Journal of Bone and Joint Infection最新文献

{"title":"Blood gas analyzers enable reliable measurement of synovial pH, lactate, and glucose in native and periprosthetic joint infection: an analytical agreement study.","authors":"Dirk Müller, Igor Lazic, Benjamin Schloßmacher, Vincent Lallinger, Christian Wendler, Rüdiger von Eisenhart-Rothe, Susanne Weber","doi":"10.5194/jbji-11-247-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-247-2026","url":null,"abstract":"<p><p><b>Background:</b> Synovial pH, lactate, and glucose are established biomarkers for septic arthritis in native joints and have emerging utility in periprosthetic joint infection (PJI). In routine care, these biomarkers are commonly analyzed in central laboratories, which may delay clinical decision-making. Blood gas analyzers (BGAs), which can also measure these parameters, are widely available at the point of care, and their use could accelerate decision-making. However, BGAs are not validated for synovial fluid analysis. <b>Materials and methods:</b> This prospective analytical agreement study included 35 consecutive patients undergoing knee joint aspiration for suspected PJI or septic arthritis of the native joint. Each sample was measured in triplicate both in the central laboratory and using a BGA. The agreement between the two methods was assessed using Passing-Bablok and Bland-Altman analyses. The study was designed to assess analytical agreement between both methods rather than diagnostic accuracy. <b>Results:</b> BGA measurements for synovial pH, lactate, and glucose demonstrated good to excellent agreement with those obtained using central laboratory methods. Agreement was excellent for synovial glucose and overall good for lactate, with negligible mean bias. Linear regression showed very strong correlations for glucose ( <math><mrow><mi>r</mi> <mo>=</mo></mrow> </math> 0.997) and lactate ( <math><mrow><mi>r</mi> <mo>=</mo></mrow> </math> 0.989). Synovial pH showed greater variability, with a mean bias of <math><mo>-</mo></math> 0.10 pH units; however, repeatability analysis revealed lower within-sample variability for BGA-based pH measurements compared with laboratory pH measurements. <b>Conclusion:</b> BGAs enable rapid, reliable measurement of synovial pH, lactate, and glucose from small sample volumes and may support timely clinical decision-making in suspected septic arthritis and PJI. Further studies should assess inter-device generalizability and establish device-specific reference ranges.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"247-256"},"PeriodicalIF":2.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rifampin resistance and multidrug resistance or extensive drug resistance (MDR/XDR) predict failure in monomicrobial <i>Staphylococcus epidermidis</i> periprosthetic joint infection (PJI) - a 15-year single-center cohort study.","authors":"Álvaro Auñon, Santiago Gabardo, Carmen Álvaro, Ricardo de la Concha, Javier Sanado, Jaime Esteban","doi":"10.5194/jbji-11-237-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-237-2026","url":null,"abstract":"<p><p><b>Introduction:</b> <i>Staphylococcus epidermidis</i> is a leading coagulase-negative pathogen in periprosthetic joint infection (PJI), but the outcome impact of key resistance phenotypes is unclear. <b>Methods:</b> We retrospectively studied consecutive monomicrobial <i>S. epidermidis</i> PJIs treated at a tertiary hospital (2010-2024). PJI was defined according to 2018 ICM criteria. Success required infection eradication without suppressive antibiotics or further infection-related surgery after <math><mo>≥</mo></math> 12 months. <b>Results:</b> Among 516 evaluable PJIs, 105 (20.3 %) were monomicrobial PJIs due to <i>S. epidermidis</i>. The mean age was 71, and 56 % of cases were women; 51 % of cases involved the knee, and 49 % involved the hip. Chronic infection accounted for 79 %. Surgical strategies were DAIR in 27.6 % of cases, one-stage revision in 28.6 % of cases, and two-stage revision in 39.0 % of cases. Overall success was 78.1 % (DAIR - 75.9 %, one-stage - 93.3 %, two-stage - 73.2 %). Resistance rates were as follows: methicillin - 72.3 %, fluoroquinolone - 53.3 %, rifampin - 24.8 %, and multidrug resistance or extensive drug resistance (MDR/XDR) - 43.8 %. Rifampin resistance (73.1 % vs. 91.3 %, <math><mi>p</mi></math> <math><mo>=</mo></math> 0.021) and MDR/XDR (67.4 % vs 84.7 %, <math><mi>p</mi></math> <math><mo>=</mo></math> 0.035) were associated with failure; methicillin ( <math><mi>p</mi></math> <math><mo>=</mo></math> 