma type with a peak in the erythrocyte field) and 4 cases with type VI (mixed infection and hematoma). The LMNE matrix assessment had an accuracy of 98.7%, sensitivity of 96.9%, specificity of 98.7%, positive predictive value of 96.9%, negative predictive value of 98.7%, a positive likelihood ratio of 73.62, and a negative likelihood ratio of 0.03. Only one single non-infectious hematoma sample was misclassified as type VI (mixed infection/hematoma). Conclusions: The graphical type differentiation of the cell count analysis of synovial aspirates is a helpful method for diagnosis of acute periprosthetic joint infection and differentiating between hematoma and real early periprosthetic infections. This report shows that the new erythrocyte field of the Yumizen H500 is a useful additional diagnostic tool. Full article
(This article belongs to the Special Issue Diagnostics, Antibiotic Usage and Surgery Related Techniques in Prevention and Treatment of Prosthetic Joint and Implant Related Infections)
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11 pages, 1184 KB  
Article
Antibiotic Prophylaxis in Instrumented Lumbar Spine Surgery: Cefazolin Outperforms Clindamycin Regardless of Duration
by Zoltán Nagy, Dóra Szabó, Gergely Agócs, Konrád Szilágyi, Zsanett Rojcsik, József Budai, Zoltán Papp, Csaba Padányi, Loránd Erőss, László Sipos and Péter Banczerowski
Antibiotics 2025, 14(8), 830; https://doi.org/10.3390/antibiotics14080830 - 15 Aug 2025
Cited by 2 | Viewed by 3663
Abstract
Background: Surgical site infections (SSIs) are a significant postoperative complication in instrumented lumbar spine surgery, and the selection and duration of appropriate prophylactic antibiotics are key to their prevention. The aim of our study was to evaluate the effectiveness of various prophylactic antibiotics, [...] Read more.
Background: Surgical site infections (SSIs) are a significant postoperative complication in instrumented lumbar spine surgery, and the selection and duration of appropriate prophylactic antibiotics are key to their prevention. The aim of our study was to evaluate the effectiveness of various prophylactic antibiotics, primarily cefazolin and clindamycin, as well as the role of the duration of antibiotic prophylaxis in the development of SSI in instrumented lumbar spine surgeries through retrospective analysis. Methods: We performed a retrospective analysis of data from 915 patients who underwent instrumented lumbar spine surgery between 2016 and 2024 in a university center database. We examined the incidence of SSI according to the type of antibiotic used (cefazolin 1 g or 2 g, or clindamycin 0.6 g) and the duration of prophylaxis (single dose versus 72 h administration). We used the Fisher test and Welch test as a statistical analysis to examine the differences between SSI rates. Results: The incidence of SSI was 11.7%. We measured a significantly lower infection rate with cefazolin compared to clindamycin (OR = 0.45; 95% CI: 0.23–0.94; p = 0.0206), regardless of the duration of antibiotic administration. The 72 h cefazolin prophylaxis showed a slight but statistically insignificant advantage over single dose prophylaxis. The risk of SSI was significantly higher in multi-segment surgeries (p = 0.0005). Conclusions: Cefazolin is a more effective prophylactic antibiotic than clindamycin during instrumented lumbar spine surgery. The duration of antibiotic administration has less influence on the risk of SSI development; therefore, short-term, adequate-dose cefazolin prophylaxis is recommended, which also minimizes the risk of antimicrobial resistance and side effects. Full article
(This article belongs to the Special Issue Diagnostics, Antibiotic Usage and Surgery Related Techniques in Prevention and Treatment of Prosthetic Joint and Implant Related Infections)
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Review

