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Microorganisms
Special Issues
Challenges of Biofilm-Associated Bone and Joint Infections
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Challenges of Biofilm-Associated Bone and Joint Infections

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Biofilm".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 1266

Special Issue Editors

Dr. Christof Berberich

E-Mail Website
Guest Editor
JDepartment of Medical Training, Heraeus Medical GmbH, 612173 Wehrheim, Germany
Interests: bacterial biofilm
Dr. Jaime Esteban

E-Mail Website
Guest Editor
Departamento de Microbiología Clínica, Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
Interests: clinical microbiology; biofilms; mycobacteria; implant-associated infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The incidence of bone and joint infections is increasing owing to factors such as ageing of the global population, higher prevalence of patient comorbidities, and growing numbers of surgical procedures with the incorporation of foreign materials. However, appropriate diagnosis and treatment remains a challenge due to the presence of biofilms on implants. Bone and joint infections include sequelae such as septic arthritis, osteomyelitis, infections after fracture repair or after endoprosthetic replacement of a joint, and spinal infections. Although guidelines and recommendations exist, solid evidence is still lacking in many aspects of the diagnostic, preventive, and therapeutic framework. This also refers to the use of local antibiotics, which have the potential advantage of delivering high concentrations directly at the infected situs while reducing the burden of long-lasting systemic antimicrobial therapy.

Interdisciplinary case discussions among orthopaedic and trauma surgeons, infectious disease specialists, microbiologists, pathologists, plastic surgeons, and other disciplines have been reported to improve the likelihood of good clinical outcomes of bone and joint infections. This not only relates to the eradication of the pathogens but also to the relief of pain and restoration of limb and joint function.

We would like to invite esteemed researchers and clinicians to contribute to this Special Issue with the objective of advancing our knowledge and expanding our perspectives on the prevention, diagnosis, and management of bone and joint infections. We also aim to capture a global perspective, since we are aware that the pathogen environment, the diagnostic algorithms, and the therapeutic options do widely differ between the countries and the continents.

Dr. Christof Berberich
Dr. Jaime Esteban
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. Microorganisms 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 2700 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

  • diagnostics
  • prevention
  • antibiotic

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Published Papers (3 papers)

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Research

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9 pages, 224 KiB  
Communication
Clinical Outcome of Patients with Acute Periprosthetic Joint Infections Caused by Pseudomonas aeruginosa Compared to Other Gram-Negative Bacilli
by Wai-Yan Liu, Johannes G. E. Hendriks, Robin W. T. M. van Kempen, Walter van der Weegen, Wim H. C. Rijnen, Jon H. M. Goosen, Babette C. van der Zwaard, Yvette Pronk, Wierd P. Zijlstra, Bas L. E. F. ten Have, Joris J. W. Ploegmakers and Marjan Wouthuyzen-Bakker
Microorganisms 2025, 13(4), 904; https://doi.org/10.3390/microorganisms13040904 - 14 Apr 2025
Viewed by 249
Abstract
Pseudomonas aeruginosa is considered as more difficult to treat than other Gram-negatives in patients with acute periprosthetic joint infections (PJIs). However, clinical data to support this hypothesis are lacking. This retrospective multicenter cohort study included 39 patients with acute PJIs caused by P. [...] Read more.
Pseudomonas aeruginosa is considered as more difficult to treat than other Gram-negatives in patients with acute periprosthetic joint infections (PJIs). However, clinical data to support this hypothesis are lacking. This retrospective multicenter cohort study included 39 patients with acute PJIs caused by P. aeruginosa and 84 control patients with another Gram-negative bacillus (i.e., Enterobacterales). Both groups were managed by surgical debridement, antibiotics, and implant retention (DAIR). Treatment failure within one-year follow-up was defined as prosthesis extraction, a clinical need for suppressive antibiotic treatment and/or PJI-related death. Distribution of affected joints, and revision versus primary arthroplasties, did not differ between groups. Most PJIs were polymicrobial (87% in cases, 81% in control patients, p = 0.451). Surgical and antibiotic management was similar between groups. Treatment failure did not differ between groups: 5/39 cases (12.8%) and 14/84 control patients (16.7%, p = 0.610). An acceptable success rate of acute PJI caused by P. aeruginosa when treated with DAIR was observed. This success rate did not differ compared to PJIs caused by Enterobacterales. Therefore, P. aeruginosa should not be considered a more difficult to treat microorganism compared to other Gram-negatives. No additional surgical or antimicrobial interventions are needed when patients can be treated with a fluoroquinolone. Full article
(This article belongs to the Special Issue Challenges of Biofilm-Associated Bone and Joint Infections)
13 pages, 977 KiB  
Article
Saponin Improves Recovery of Bacteria from Orthopaedic Implants for Enhanced Diagnosis Ex Vivo
by Tiziano Angelo Schweizer, Adrian Egli, Philipp P. Bosshard and Yvonne Achermann
Microorganisms 2025, 13(4), 836; https://doi.org/10.3390/microorganisms13040836 - 7 Apr 2025
Viewed by 308
Abstract
Biofilm formation on orthopedic joint implants complicates diagnosis of periprosthetic joint infections (PJIs). Sonication of explanted orthopedic implants for diagnostic enhances pathogen detection, but it shows limitations in sensitivity and handling. We investigated whether the biosurfactant saponin could improve bacterial recovery from orthopaedic [...] Read more.
Biofilm formation on orthopedic joint implants complicates diagnosis of periprosthetic joint infections (PJIs). Sonication of explanted orthopedic implants for diagnostic enhances pathogen detection, but it shows limitations in sensitivity and handling. We investigated whether the biosurfactant saponin could improve bacterial recovery from orthopaedic implants and thereby enhance infection diagnosis ex vivo. Orthopaedic material discs of 1 cm diameter were contaminated with different clinical bacterial PJI isolates. Biofilms of Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, Cutibacterium avidum, and Cutibacterium acnes were grown on the discs, which were then treated with either saline solution or various concentrations of saponin. Next, the discs were vortexed or sonicated. Colony-forming units (CFUs) enumeration and time-to-positivity of liquid cultures were determined. Additionally, a novel 3D PJI soft tissue in vitro model was established to validate these findings in a more representative scenario. Median CFU enumeration showed that 0.001% (w/v) saponin as compared to saline solution increased CFUs recovery by 2.2 log10 for S. epidermidis, 0.6 log10 for S. aureus, 0.6 log10 for C. avidum, 1.1 log10 for C. acnes, and 0.01 log10 for E. coli. Furthermore, saponin treatment resulted in a >1 log10 increase in S. epidermidis CFU recovery from implants in the 3D tissue model compared to standard saline sonication. With that, we propose a novel two-component kit, consisting of a saponin solution and a specialized transportation box, for the efficient collection, transportation, and processing of potentially infected implants. Our data suggest that biosurfactants can enhance bacterial recovery from artificially contaminated orthopedic implants, potentially improving the diagnosis of PJIs. Full article
(This article belongs to the Special Issue Challenges of Biofilm-Associated Bone and Joint Infections)
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Review

