Journal of Bone and Joint Infection最新文献

{"title":"Differential synovial fluid white blood cell count for the diagnosis of chronic peri-prosthetic joint infection - a systematic review and meta-analysis.","authors":"Marta Sabater-Martos, Martin Clauss, Ana Ribau, Ricardo Sousa, On Behalf Of The Leukocyte Count Synovial Fluid Working Group For The Unified Pji Definition Task Force","doi":"10.5194/jbji-10-165-2025","DOIUrl":"10.5194/jbji-10-165-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Peri-prosthetic joint infection (PJI) is a significant complication of arthroplasty, lacking a single gold standard diagnostic test. Synovial fluid white blood cell (WBC) count and polymorphonuclear neutrophil (PMN) proportion are widely used diagnostic tools, but their optimal cutoffs remain unclear, particularly for chronic PJI. <b>Material and methods</b>: This systematic review and meta-analysis included 74 studies published between 2000 and 2024. Data on diagnostic performance (sensitivity, specificity, and diagnostic odds ratios - DORs) of WBC count and PMN proportions were analysed. Sub-group analyses and heterogeneity assessments were performed, and optimal cutoffs for diagnostic accuracy were identified. <b>Results</b>: The meta-analysis revealed a WBC count summary DOR of 58.38 (95 % CI - confidence interval: 48.48-70.32) with an area under the curve (AUC) of the summarized receiver operating characteristic curve of 0.952. The PMN proportion showed a DOR of 43.17 (95 % CI: 35.31-52.79) and an AUC of 0.941. Optimal diagnostic thresholds for chronic PJI were WBC count <math><mo>></mo></math> 2600 cells per microlitre and PMN <math><mo>></mo></math> 70 %. Rule-in thresholds (specificity <math><mrow><mo>></mo> <mn>95</mn></mrow> </math> %) were WBC count <math><mo>≥</mo></math> 3000 cells per microlitre and PMN <math><mo>≥</mo></math> 75 %, while rule-out thresholds (sensitivity <math><mo>></mo></math> 95 %) were WBC count <math><mo>≤</mo></math> 1500 cells per microlitre and PMN <math><mo>≤</mo></math> 65 %. Confounding conditions such as fractures, inflammatory arthritis, and metal-related reactions reduced test accuracy. <b>Conclusions</b>: Synovial fluid analysis remains a critical diagnostic tool for chronic PJI. Thresholds of WBC count <math><mo><</mo></math> 1500 and <math><mrow><mo>></mo> <mn>3000</mn></mrow> </math>  cells per microlitre and PMN <math><mo><</mo></math> 65 % and <math><mrow><mo>></mo> <mn>75</mn></mrow> </math> % provide reliable negative and positive predictive values. A standardized diagnostic framework is essential for addressing remaining controversies and ensuring consistent interpretation across clinical settings.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 3","pages":"165-184"},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093826","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":"Autogenous bone graft in the management of post-osteomyelitis bone defects in children in a limited-resource setting - a retrospective cohort study with a minimum follow-up of 7 years.","authors":"Antonio Loro, Fulvio Franceschi, Muhumuza M Fisha, Emmanuel Ewochu, Geoffrey Mwanje, Annamaria Dal Lago, Martin McNally","doi":"10.5194/jbji-10-155-2025","DOIUrl":"10.5194/jbji-10-155-2025","url":null,"abstract":"<p><p><b>Background.</b> Post-osteomyelitis bone defects represent a challenging clinical situation. This retrospective cohort study was designed to evaluate the long-term outcome of the use of non-vascularized bone grafts in the management of such defects in children. <b>Methods.</b> Twenty-three children (mean age 7 years, range 2-13 years) were studied. All of the defects were segmental (mean defect length 6 cm, range 3-12 cm), involving the tibia, femur, humerus and radius. Fifteen children presented with an active infection and were managed with a staged protocol. The first stage included sequestrectomy or debridement of the site. The second stage, i.e. the graft procedure, was performed after 12 weeks on average. The mean follow-up was 9.2 years (range 7-15 years). <b>Results.</b> Bone union was primarily achieved in 14 children (61 %). Complications were experienced in the remaining nine children. Conservative and surgical treatment led to bone union in all patients within 5 years of the index procedure. Recurrence of infection was observed in two patients (8.7 %). All of the children were able to use the limb at the final follow-up; only three required the use of a brace. <b>Conclusions.