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Pathogens
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Diagnostic Challenges in Joint Infections: From Culture to Molecular Techniques
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Diagnostic Challenges in Joint Infections: From Culture to Molecular Techniques

A special issue of Pathogens (ISSN 2076-0817).

Deadline for manuscript submissions: closed (15 December 2025) | Viewed by 1818

Special Issue Editor

Dr. Jochen Hofstaetter

E-Mail Website
Guest Editor
1. Orthopaedic Hospital Vienna Speising, Vienna, Austria
2. Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna Speising, Vienna, Austria
Interests: arthroplasty; infection
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Joint infections, particularly periprosthetic joint infections (PJIs), pose significant diagnostic challenges due to their complex aetiology and often subtle clinical presentations. Traditional culture-based methods, while foundational, are limited by their sensitivity and turnaround time. This Special Issue will explore the latest advancements in diagnostic techniques, including molecular methods such as PCR, next-generation sequencing (NGS), and mass spectrometry, which offer improved accuracy and faster results. We aim to highlight the integration of these technologies into clinical practice, addressing their potential to enhance early detection and tailored treatment strategies for joint infections.

Dr. Jochen Hofstaetter
Guest Editor

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. Pathogens 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 2200 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

  • joint infections
  • molecular diagnostics
  • periprosthetic joint infections

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Published Papers (3 papers)

