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Diagnostics and Antibiotic Therapy in Bone and Joint Infections

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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 July 2026 | Viewed by 5499

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Special Issue Editors

Dr. Sebastian Meller

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Guest Editor

Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany
Interests: periprosthetic joint infection (pji); revision arthroplasty; local antibiotic carriers; one-stage and two-stage exchange; biofilm and implant-associated infection; musculoskeletal infection; hip surgery; knee surgery

Dr. Stavros Goumenos

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Guest Editor

Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany
Interests: Bone and joint infections (BJI); arthroplasty; osteomyelitis; immune responses to BJI; antibiotics

Special Issue Information

Dear Colleagues,

We are pleased to announce the forthcoming Special Issue of Antibiotics, titled “Diagnostics and Antibiotic Therapy in Bone and Joint Infections”.

Bone and joint infections represent a complex clinical challenge, often requiring timely diagnosis and multidisciplinary management to ensure optimal clinical and functional outcomes. Despite advances in imaging, microbiology, surgical techniques, and antimicrobial stewardship, significant gaps remain in our understanding and standardization of diagnostic and therapeutic approaches.

This Special Issue aims to bring together high-quality original research (clinical or experimental) and comprehensive reviews that explore current trends, innovative diagnostic tools, surgical strategies, and evolving antibiotic regimens in the management of osteomyelitis, implant-related infections, and other musculoskeletal infections.

We warmly invite researchers, clinicians, microbiologists, and infectious disease specialists to contribute their relevant work to this issue. Submissions addressing novel biomarkers, rapid diagnostic techniques, biofilm-related challenges, antibiotic resistance, the use of new local antimicrobial carriers, and alternative treatment algorithms for bone and joint infections are particularly encouraged.

We look forward to hearing from you.

Dr. Sebastian Meller
Dr. Stavros Goumenos
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

bone and joint infections
osteomyelitis
implant-related infections
diagnostics
antimicrobials
antibiotic therapy
PJI management
surgical site antisepsis
local antibiotic therapy
diagnostic biomarkers
multidisciplinary infection management
outcome analysis after musculoskeletal infection

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Published Papers (6 papers)

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Research

13 pages, 448 KB

Open AccessArticle

Evaluation of Intravenous Administration of Anti-Infective Agents and Documentation Quality in Orthopedics and Trauma Surgery: A Quantitative Study on Discrepancies Between Physician Prescriptions and Nursing Records

by Anna-Judith Dahse, Laura Klimpel, Katrin Heinitz, Martina P. Neininger, Christoph Lübbert, Annett Huke, Christian Kleber, Andreas Roth, Christina Pempe, Dmitry Notov, Pierre Hepp, Christoph-Eckhard Heyde, Thilo Bertsche and Yvonne Remane

Antibiotics 2026, 15(4), 341; https://doi.org/10.3390/antibiotics15040341 - 27 Mar 2026

Viewed by 556

Abstract

Background: Intravenous anti-infectives are an important part of postoperative care, but discrepancies between prescribed and documented administrations remain widespread and require systematic evaluation. Methods: In an exploratory study, prescribed and documented intravenous anti-infective administrations were retrospectively analyzed using patient charts, digital nursing reports and, in cases of deviations, consultations with the responsible staff. The discrepancies were classified into three categories: (I) documentation, (II) administration, and (III) a combination of both. The relationship between discrepancies and dosing interval, time of administration (weekday and shift assignment), and intravenous administration route was statistically analyzed (Χ² test, residual analysis). Results: Of 5016 anti-infective administrations in 219 patients, 1135 (22.6%) had at least one discrepancy, of which 68.2% (774 of 1135) belonged to category I. Significant differences in the frequency of discrepancies between surgical wards and the dosing intervals were observed. On weekdays, 23.6% of drug administrations (832 of 3519) showed discrepancies compared to 20.2% on weekends (303 of 1497, OR = 1.22, 95% CI 1.05–1.42, p = 0.008). Although the early shift had the lowest administration rate, it showed significantly more discrepancies than expected (313.6 expected vs. 553 observed; adjusted standardized residual +18.1; p < 0.001). Drug administration via the peripheral venous route was more susceptible to discrepancies than the central venous administration route (23.2% [963 of 4149] vs. 19.8% [172 of 867]), OR 1.18; 95% CI 1.01–1.38; p = 0.031). Conclusions: Approximately a quarter of anti-infective administrations were affected by discrepancies, predominantly in category I, with the highest incidences occurring during the early shift and on weekdays. This requires a multi-step improvement program. Full article