</b> Autogenous non-vascularized bone graft may be considered a valid option in the treatment of bone defects secondary to osteomyelitis in children.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"155-163"},"PeriodicalIF":1.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093812","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":"Oral tetracyclines for bone and joint infections: what do we know?","authors":"Tom Cartau, Jocelyn Michon, Renaud Verdon, Aurelie Baldolli","doi":"10.5194/jbji-10-143-2025","DOIUrl":"10.5194/jbji-10-143-2025","url":null,"abstract":"<p><p><b>Background and aim</b>: Complex bone and joint infections (BJIs), including prosthetic joint infections (PJIs) and infections associated with osteosynthetic materials, present significant treatment challenges that often require surgical intervention and prolonged antibiotic therapy. In France, the incidence of PJIs in knee and hip arthroplasties ranges from 0.79 % to 2.4 %, with staphylococci being the primary pathogens involved. Recent studies have suggested that oral antibiotic therapy may be as effective as intravenous therapy and that 12 weeks of antibiotic treatment are needed. Tetracyclines, particularly doxycycline and minocycline, are of interest because of their broad-spectrum activities, good oral bioavailability, and potential efficacy in treating BJIs. We aimed to provide a literature review on the role of oral tetracyclines in the management of BJIs. <b>Method</b>: We performed a systematic review of the literature identified via an electronic search of PubMed and ScienceDirect. <b>Results</b>: A total of 648 articles were screened, and 31 studies were included. Pharmacological studies demonstrated that the bone to blood penetration ratio ranged from 0.06 to 0.75. Less than 20 % of strains implicated in BJIs exhibited resistance to oral tetracyclines. Four studies demonstrated potential inhibition of strain growth. Eight studies that included 62 patients reported curative treatment, with a success rate ranging from 82 % to 100 % for PJIs regardless of the surgical management. For suppressive therapy, 10 studies that included 201 patients reported success rates ranging from 57 % to 100 %. The rate of adverse effects ranged from 0 % to 14 % for curative treatment and from 0 % to 57 % for suppressive treatment, leading to treatment discontinuation in less than 20 % of cases. <b>Conclusion</b>: This review highlights that the number of studies supporting the use of oral tetracyclines for the treatment of BJIs is limited. More robust pharmacological and clinical studies are needed to confirm the safety and efficacy profiles of oral tetracyclines for the treatment of BJIs.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"143-154"},"PeriodicalIF":1.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093817","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":"Dalbavancin to facilitate early discharge in the treatment of complex musculoskeletal infections: a multi-centre real-life application.","authors":"Tariq Azamgarhi, Simon Warren, Antonia Scobie, Natasha Karunaharan, Cristina Perez-Sanchez, Rebecca Houghton, Salma Hassan, Julie Lourtet-Hascoët, Hannah Kershaw, Parham Sendi, Kordo Saeed","doi":"10.5194/jbji-10-93-2025","DOIUrl":"https://doi.org/10.5194/jbji-10-93-2025","url":null,"abstract":"<p><p>Dalbavancin is a lipoglycopeptide with a half-life of 14 d, significantly reducing the need for daily antibiotic dosing. Although dalbavancin is approved for acute bacterial skin and skin structure infections, its off-label use in complex musculoskeletal infection (MSKI) is increasing. Evidence on its effectiveness for MSKI, especially in facilitating early discharge for patients unsuitable for oral or OPAT (outpatient parenteral antimicrobial therapy) treatments, is limited. This multi-centre observational study aims to evaluate dalbavancin's role in facilitating discharge and improving clinical outcomes in MSKI. <b>Method</b>: this study included adult patients treated with dalbavancin between January 2017 and December 2022 across five hospitals in the UK and France. Data on patient demographics, clinical characteristics, microbiology and treatment outcomes were collected using a standardised form. The study also