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28 pages, 400 KiB  
Review
Emerging Concepts for the Treatment of Biofilm-Associated Bone and Joint Infections with IV Fosfomycin: A Literature Review
by Sara Tedeschi, Efthymia Giannitsioti and Christian Mayer
Microorganisms 2025, 13(5), 963; https://doi.org/10.3390/microorganisms13050963 - 23 Apr 2025
Viewed by 288
Abstract
Due to the involvement of biofilms in the pathogenesis of bone and joint infections (BJI), the treatment of these infections is often challenging, especially when multidrug- or extensively drug-resistant (MDR/XDR) pathogens are involved. Intravenous fosfomycin (FOS) is a phosphoenolpyruvate analogue with a unique [...] Read more.
Due to the involvement of biofilms in the pathogenesis of bone and joint infections (BJI), the treatment of these infections is often challenging, especially when multidrug- or extensively drug-resistant (MDR/XDR) pathogens are involved. Intravenous fosfomycin (FOS) is a phosphoenolpyruvate analogue with a unique mode of action and broad-spectrum activity against both Gram-positive (GP) and Gram-negative (GN) pathogens. It is used in various severe and deep-seated infections, including BJIs. This review article focuses on preclinical and clinical data surrounding the use of FOS for biofilm-related BJIs. Data from several in vitro and animal models of infection demonstrated that FOS, especially in combination with other antibiotics, is effective against biofilms of (methicillin-resistant) Staphylococcus spp., (vancomycin-resistant) Enterococcus spp., carbapenem-resistant and extended-spectrum beta-lactamase-producing Enterobacterales, and MDR Pseudomonas aeruginosa. Data from clinical studies, mostly retrospective observational studies and case reports/case series, revealed that FOS was typically used in combination with other antibiotics for the treatment of various BJI, including acute and chronic osteomyelitis, prosthetic joint infections, and fracture-related infections, in adult and pediatric patients. Success rates often exceeded 80%. FOS exhibits good and fast penetration into bone tissue and is generally well tolerated, with only a few adverse drug reactions, such as gastrointestinal disorders and electrolyte imbalances. Collectively, the data indicate that FOS is a valuable option as part of combination regimens for the treatment of BJIs caused by both GP and GN bacteria. Full article
(This article belongs to the Special Issue Challenges of Biofilm-Associated Bone and Joint Infections)
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