0.853) and fluoroquinolone resistance ( <math><mi>p</mi></math> <math><mo>=</mo></math> 0.129) were not. In the univariable analyses, levofloxacin resistance was significantly associated with treatment failure (OR (odds ratio): 3.71; 95 % CI (confidence interval): 1.58-8.69; <math><mi>p</mi></math> <math><mo>=</mo></math> 0.002), as was rifampicin resistance (OR: 5.83; 95 % CI: 2.22-15.34; <math><mi>p</mi></math> <math><mo><</mo></math> 0.001). Double resistance to levofloxacin and rifampicin showed the strongest association with failure (OR: 8.01; 95 % CI: 2.82-22.77; <math><mi>p</mi></math> <math><mo><</mo></math> 0.001). <b>Conclusion:</b> Rifampin-resistant and MDR/XDR <i>S. epidermidis</i> PJIs represent higher-risk infections and should prompt early optimization of biofilm-active therapy and surgical source control. Univariable analysis confirmed rifampin resistance; levofloxacin resistance; and, in particular, their combination as strong predictors of treatment failure.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"237-246"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empirical antibiotic therapy in acute orthopaedic infections: differences in antimicrobial susceptibility across anatomical sites.","authors":"Yoni Lodewijk-van den Brink, Jon H M Goosen, Denise S C Telgt, Marrigje Nabuurs-Franssen, Karin C M Veerman","doi":"10.5194/jbji-11-229-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-229-2026","url":null,"abstract":"<p><p><b>Background:</b> The selection of empirical antibiotic therapy for early postoperative orthopaedic infections is challenging because pathogen distribution, antimicrobial resistance, and microbiology vary locally and by anatomical site. Dutch national guidelines from the Dutch Working Party on Antibiotic Policy (SWAB) recommend vancomycin-based combination therapy for prosthetic joint infection (PJI), but the adequacy of these regimens for the broader spectrum of early postoperative orthopaedic infections has not been systematically evaluated. <b>Methods:</b> We conducted a retrospective, single-centre cohort study including early postoperative orthopaedic infections ( <math><mo>≤</mo></math> 90 d) treated between January 2022 and January 2025 with complete microbiological- and antimicrobial-susceptibility data. Microbiological isolates, susceptibility profiles, anatomical location, and the type of index procedure were analysed. Empirical coverage was assessed for cefazolin, vancomycin-ceftriaxone (SWAB-recommended), and vancomycin-ciprofloxacin, both overall and stratified by anatomical site. <b>Results:</b> A total of 304 infections were included. Gram-positive organisms predominated, including <i>Staphylococcus aureus</i> (one MRSA isolate) and coagulase-negative staphylococci, alongside Gram-negative bacteria, mainly <i>Enterobacter</i> spp. Despite high cefazolin susceptibility among <i>S. aureus</i>, cefazolin monotherapy covered only 49 % of infections due to resistance in <i>S. epidermidis</i> and Gram-negative pathogens. Vancomycin-ceftriaxone provided 89.8 % coverage and increased to approximately 93.4 % when foot and ankle infections were excluded; this subgroup showed frequent ceftriaxone-resistant <i>Enterobacter</i> spp. Vancomycin-ciprofloxacin achieved the highest coverage (97.7 %). <b>Conclusion:</b> Cefazolin monotherapy is insufficient as an empirical treatment for early postoperative orthopaedic infections at our centre. Vancomycin-ceftriaxone offers high coverage for most anatomical sites and aligns with SWAB recommendations. For foot and ankle infections, vancomycin-ciprofloxacin offers superior coverage.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"229-235"},"PeriodicalIF":2.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty common errors in the prevention, diagnosis, and treatment of fracture-related infection (FRI).","authors":"Goran Georgievski, Nike Walter, Ronald Man Yeung Wong, Irene Katharina Sigmund, Ashok Kanuri, Christian Heiss, Markus Rupp","doi":"10.5194/jbji-11-219-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-219-2026","url":null,"abstract":"<p><p>Fracture-related infections are among the most serious complications following osteosynthesis. They jeopardize fracture healing, prolong treatment duration, and can lead to loss of function or even amputation. Despite established standards, avoidable errors continue to occur in clinical practice. Fracture-related infections not only compromise healing but also significantly reduce life expectancy, and increase morbidity and mortality. The standardization of procedures is essential to improve outcomes and ensure consistent high-quality care. This article describes 20 common errors in the prevention, diagnosis, and treatment of fracture-related infection. For each error, the clinical consequences and practical recommendations are provided. The aim is to improve treatment quality and patient safety by identifying and avoiding typical decision-making pitfalls. Consistent standardization of surgical and microbiological procedures, interdisciplinary collaboration, and structured follow-up care are essential prerequisites for successful infection management.