compared treatment costs between dalbavancin and hypothetical alternatives involving either inpatient care or OPAT. Clinical success was defined as the absence of definite failure based on the OVIVA (oral versus intravenous antibiotics) trial criteria. <b>Results</b>: a total of 39 patients were included, with a median age of 51 years (interquartile range (IQR) 40-72). Prosthetic joint infections (38 %) and septic arthritis (31 %) were the most common indications for dalbavancin use. The primary pathogens identified were <i>Staphylococcus aureus</i> (51 %) and coagulase-negative staphylococci (44 %). Dalbavancin was primarily chosen due to poor adherence or lack of OPAT options in 77 % of cases and for convenience in 23 %. In the necessity group, the use of dalbavancin resulted in a median cost saving of GBP 8894 per patient, and 31 inpatient days were avoided. Of the 32 patients (82 %) assigned a definite outcome, 72 % achieved clinical success. No significant adverse drug reactions were reported. <b>Conclusion</b>: this study fills an important evidence gap by demonstrating that dalbavancin is a viable and cost-effective option for MSKI patients that are unsuitable for oral or OPAT treatments. Dalbavancin facilitates early discharge, reduces hospital stays and achieves comparable clinical outcomes to conventional therapies.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"93-100"},"PeriodicalIF":1.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016242","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":"The hidden connection between gut microbiota and periprosthetic joint infections: a scoping review.","authors":"Alessandro Singlitico, Daniele Grassa, Rami Kaplan, Alessandro Smimmo, Giulio Maccauro, Raffaele Vitiello","doi":"10.5194/jbji-10-85-2025","DOIUrl":"https://doi.org/10.5194/jbji-10-85-2025","url":null,"abstract":"<p><p><b>Background</b>: Periprosthetic joint infections (PJIs) pose a significant challenge in orthopedic surgery, and emerging evidence suggests that the gut microbiome may play a crucial role in their development and management. Despite the rarity of these infections, the continuous increase in prosthetic joint arthroplasties has made understanding how to prevent them more pressing. A stronger comprehension of the disruption of the gut microbiome and how this can lead to more of these infections and other pre-surgical risks may be crucial in preventing them. <b>Objective</b>: This article aims to provide a stronger understanding of the topic through the analysis of different pieces of already existing literature to help draw new conclusions and raise potential questions that need answering. <b>Methods</b>: A comprehensive search strategy without filters was employed, and multiple papers were thoroughly analyzed, understood, and compiled into this paper. <b>Conclusions</b>: Despite the limitations of some of the analyzed studies and finite evidence, this paper suggests that there could be a connection between periprosthetic joint infections and a compromised gut microbiome. However, further research is required to draw a definitive conclusion.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"85-92"},"PeriodicalIF":1.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984928","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":"Comparison of surgical treatments for hip and knee periprosthetic joint infections using the desirability of outcome ranking in a prospective multicentre study.","authors":"Brenton P Johns, Mark R Loewenthal, David C Dewar, Laurens A Manning, Joshua S Davis","doi":"10.5194/jbji-10-73-2025","DOIUrl":"https://doi.org/10.5194/jbji-10-73-2025","url":null,"abstract":"<p><p><b>Introduction</b>: In periprosthetic joint infection (PJI), there is a paucity of prospective data comparing debridement, antibiotics and implant retention (DAIR) with two-stage revision while also accounting for time since the initial arthroplasty. Additionally, comparisons often lack patient-centred measures. A desirability of outcome ranking for PJI (DOOR-PJI) unifies joint function, infection cure and mortality into one outcome. We aimed to describe the DOOR-PJI distribution in a large patient cohort and use it to compare DAIR and two-stage revision. <b>Methods</b>: Adults with a newly diagnosed hip or knee PJI from the prospective Prosthetic joint Infection in Australia and New