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Research

21 pages, 1254 KB  
Article
Microbiological Characteristics and Clinical Outcomes of Periprosthetic Infections Following Oncologic Megaprosthetic Reconstruction: A Retrospective Cohort Study
by Vasileios Karampikas, Stavros Goumenos, Andreas G. Tsantes, Ioannis G. Trikoupis, Panayiotis Gavriil, Anastasios G. Roustemis, Alexandros Zikopoulos, Vasileios Petrakis, Dimitrios V. Papadopoulos, Petros Ioannou, Olga Savvidou, Vasileios Kontogeorgakos and Panayiotis J. Papagelopoulos
Pathogens 2026, 15(3), 306; https://doi.org/10.3390/pathogens15030306 - 11 Mar 2026
Viewed by 283
Abstract
Background: Periprosthetic joint infection (PJI) is a severe complication following megaprosthetic reconstruction in musculoskeletal oncology. This study aimed to evaluate outcomes of different surgical strategies for PJI in lower-limb megaprostheses and identify factors associated with treatment failure. Methods: We performed a retrospective cohort [...] Read more.
Background: Periprosthetic joint infection (PJI) is a severe complication following megaprosthetic reconstruction in musculoskeletal oncology. This study aimed to evaluate outcomes of different surgical strategies for PJI in lower-limb megaprostheses and identify factors associated with treatment failure. Methods: We performed a retrospective cohort study of 29 consecutive patients treated for PJI after oncologic megaprosthetic reconstruction. Reinfection was analyzed using cumulative incidence functions (CIFs) with death treated as a competing event. Overall survival was assessed using Kaplan–Meier analysis. Univariable cause-specific Cox regression was performed for exploratory risk-factor analysis. Results: Among 29 patients, coagulase-negative staphylococci and Staphylococcus aureus were the most frequently isolated pathogens, and difficult-to-treat organisms were identified in a substantial proportion of cases. In patients managed with two-stage revision, the cumulative incidence of reinfection was 15% (95% CI: 0–30%) at 1 year and 30% (95% CI: 10–50%) at 2 and 5 years. In the DAIR cohort, the cumulative incidence of reinfection was 25% (95% CI: 0–62.5%) at 1 and 2 years and 37.5% (95% CI: 12.2–75%) at 3 years. Positive reimplantation cultures occurred in 38% of cases and were strongly associated with subsequent treatment failure. Polymicrobial infections were present in 27.5% of cases. Amputation was required in 17.2% of patients, often due to multidrug-resistant organisms or poor soft tissue. Conclusions: Two-stage revision remains the most effective strategy for PJI management in megaprostheses. DAIR may control acute infection but is suboptimal for definitive treatment. Individualized, multidisciplinary approaches are essential to improve outcomes in this high-risk population. Full article
(This article belongs to the Special Issue Diagnostic Challenges in Joint Infections: From Culture to Molecular Techniques)
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12 pages, 525 KB  
Article
The Role of Positive Klebsiella Culture in Revision Hip and Knee Arthroplasty
by Vinzenz Bussek, Marion T. Tödtling, Jennyfer A. Mitterer, Veronika Achatz, Selma Tobudic and Jochen G. Hofstaetter
Pathogens 2026, 15(2), 164; https://doi.org/10.3390/pathogens15020164 - 3 Feb 2026
Viewed by 372
Abstract
Gram-negative (GN) periprosthetic joint infections (PJIs) are being increasingly reported. However, the role of Klebsiella species in PJIs remains unclear. Therefore, we aimed to analyze the prevalence, clinical presentation, microbial spectrum, antibiogram, treatment strategies and outcomes of Klebsiella-associated PJIs. A total of [...] Read more.
Gram-negative (GN) periprosthetic joint infections (PJIs) are being increasingly reported. However, the role of Klebsiella species in PJIs remains unclear. Therefore, we aimed to analyze the prevalence, clinical presentation, microbial spectrum, antibiogram, treatment strategies and outcomes of Klebsiella-associated PJIs. A total of 1925 culture-positive total joint revision arthroplasties (rTJA) were retrospectively reviewed at a single center. Patient data were extracted from our institutional arthroplasty and PJI database. We identified 20 Klebsiella-positive PJIs (hip/knee, 11/9), representing 1.0% of all culture-positive rTJAs. The cases were predominantly polymicrobial (80%) and chronic (50%). Notably, Klebsiella spp. was rarely detected as an initial infectious event but was predominantly identified in the context of revision or re-revision procedures, frequently in patients with prior or persistent PJIs. Klebsiella pneumoniae was the most frequent species, with 44% showing multi-drug resistance. The antimicrobial susceptibility of Klebsiella isolates showed high resistance to cephalosporines and penicillin, in contrast little to no resistance to meropenem, gentamicin and levofloxacin. The most common initial surgical intervention was a two-stage revision (65%). Infection control (Tier 1) was observed in 11%, while further intervention was needed in 56% (Tier 3). All patients who had already died were classified as Tier 4 (33%). Klebsiella spp. was detected in 10.0% of GN rTJAs and was mainly associated with complex revision settings rather than primary infections. It is often associated with chronic polymicrobial infections and high antimicrobial resistance. The outcomes were generally poor, highlighting the need for pathogen-specific treatment strategies and improved diagnostics. Full article
(This article belongs to the Special Issue Diagnostic Challenges in Joint Infections: From Culture to Molecular Techniques)
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8 pages, 1173 KB  
Communication
Synovial Fluid Analysis in Melioidosis: Experiences from the Darwin Prospective Melioidosis Study
by Stuart Campbell, Tze I. Lee, Robert W. Baird, Ella M. Meumann and Bart J. Currie
Pathogens 2025, 14(11), 1120; https://doi.org/10.3390/pathogens14111120 - 3 Nov 2025
Viewed by 732
Abstract
Melioidosis is a multisystem disease caused by the sapronotic soil bacterium Burkholderia pseudomallei. Septic arthritis (SA) can occur as either a primary or secondary focus and requires surgical management with prolonged antimicrobial treatment. We used the Darwin Prospective Melioidosis Study to identify [...] Read more.
Melioidosis is a multisystem disease caused by the sapronotic soil bacterium Burkholderia pseudomallei. Septic arthritis (SA) can occur as either a primary or secondary focus and requires surgical management with prolonged antimicrobial treatment. We used the Darwin Prospective Melioidosis Study to identify patients with melioidosis and SA, filtered by culture confirmation of B. pseudomallei, and subsequently collected synovial fluid analysis, laboratory, clinical, and risk factor data. We identified 68 patients in total with a label of SA, of which 46 patients supplied 69 synovial fluid samples which were culture-positive. These most commonly came from the knee (61%) and ankle (16%), though half (54%) of the specimens were clotted and unable to undergo cell count. We found a median white cell count (WCC) of 63,000 × 106 cells/L in B. pseudomallei culture-positive samples. There was a numerical, but non-significant, difference in median synovial fluid WCC when stratified by preceding antimicrobial use (90,000 × 106 cells/L prior versus 27,800 × 106 cells/L in samples taken post antimicrobial initiation; p = 0.053). One sample was B. pseudomallei culture-positive 32 days following antimicrobial initiation. The presence/absence of contiguous osteomyelitis did not alter synovial fluid white cell counts. These findings suggest that in cases of suspected melioidosis SA, it is not necessary to withhold empirical antimicrobial therapy while awaiting joint aspiration. Further research is needed to define the role of non-culture-based diagnostics in suspected melioidosis SA. Full article
(This article belongs to the Special Issue Diagnostic Challenges in Joint Infections: From Culture to Molecular Techniques)
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