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Osteoarticular Infections: New Challenges and Current Concepts in Antibiotic Therapy
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Osteoarticular Infections: New Challenges and Current Concepts in Antibiotic Therapy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (25 January 2025) | Viewed by 9807

Special Issue Editors

Dr. Andreas G. Tsantes

E-Mail Website
Guest Editor
1. Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece
2. Department of Microbiology, 'Saint Savvas' Oncology Hospital, 11635 Athens, Greece
Interests: clinical microbiology; infectious diseases; antimicrobial resistance; laboratory medicine; laboratory hematology; transfusion medicine; hemostasis; thrombosis; biostatistics
Special Issues, Collections and Topics in MDPI journals
Dr. Dimitrios V. Papadopoulos

E-Mail Website
Guest Editor
Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, Athens, Greece
Interests: orthopedics; musculoskeletal infections; hand surgery; musculoskeletal trauma; spine diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Christos Koutserimpas

E-Mail Website
Guest Editor
1. Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Athens, Greece
2. Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
Interests: orthopaedics; joint reconstruction surgery; musculoskeletal infections; periprosthetic joint infections; revision arthroplasty; traumatology; hip and knee reconstruction
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The management of osteoarticular infections poses a challenge in clinical practice, and a multidisciplinary approach must be taken by microbiologists, infectious disease specialists, and orthopaedic surgeons for their successful eradication. The rising number of multiresistant pathogens over the past decade is especially worrisome, calling for new diagnostic and treatment strategies. During the COVID-19 pandemic, the problem of multiresistant pathogens worsened as antimicrobial stewardship was challenging during these years, and use of broad-spectrum antibiotics, without clear indications in many cases, significantly increased. Moreover, the long duration of antibiotic therapy that is recommended in many osteoarticular infections has also contributed to the emergence of antibiotic resistance, especially in patients with osteoarticular infections.

This Special Issue focuses on the antibiotic management of osteomyelitis, spondylodiscitis, septic arthritis, and periprosthetic infections in paediatric patients, adults, and immunocompromised patients such as cancer patients. Specifically, our goal is to shed light on certain aspects of antibiotic management, such as the optimal antibiotic regime, the ideal route of administration, and the recommended duration of antibiotic therapy for patients with osteoarticular infections. Moreover, recent advances, including newer antibiotics with optimal pharmacokinetics for osseous administration, will be discussed, and the efficacy of these new antibiotics will be evaluated through clinical studies. The microbiology of osteoarticular infections also varies between countries and populations; therefore, differences in antibiotic regimes based on geography must be evaluated through robust clinical research. This issue will include studies that employ experimental models of osteomyelitis in order to assess the in vivo and in vitro efficacy of newer antibiotics. Original research articles, reviews, and case reports are welcome.

You may choose our Joint Special Issue in Antibiotics.

Dr. Andreas G. Tsantes
Dr. Dimitrios V. Papadopoulos
Dr. Christos Koutserimpas
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 100 words) can be sent to the Editorial Office for announcement on this website.

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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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

  • ostoarticular infections
  • osteomyelitis
  • septic arthritis
  • periprosthetic infections
  • antibiotics
  • therapy

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Published Papers (4 papers)