(This article belongs to the Special Issue Diagnostics and Antibiotic Therapy in Bone and Joint Infections)

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11 pages, 859 KB

Open AccessArticle

Diagnostic Utility of Synovial Cell Count Prior to Revision Compared to Re-Revision Arthroplasty

by Jennifer Straub, Paul M. Schwarz, Laurenz Willmann, Joachim Ortmayr, Kevin Staats, Irene K. Sigmund, Reinhard Windhager and Christoph Böhler

Antibiotics 2026, 15(2), 143; https://doi.org/10.3390/antibiotics15020143 - 1 Feb 2026

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Abstract

Background/Objectives: The aim of this study is to investigate how the joint, the number and the type of prior revision surgeries influence the diagnostic thresholds for synovial cell count for patients who undergo their first total hip or knee arthroplasty revision compared to re-revisions, as different cutoffs might substantially influence treatment courses. Methods: In this retrospective single-center register analysis, data from 214 revised THAs (total hip arthroplasties) and TKAs (total knee arthroplasties) were collected, of which 103 (48.1%) have so far undergone at least one revision surgery. Diagnosis was based on the EBJIS criteria, and we identified 163 (76.2%) septic and 51 (23.8%) aseptic cases. Data on synovial cell count were collected and analyzed for their diagnostic accuracy and optimal cutoffs. For re-revisions, a covariate-adjusted ROC (receiver operating characteristic) for the joint, type of previous surgery and number of surgeries was created. Results: We found no significant differences in cell counts between patients before first revision compared to those undergoing re-revision for septic (p = 0.40) and aseptic indications (p = 0.84). The overall diagnostic accuracy was high for all re-revision cases, with a sensitivity of 0.86, specificity of 0.91, AUC (area under the curve) of 0.92, at an optimal cutoff value of 2439.50 G/L. As for re-revised hip joints, the optimal cutoffs were higher compared to knee joints (2439.5 G/L vs. 2626.5 G/L, hip AUC = 0.90, knee AUC = 0.93, p = 0.14). Furthermore, the AUCs for cell count differed significantly depending on the type of previous surgery in re-revision (p = 0.03). The covariate-adjusted analysis showed no significant differences compared to the unadjusted analysis. Conclusions: Cell count remains reliable for diagnosing periprosthetic joint infection in patients with prior revisions, with minor threshold variations from the EBJIS (European Bone and Joint Infection Society) criteria. While the type of preceding revision affects accuracy, the diagnostic value remains consistently high overall. Full article

(This article belongs to the Special Issue Diagnostics and Antibiotic Therapy in Bone and Joint Infections)

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11 pages, 677 KB

Open AccessArticle

The Significance of Sonication in the Detection of Peri-Implant Infections

by Christian Prangenberg, Alberto Alfieri Zellner, Jonas Roos, Lisa Fiona Roder, Soufian Ben Amar, Kristian Welle, Frank Sebastian Fröschen and Gunnar Thorben Rembert Hischebeth

Antibiotics 2026, 15(1), 35; https://doi.org/10.3390/antibiotics15010035 - 1 Jan 2026

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Abstract

Objective: The current gold standard for detection of implant-related infections is the intraoperative collection of tissue samples. However, false-negative results frequently occur, particularly in infections caused by biofilm-forming bacteria. As a complementary method, sonication has therefore been established for detecting implant-associated infections, especially in periprosthetic joint infections. In trauma surgery, this technique is still rarely used. The aim of this study is to evaluate the diagnostic significance of sonication after osteosynthesis. Methods: A retrospective single-center analysis was conducted on all patients who underwent plate osteosynthesis removal between 1 January 2019, and 1 May 2021, with both sonication and intraoperative tissue sampling performed. Patients with inlying arthroplasties or nail-less osteosynthesis systems were excluded. Pre- and postoperative infection parameters (leukocytes, CRP) were recorded, and preoperative clinical findings were used to classify suspected infection. Results: A total of 57 patients (30 men, 27 women; mean age 57.6 years, range 12–91) were included. The mean treatment duration was 20.1 days (range 1–152). Sonication was positive in 33 patients, tissue samples in 28, with 31 cases (54%) showing concordant results. In cases with preoperative suspicion of infection, sonication was positive in 21 of 26 cases (80.7%) and tissue samples in 18 of 26 (69.2%), whereas without suspicion, positivity rates were 38% and 31%, respectively. Sonication and tissue results matched in 14 of 26 cases; in the remainder, results were different or incomplete. Preoperative CRP elevation and the presence of an infection membrane influenced sensitivity: sonication generally detected more bacteria (59–81%) than tissue samples (49–73%), though discrepancies remained. Conclusions: Sonication represents a valuable complementary method for detecting implant-related infections. Due to its high sensitivity but limited specificity, it should not be used as a standalone diagnostic method. Full article