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"219-228"},"PeriodicalIF":2.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147689437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a role for lavage aspiration after a dry tap in the work-up for potential periprosthetic joint infection? A systematic review.","authors":"Sander Bruyninckx, Stijn Ghijselings, Melissa Depypere, Alex Soriano, Willem-Jan Metsemakers, Georges Vles","doi":"10.5194/jbji-11-207-2026","DOIUrl":"10.5194/jbji-11-207-2026","url":null,"abstract":"<p><p><b>Aim</b>: Lavage aspiration following a dry tap remains a debated technique in the work-up for periprosthetic joint infection (PJI) of the hip and knee. This systematic review critically appraises the available evidence, with a particular focus on the diagnostic yield of lavage aspiration in detecting PJIs that would otherwise be missed. <b>Methods</b>: A comprehensive literature search was conducted in accordance with PRISMA guidelines across PubMed, Embase, MEDLINE, and Cochrane databases. <b>Results</b>: Eleven studies met the inclusion criteria, all level IV case series. Across 1965 patients, 2199 aspirations were performed. Overall, 798 procedures (36 %) resulted in a dry tap. Lavage aspiration was attempted in 698 of these cases, with 691 successful attempts. Among dry taps, 154 PJIs were ultimately identified, corresponding to a PJI prevalence of 19 %. Lavage aspiration contributed to a correct diagnosis in 22 % of successful procedures. Pooled culture sensitivity and specificity following saline lavage were 66 % and 89 %, respectively. The diagnostic performance of polymorphonuclear neutrophils (PMNs) <math><mrow><mo>></mo> <mn>80</mn></mrow> </math> % was similar between saline lavage and normal aspiration. Although no safety concerns were reported, the potential introduction of pathogens and the risk of false-positive results remain concerns that are not fully mitigated by the available evidence. <b>Conclusion</b>: One in three aspirations result in a dry tap. Lavage aspiration provides analysable fluid in nearly all cases and appears to enable the diagnosis of PJI in roughly one out of five patients in whom standard aspiration fails. However, more robust evidence is needed before it can be recommended as a universal technique.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"207-217"},"PeriodicalIF":2.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147689469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone transport in the management of fracture-related infection: current concepts and innovations.","authors":"Willem-Jan Metsemakers, Austin T Fragomen, Mario Morgenstern, Steffen B Rosslenbroich, Stephen M Quinnan, Pablo S Corona, Mitchell Bernstein, Kevin Tetsworth","doi":"10.5194/jbji-11-191-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-191-2026","url":null,"abstract":"<p><p>Despite advances in musculoskeletal trauma care, segmental bone loss remains a major clinical challenge. A substantial proportion of these cases are associated with fracture-related infection (FRI), which fundamentally alters the biological environment and reconstructive strategy. In this context, FRI should be considered in any patient with a segmental bone defect, and thorough surgical debridement with acquisition of multiple deep-tissue cultures represents an essential first step in management. The presence of infection reduces the likelihood of bone consolidation and eradication of disease, emphasizing the need for strict adherence to established FRI treatment principles. Depending on the extent of bone loss, host factors, and available expertise, patients may be eligible for a range of reconstructive options. Bone transport is one of these surgical methods and involves the gradual translocation of bone segments to reconstruct defects in long bones. Based on the