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Review

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14 pages, 292 KiB  
Review
Prevention and Management of Postoperative Infection After Anterior Cruciate Ligament Reconstruction: A Narrative Review
by Efstathios Konstantinou, Thomas Pfeiffer, Michael S. Rocca, Camila Grandberg, Karina Dias and Volker Musahl
J. Clin. Med. 2025, 14(2), 336; https://doi.org/10.3390/jcm14020336 - 8 Jan 2025
Viewed by 1550
Abstract
Background: Postoperative infection following anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication that can compromise patient outcomes, leading to prolonged recovery, graft failure, and knee dysfunction. Although infection rates are reported to be less than 2%, it remains essential [...] Read more.
Background: Postoperative infection following anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication that can compromise patient outcomes, leading to prolonged recovery, graft failure, and knee dysfunction. Although infection rates are reported to be less than 2%, it remains essential to implement strategies to reduce infection risk and improve surgical outcomes. Methods: This review explores current evidence on the prevention of infections in ACLR, emphasizing the importance of timely antibiotic prophylaxis and vancomycin presoaking of grafts, which has been associated with a substantial reduction in infection rates. Results: Empirical antibiotic therapy should be started immediately after joint aspiration when infection is suspected. Treatment must prioritize culture-specific antibiotic regimens to optimize patient outcomes. Surgical intervention with arthroscopic debridement and irrigation needs to occur as soon as the diagnosis of infection is made. Often, this is performed with a focus on retaining the graft in order to preserve knee stability, if possible. Careful intraoperative management, along with the aid of infectious disease specialists, is paramount to help optimize outcomes following infection after ACLR. Conclusions: This review emphasizes the need for treatment protocols and highlights areas for future research to establish clear guidelines on infection after ACLR, especially with decisions of graft retention versus removal. Full article
(This article belongs to the Special Issue Osteoarticular Infections: New Challenges and Current Concepts in Antibiotic Therapy)
16 pages, 954 KiB  
Review
Culture-Negative Native Vertebral Osteomyelitis: A Narrative Review of an Underdescribed Condition
by Seyed Mohammad Amin Alavi, Francesco Petri, Omar K. Mahmoud, Rita Igwilo-Alaneme, Said El Zein, Ahmad N. Nassr, Andrea Gori and Elie F. Berbari
J. Clin. Med. 2024, 13(19), 5802; https://doi.org/10.3390/jcm13195802 - 28 Sep 2024
Cited by 3 | Viewed by 2586
Abstract
The incidence of culture-negative NVO (CN-NVO) cases is increasing, presenting significant diagnostic and therapeutic challenges due to the inability to isolate causative organisms with conventional microbiological methods. Factors influencing the diagnosis of CN-NVO include prior antimicrobial therapy, low pathogen burden, fastidious or intracellular [...] Read more.
The incidence of culture-negative NVO (CN-NVO) cases is increasing, presenting significant diagnostic and therapeutic challenges due to the inability to isolate causative organisms with conventional microbiological methods. Factors influencing the diagnosis of CN-NVO include prior antimicrobial therapy, low pathogen burden, fastidious or intracellular organisms, technical issues, and non-infectious mimickers. Diagnosis often relies on imaging modalities like magnetic resonance imaging (MRI) and computed tomography (CT)-guided biopsy, though these methods can sometimes fail to yield positive microbiological results. Advanced diagnostic tools, such as polymerase chain reaction (PCR), metagenomic next-generation sequencing (mNGS), and cell-free DNA analysis, may be necessary to identify the pathogen. The causative pathogen cannot be isolated in some patients, among which an empirical antimicrobial therapy should be initiated. This narrative review discusses the management, monitoring, surgical indications, and outcomes for patients with CN-NVO. Full article
(This article belongs to the Special Issue Osteoarticular Infections: New Challenges and Current Concepts in Antibiotic Therapy)
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13 pages, 3438 KiB  
Review
Post-Discectomy Infection: A Critical Review and Suggestion of a Management Algorithm
by Constantinos Chaniotakis, Christos Koutserimpas, Andreas G. Tsantes, Dimitrios V. Papadopoulos, Christothea-Alexandra Tsiridis, Apostolos Karantanas, Kalliopi Alpantaki and Alexander Hadjipavlou
J. Clin. Med. 2024, 13(5), 1478; https://doi.org/10.3390/jcm13051478 - 4 Mar 2024
Cited by 2 | Viewed by 3866
Abstract
Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the [...] Read more.
Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the addition of non-instrumented fusion to 2.4% to 6.2%. It remains controversial whether POD is caused by an aseptic or infectious process. Positive cultures are presented only in 42–73% of patients with Staphylococcus species being the most common invading organisms, while Staphylococcus aureus is isolated in almost 50% of cases. The onset of POD symptoms usually occurs at 2–4 weeks after an apparently uneventful operation. Back pain and muscle spasms are usually refractory to bed rest and analgesics. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging diagnostic technique. Antimicrobial therapy depends on the results of tissue cultures, and along with bracing represents the mainstay of management. Surgical intervention is necessary in patients failing conservative treatment. For the majority of cases, extensive surgical debridement, antibiotic therapy, and orthosis immobilization are effective in eliminating the infection. According to this, we recommend an Algorithmic approach for the management of POD. Postoperative infections after spinal surgery pose a certain clinical challenge, and in most cases can be treated conservatively. Nevertheless, disability may be persistent, and surgery could be necessary. The purpose of this concise review is to describe the manifestation of post-discectomy infection, its pathogenesis and particularly a rational approach for its management. Full article
(This article belongs to the Special Issue Osteoarticular Infections: New Challenges and Current Concepts in Antibiotic Therapy)
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12 pages, 889 KiB  
Systematic Review
Prevalence of Osteosynthesis Hardware Removal Due to Surgical Site Infections Following Sagittal Split Osteotomy: A Systematic Review and Meta-Analysis
by Maria Kantzanou, Evangelos Kostares, Vasiliki Koumaki, Georgia Kostare, Michael Kostares and Athanasios Tsakris
J. Clin. Med. 2025, 14(10), 3558; https://doi.org/10.3390/jcm14103558 - 19 May 2025
Abstract
Background/Objectives: Sagittal split ramus osteotomy (SSRO) is a commonly performed procedure in orthognathic surgery. Despite its effectiveness, surgical site infections (SSI) represent a significant postoperative complication, often necessitating the removal of osteosynthesis materials. This study aims to quantify the prevalence of hardware removal [...] Read more.
Background/Objectives: Sagittal split ramus osteotomy (SSRO) is a commonly performed procedure in orthognathic surgery. Despite its effectiveness, surgical site infections (SSI) represent a significant postoperative complication, often necessitating the removal of osteosynthesis materials. This study aims to quantify the prevalence of hardware removal due to SSI following SSRO highlighting its impact on clinical outcomes. Methods: A systematic review and meta-analysis were conducted according to the PRISMA statement. Databases including Medline/PMC Central, Scopus, and Web of Science were searched up until 27 December 2024. Observational studies reporting osteosynthesis material removal due to SSI after SSRO were included. Data were extracted and analyzed using a random-effects model, calculating pooled prevalence and 95% confidence intervals (CI). Meta-regression was performed to explore potential predictors. Results: Twenty-nine studies published between 1992 and 2024 were included, encompassing 4489 patients. The pooled prevalence of osteosynthesis material removal due to SSI was 1.9% (95% CI: 0.7–3.4%), with substantial heterogeneity (I2 = 87%). Meta-regression demonstrated that the mean age of patients was significantly associated with the prevalence of osteosynthesis hardware removal due to SSI. On the other hand, no significant association was demonstrated between the year of publication, the proportion of males, or the mean age with the prevalence of removal. Conclusions: SSI following SSRO clearly impacts patient outcomes and healthcare resources, while removal of osteosynthesis materials is often required. The substantial heterogeneity among studies included in the present systematic review may point to variability in patient characteristics, surgical techniques, and healthcare practices. The present findings underscore the importance of standardized prevention protocols and targeted management strategies. Future research should focus on understanding microbial profiles, patient-specific risk factors, and innovative surgical approaches to minimize SSI risks and improve patient outcomes. Full article
(This article belongs to the Special Issue Osteoarticular Infections: New Challenges and Current Concepts in Antibiotic Therapy)
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