(This article belongs to the Special Issue Diagnostics and Antibiotic Therapy in Bone and Joint Infections)

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13 pages, 258 KB

Open AccessArticle

AI-Generated Antibiotic Therapies for Acute Periprosthetic Joint Infections with Implant Retention in Comparison with an Interdisciplinary Team

by Alberto Alfieri Zellner, Tamaradoubra Tippa Tuburu, Alexander Franz, Jonas Roos, Frank Sebastian Fröschen and Gunnar Thorben Rembert Hischebeth

Antibiotics 2026, 15(1), 25; https://doi.org/10.3390/antibiotics15010025 - 29 Dec 2025

Cited by 1 | Viewed by 889

Abstract

Background: Periprosthetic joint infections (PJI) represent a serious complication following joint arthroplasty and require, in addition to surgical intervention, a targeted antibiotic therapy. The aim of this study was to compare microbiological recommendations for the antibiotic treatment of fictitious PJI patients generated by an artificial intelligence (AI) system with those of an interdisciplinary team (IT) consisting of microbiologists and orthopedic surgeons. The differences between the recommendations suggested by AI and the IT were analyzed with regard to the suggested agents and duration of antibiotic therapy. Methods: Based on meta-analyses, a cohort of 100 fictitious patients with acute early- and acute late-onset PJI was created, reflecting the typical demographic data, comorbidities and pathogen profiles of such a population. This information was input into the AI system ChatGPT (OpenAI, GPT-5 “Thinking mode” accessed via ChatGPT Plus, San Francisco, CA, USA) to generate corresponding recommendations. The objective was to use these profiles to obtain recommendations for definitive antibiotic therapy, including daily dosage, intravenous and oral treatment durations. Simultaneously, the same fictitious patient data were reviewed by the IT to produce their own recommendations. Results: The results revealed both concordances and discrepancies in the selection of antibiotics. Notably, in cases involving multidrug-resistant organisms and more complex clinical scenarios, the AI-generated recommendations were incongruent with those of the IT, with estimated percentage agreement ranging from 0–33%. In straightforward clinical scenarios with monomicrobial infections, AI reached an estimated percentage agreement of up to 57% (95%-CI [0.47–0.67]). Furthermore, AI consistently recommended 12 weeks of therapy duration vs. six weeks usually recommended by the IT. Conclusions: The study provides important insights into the potential and limitations of AI-assisted decision-making models in orthopedic infection treatments. Consultation of AI is universally accessible at all times of day, which may offer a significant advantage in the future for the treatment of PJI. This kind of application will be of particular interest for institutions without in-house microbiology services. However, from our perspective, the current level of incongruence between the AI-generated recommendations and those of an experienced interdisciplinary team remains too high for this approach to be clinically implemented at this time. Furthermore, AI lacks transparency regarding the sources it uses to inform about its decision-making and therapeutic recommendations, currently carries no legal weight and clinical implementation is severely hindered by restrictive privacy laws regarding health care data. Full article

(This article belongs to the Special Issue Diagnostics and Antibiotic Therapy in Bone and Joint Infections)

15 pages, 1753 KB

Open AccessArticle

Exploring the Value of Paired Microbiology and Histology in Chronic Osteomyelitis and Fracture-Related Infections

by Anton A. N. Peterlin, Martin McNally, Nicole L. Henriksen, Sophie A. Blirup-Plum, Ann Jørgensen, Andreas Ibrahim Jørgensen, Inger Brock, Hans Gottlieb and Louise K. Jensen

Antibiotics 2025, 14(12), 1277; https://doi.org/10.3390/antibiotics14121277 - 16 Dec 2025