principles of distraction osteogenesis (DO), controlled mechanical distraction promotes predictable bone regeneration according to Ilizarov's principles. Traditionally, DO has relied on circular external fixators. Recent developments involving integrated fixation, such as bone transport over a nail, have reduced morbidity and enabled faster reconstruction. Although these techniques carry a risk of contaminating the intramedullary canal, exclusive long-term use of external fixators is not harmless. Further innovations, such as motorized telescopic intramedullary nails, have led to the gradual replacement of external fixation, making the procedure less burdensome for patients. Advances in surgical skills and technology have enabled the treatment of more complex cases, making a specialized, multidisciplinary approach essential in modern clinical care.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"191-206"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hidden threat: a case of relapsed disseminated <i>Mycobacterium abscessus</i> infection and its therapeutic challenges.","authors":"Katherine Grace Egan, Lisa Duffy, Catherine Fleming, Padraig McGettrick, Eavan G Muldoon, Christine Kelly, James Woo, Emer Kilbride, Joseph Butler, Richard Storey, Christine Quinlan, Edward McDermott, Jonathan Hunter, Carlos Mejia-Chew","doi":"10.5194/jbji-11-185-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-185-2026","url":null,"abstract":"<p><p><i>Mycobacterium abscessus</i> (<i>M. abscessus</i>) is a rapidly growing nontuberculous mycobacterium (NTM). We present the case of a 57-year-old female on immunosuppressive therapy for polymyalgia rheumatica (PMR) who developed disseminated <i>M. abscessus</i> infection with vertebral osteomyelitis following bariatric surgery abroad. Her case highlights core treatment principles of disseminated NTM infections.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"185-189"},"PeriodicalIF":2.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic parameters in native joint septic arthritis and development of a new evaluation score.","authors":"Lorenz Huber, Hasan S Aguicenoglu, Susanne Baertl, Julia Elisabeth Lenz, Kristina Gerhardinger, Frank Hanses, Florian Zeman, Nike Walter, Volker Alt, Markus Rupp","doi":"10.5194/jbji-11-175-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-175-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Septic arthritis (SA) is an orthopaedic emergency; delayed treatment endangers joint function and survival. Unlike periprosthetic infections, diagnostic criteria for native joints are poorly standardized. This study aimed to (1) evaluate diagnostic parameters including synovial white blood cell (sWBC) count, neutrophil percentage, serum C-reactive protein (CRP), and leukocyte count and (2) assess a new evaluation score combining these parameters. <b>Methods</b>: In a retrospective cohort study, cases of knee and shoulder SA treated at a German university hospital (2013-2022) were analysed. Parameters included synovial fluid analysis (sWBC, neutrophils), blood samples (CRP, leukocytes), and intraoperative cultures. Cut-offs for sWBC and neutrophils were determined using receiver-operating characteristic (ROC) analysis and the Youden index, comparing SA patients with non-infected controls. A new evaluation score for SA (Septic Arthritis Evaluation Score, SAES) was created: 2 points each for sWBC and neutrophils and 1 point each for CRP and leukocytes. <b>Results</b>: Complete data were available for 45 patients (71.4 % male, mean age 64.3 years). Knees were affected in 73.7 %, and shoulders were affected in 26.3 %. Median values were as follows: leukocytes - 11/nl, CRP - 158 mg L^-1, sWBC - 42 910/ <math><mrow><mi>µ</mi></mrow> </math> L, and neutrophils - 93.6 %. ROC analysis identified an optimal sWBC cut-off of 35 650/ <math><mrow><mi>µ</mi></mrow> </math> L (sensitivity of 64.4 %, specificity of 87.8 %). The SAES showed higher discriminatory performance; with a threshold <math><mo>≥</mo></math> 3 points, sensitivity was 95.6 %, and specificity was 70.7 %. <b>Conclusions</b>: In this retrospective cohort, commonly used laboratory parameters for native joint SA showed limited discriminatory ability when applied individually. A newly developed composite score combining synovial and serum markers demonstrated higher sensitivity within this dataset. Prospective validation in larger cohorts is required before clinical application.