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15 pages, 490 KB  
Review
Oritavancin for Gram-Positive Bone and Joint Infections: A Comprehensive Review of the Literature
by Zain Ahmed Raza, Alex Giannini and Marco Bongiovanni
Antibiotics 2026, 15(2), 226; https://doi.org/10.3390/antibiotics15020226 - 19 Feb 2026
Viewed by 844
Abstract
Background: Bone and joint infections (BJIs), including osteomyelitis, septic arthritis, and periprosthetic joint infections, typically require prolonged antimicrobial therapy and often involve complex outpatient management. Oritavancin, a long-acting lipoglycopeptide approved for the treatment of acute bacterial skin and skin structure infections caused by [...] Read more.
Background: Bone and joint infections (BJIs), including osteomyelitis, septic arthritis, and periprosthetic joint infections, typically require prolonged antimicrobial therapy and often involve complex outpatient management. Oritavancin, a long-acting lipoglycopeptide approved for the treatment of acute bacterial skin and skin structure infections caused by Gram-positive bacteria, has emerged as a potential off-label option for BJIs owing to its favourable pharmacokinetic and pharmacodynamic properties. Objectives: To provide a comprehensive overview of the pharmacological rationale, microbiological activity, and available clinical evidence supporting the use of oritavancin in BJIs. Methods: A comprehensive narrative review of the literature was performed using MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL), focusing on publications from 2011 to 2025. Observational studies, case series, and case reports describing the off-label use of oritavancin in BJIs were considered. Results: The available literature primarily consists of observational studies and real-world experiences. Eighteen studies met the inclusion criteria. Oritavancin was most frequently evaluated for osteomyelitis (n = 14 studies), prosthetic joint infections (n = 10) and septic arthritis (n = 5). Multi-dose regimens, typically including a 1200 mg loading dose followed by weekly doses of 800–1200 mg, were the most commonly described strategies. Reported clinical success rates generally ranged from approximately 70% to over 90%. Oritavancin was overall well tolerated, with adverse events being mostly mild and self-limiting. Conclusions: Current evidence suggests that oritavancin may represent an effective and well-tolerated off-label option for selected patients with Gram-positive BJIs. Its use may offer practical advantages, including reduced hospitalization and avoidance of prolonged intravenous antimicrobial therapy, particularly in patients for whom standard treatment approaches are challenging. Full article
(This article belongs to the Special Issue Diagnostics, Antibiotic Usage and Surgery Related Techniques in Prevention and Treatment of Prosthetic Joint and Implant Related Infections)
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18 pages, 333 KB  
Review
Antibiotic Elution from Cement Spacers and Its Influencing Factors
by Bernd Fink and Kevin D. Tetsworth
Antibiotics 2025, 14(7), 705; https://doi.org/10.3390/antibiotics14070705 - 14 Jul 2025
Cited by 10 | Viewed by 5052
Abstract
Antibiotic-loaded cement spacers play a crucial role in two-stage revision arthroplasty of infected total hip and knee prostheses. There is still controversy regarding whether the elution from antibiotic-loaded cement spacers is greater than the MIC for a prolonged time between stages. Therefore, the [...] Read more.
Antibiotic-loaded cement spacers play a crucial role in two-stage revision arthroplasty of infected total hip and knee prostheses. There is still controversy regarding whether the elution from antibiotic-loaded cement spacers is greater than the MIC for a prolonged time between stages. Therefore, the aim of the current review was to determine how long spacers elute antibiotics above the MIC for most causative microorganisms, as well as to evaluate what factors influence that elution. Independent of methodological differences and weaknesses of the studies themselves, several study results indicate that after an early peak of antibiotic release from the spacer in the first 1 to 2 days (followed by a gradual decline), a sufficient release above the MIC for most causative bacteria continues for 6 to 12 weeks. Full article
(This article belongs to the Special Issue Diagnostics, Antibiotic Usage and Surgery Related Techniques in Prevention and Treatment of Prosthetic Joint and Implant Related Infections)

Other

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9 pages, 216 KB  
Case Report
Use of Aztreonam–Avibactam with Rapid Eravacycline Step-Down Therapy for a Tibial Septic Non-Union by NDM-Producing Enterobacter cloacae
by Jacob M. Keck, Ryan K. Dare, Michael Saccente, Keyur S. Vyas and Rebekah N. Thompson
Antibiotics 2025, 14(11), 1109; https://doi.org/10.3390/antibiotics14111109 - 4 Nov 2025
Viewed by 1692
Abstract
New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales represent a major therapeutic challenge due to their resistance to nearly all β-lactams and frequent co-resistance to other antibiotic classes, leaving clinicians with few effective options. These challenges are amplified in orthopedic infections with hardware involvement, where biofilm [...] Read more.
New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales represent a major therapeutic challenge due to their resistance to nearly all β-lactams and frequent co-resistance to other antibiotic classes, leaving clinicians with few effective options. These challenges are amplified in orthopedic infections with hardware involvement, where biofilm formation and the need for prolonged antimicrobial therapy limit success. We describe a 55-year-old female with a history of right type 3 open pilon fracture complicated by hardware failure and revision, who presented with septic tibial nonunion and chronic drainage. During this admission, she underwent irrigation and debridement with hardware removal and intramedullary nail placement. Cultures grew Enterobacter cloacae complex resistant to meropenem, ceftazidime–avibactam, meropenem–vaborbactam, and cefiderocol, as well as Candida parapsilosis. Molecular testing confirmed NDM production, while reference testing showed susceptibility to aztreonam–avibactam (ATM-AVI). The patient was treated with ATM-AVI plus micafungin, achieving clinical stability within three days. Due to outpatient administration barriers with ATM-AVI, the patient was transitioned to eravacycline and micafungin. At eight-week follow-up, the patient remained clinically improved without relapse or adverse effects. This case highlights ATM-AVI as a critical therapy for NDM-producing orthopedic infections involving hardware and supports eravacycline as a feasible step-down option in outpatient management. Full article
(This article belongs to the Special Issue Diagnostics, Antibiotic Usage and Surgery Related Techniques in Prevention and Treatment of Prosthetic Joint and Implant Related Infections)
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