Cited by 2 | Viewed by 953

Abstract

Background: Microbiological culture and histology are gold standards for diagnosing chronic osteomyelitis (cOM) and fracture-related infection (FRI). This study investigated whether combining these modalities within a single tissue sample provides additional insight into disease severity. We hypothesized that high neutrophil and osteoclast numbers correlate with culture-positive microbiology and that double-positive samples may indicate more severe disease. Methods: In this prospective single-centre study, adults undergoing surgery for confirmed FRI or cOM were included. Clinical and disease classification data (FRI and BACH) were recorded. Five deep-tissue samples were collected intraoperatively and divided for paired microbiological culture and histological assessment of neutrophil infiltration, according to international diagnostic guidelines. Results: Forty-one patients were included (11 cOM, 30 FRI) of whom 68% received preoperative antibiotics. Nineteen patients (46%) were identified as culture-positive, while 32 patients (78%) were histologically positive according to international diagnostic guidelines, respectively. Among the 205 samples, 31% were culture-positive, 56% histology-positive, and 26% double-positive. Histological scores were significantly higher in culture-positive samples (p < 0.001). Treatment failure occurred in seven patients (18%), all with FRI. Paired positive samples were associated with increased odds of clinical failure and earlier revision, with odds increasing 1.68-fold for each additional paired positive sample (95% CI, 1.10–2.77). Conclusions: The paired analysis demonstrated a strong concordance between culture-positivity and suppurative inflammation within the same sample. Combining microbiology and histology may help identify patients at increased risk of revision and enhance diagnostic certainty, particularly in patients identified as culture-negative. Full article

(This article belongs to the Special Issue Diagnostics and Antibiotic Therapy in Bone and Joint Infections)

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12 pages, 483 KB

Open AccessArticle

Local Vancomycin Application Reduces Periprosthetic Joint Infections in Oncologic Megaprosthetic Reconstruction: A Retrospective Cohort Study

by Andreas G. Tsantes, Dimitrios V. Papadopoulos, Stavros Goumenos, Petros Ioannou, Nikolaos Stavropoulos, Eleni Petrou, Ioannis G. Trikoupis, Christos Koutserimpas, Alexandra Mpakosi, Vasileios A. Kontogeorgakos, Stefanos Bonovas, Panayiotis J. Papagelopoulos, Athanasios Tsakris and Argirios E. Tsantes

Antibiotics 2025, 14(9), 952; https://doi.org/10.3390/antibiotics14090952 - 19 Sep 2025

Cited by 1 | Viewed by 1258

Abstract

Background/Objectives: Periprosthetic joint infections (PJIs) represent a serious complication following musculoskeletal tumor resection and megaprosthetic reconstruction. Local antibiotic administration may reduce infection risk by achieving high local drug concentrations. The aim of this study was to evaluate whether local vancomycin powder reduces postoperative periprosthetic infections in bone tumor surgeries involving megaprostheses. Methods: This retrospective cohort study included 276 patients who underwent bone tumor resection and megaprosthetic reconstruction. Study subjects were divided into two groups: the control group (n = 142) that received standard perioperative intravenous antibiotics, and the vancomycin group (n = 134) that received an additional 1 g of vancomycin powder locally at wound closure. Periprosthetic joint infections were defined using the 2018 International Consensus Meeting (ICM) criteria and monitored for 2 years. A multivariable competing risks regression model was used to assess the independent effect of local vancomycin on infection risk. Results: Periprosthetic joint infections occurred in 28 patients in the control group (19.7%) vs. eight patients in the vancomycin group (5.9%, p = 0.001). The most frequently isolated pathogens were coagulase-negative staphylococci (52.7%), followed by Staphylococcus aureus (22.2%). Among infected patients in the vancomycin group, only two had Gram-positive infections, suggesting efficacy against staphylococcal PJIs. The multivariable regression confirmed a significantly lower risk of infection in the vancomycin group (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.16–0.95, p = 0.040), while pelvic tumors were associated with a higher infection risk (HR: 5.82, p < 0.001). Conclusions: Our results indicate that local vancomycin may reduce periprosthetic infection rates in oncologic megaprosthetic reconstruction without added complications. Randomized studies are warranted to confirm these findings and refine dosing strategies. Full article

(This article belongs to the Special Issue Diagnostics and Antibiotic Therapy in Bone and Joint Infections)

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