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"175-183"},"PeriodicalIF":2.8,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined analysis of host immune response, biofilm genes, and 16S rRNA detection in fracture-related infection: an observational cohort study.","authors":"Melissa Depypere, Jonathan Sliepen, Jolien Onsea, Yves Debaveye, T Fintan Moriarty, Elena Della Bella, Emmanuel André, Johan Van Weyenbergh, Willem-Jan Metsemakers","doi":"10.5194/jbji-11-161-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-161-2026","url":null,"abstract":"<p><p>Fracture-related infection (FRI) is a serious complication in orthopaedic trauma that can lead to delayed union, nonunion, and poor clinical outcomes. A better understanding of the host immune response may provide valuable insights into the pathophysiology of FRI and may help identify genomic elements that contribute to the infection. This observational study compared immune responses between patients with FRI and non-infected controls using bone/tissue biopsies and sonication fluid, and it explored the possibility of detecting bacterial and biofilm genes using transcriptome profiling with hybridization technology (nCounter^® RNA hybridization technology). A total of 15 infected patients demonstrated significant upregulation of the innate immune pathway, including Toll-like receptor (TLR) signalling and the MyD88 cascade, suggesting an active immune response contributing to both infection control and bone resorption. Among the differentially expressed genes, PTGS2 (COX-2) showed the highest level of upregulation in the infection group. Bone biopsies showed enhanced chemokine (e.g. <i>CXCL1, CXCL2, CCL4/L1/L2</i>) signalling, with higher levels compared to tissue biopsies. Transcriptomic analysis identified bacterial transcripts in cases where conventional culture was negative, revealing potential cases of low-bacterial-load infections causing culture-negativity. Transcriptome profiling exposed distinct immune activation patterns in FRI and enabled the detection of pathogens missed by conventional culture. These findings call for larger, prospective studies to further explore the clinical utility of transcriptomics in understanding and managing FRI.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"161-173"},"PeriodicalIF":2.8,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13044966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing diagnostics in suspected periprosthetic joint infections using synthetic synovial fluid and microcalorimetry.","authors":"Amber De Bleeckere, Jeroen Neyt, Jasper Van Heuverswyn, Stien Vandendriessche, Hannelore Hamerlinck, Annelynn Wallaert, Christophe Pattyn, Bruno Verhasselt, Jerina Boelens, Tom Coenye","doi":"10.5194/jbji-11-149-2026","DOIUrl":"10.5194/jbji-11-149-2026","url":null,"abstract":"<p><p>Rapid and accurate pathogen detection is essential for effective management of periprosthetic joint infections (PJIs), yet conventional culturing (CC) often yields false-negative results and requires prolonged incubation times. In the present study we compared the performance of CC to that of two alternative approaches, i.e., culturing in synthetic synovial fluid (SSF2) and isothermal microcalorimetry (IMC). A total of 79 synovial fluid (SF) samples from patients with suspected PJI were included; for these samples, CC data were available. Samples were incubated in SSF2 (aerobically and anaerobically, for 10 d), and isolates were identified by matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF MS). With IMC we determined the time to detect microbial activity in the samples (in two different media; brain heart infusion (BHI) broth and fluid thioglycolate medium (FTM)). Culturing in SSF2 yielded the highest positivity rate (53.2 %), followed by IMC and CC (34.2 % and 32.9 %, respectively). More than one-third of all positive samples were detected only after culturing in SSF2 (39.3 %), and this approach also revealed the greatest microbial diversity. IMC enabled rapid detection of microbial activity in a sample, with median detection times of 15.9 h in BHI and 15.6 h in FTM. Our results demonstrate that culturing of SF samples in SSF2 increased the diagnostic yield and that IMC reduced the time to identify clinical samples that contain viable microorganisms. This highlights the potential of these approaches; however further optimization is warranted to integrate them in diagnostic PJI workflows.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"149-160"},"PeriodicalIF":2.8,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}