Zealand Observational (PIANO) study were analysed. Patients from 27 hospitals were included. PJI was classified as \"early\" or \"late\". The primary outcome was the novel DOOR-PJI at the 2-year follow-up. Results were expressed using win ratio (WR) values. A WR <math><mo>></mo></math> 1.0 indicates that two-stage revision was superior to DAIR. <b>Results</b>: A DOOR was available for 533 patients. The most common treatments were DAIR (297 patients, 56 %) and two-stage revision (139 patients, 26 %). In early PJI, DAIR was superior to two-stage revision (WR 0.51, 95 % confidence interval (CI) [0.30-0.86], <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.012). In late PJI, two-stage revision was superior to DAIR (WR 1.61, 95 % CI [1.11-2.33], <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.012). These findings persisted following stratification by comorbidities, affected joint, symptom duration and a sensitivity analysis applying the initial (rather than the main) surgical strategy at day 90. <b>Conclusions</b>: In the first application of a DOOR in orthopaedics, DAIR was superior to two-stage revision for early PJI. Conversely, two-stage revision was superior compared with DAIR for late PJI. These findings were independent of comorbidities and symptom duration.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"73-84"},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973038","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":"Multi-centre evaluation of Gram stain in the diagnosis of septic arthritis.","authors":"Charlotte Smith, Robert J Maloney, Deborah Wearmouth, Hemant Sharma, Kordo Saeed, Nusreen Ahmad-Saeed, Rachel Annett, Lucinda Barrett, Sara E Boyd, Peter Davies, Harriet Hughes, Gwennan Jones, Laura Leach, Maureen Lynch, Deepa Nayar, Martin Marsh, Shanine Mitchell, Lynn Moffat, Luke S P Moore, Michael E Murphy, Shaan Ashk O'Shea, Teresa Peach, Christina Petridou, Niamh Reidy, Ben Talbot, Catherine Aldridge, Gavin Barlow","doi":"10.5194/jbji-10-61-2025","DOIUrl":"https://doi.org/10.5194/jbji-10-61-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Gram stain of synovial fluid is a rapid test for the diagnosis of native joint septic arthritis. Single-centre studies have suggested Gram stain will miss a considerable proportion of patients who are subsequently synovial-fluid-culture-positive or polymerase chain reaction (PCR)-positive. The object of this study was to reassess Gram stain in a large, multi-centre cohort of patients from the United Kingdom (UK) and Ireland. <b>Methods</b>: The study was a retrospective analysis combining two large datasets. We defined septic arthritis microbiologically as at least one positive joint aspirate culture and/or PCR test. \"Best case\" and \"worst case\" definitions were applied depending on the likelihood organisms were true infecting pathogens. <b>Results</b>: Gram stain missed a high proportion of culture-/PCR-positive patients using both the best (74 % missed) and worst (81 % missed) case definitions. Using the best case definition, the sensitivity of Gram stain was 0.26, specificity 0.99, positive predictive value 0.84, negative predictive value 0.87, accuracy 0.87, and area under the receiver operator curve 0.62 (95 % CI 0.57 to 0.68, <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ). False positive Gram stains were infrequent (1 %). Age, joint involved, and other synovial fluid characteristics were less predictive of a positive culture/PCR than Gram stain. <b>Conclusions</b>: While a positive synovial fluid Gram stain should always be considered to indicate potential septic arthritis, a negative Gram stain, regardless of synovial fluid crystals or white cell count, should not be used to rule out septic arthritis. The value of Gram stain as an urgent out-of-hours test for septic arthritis is open to considerable debate.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"61-71"},"PeriodicalIF":1.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063912","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":"Postoperative antibiotic treatment does not lower re-revision rate in presumed aseptic hip and knee revision arthroplasties with unexpected positive intraoperative cultures - a matched cohort study.","authors":"Sebastian Simon, Marjan Wouthuyzen-Bakker, Susana Gardete Hartmann, Jennyfer A Mitterer, Sujeesh Sebastian, Stephanie Huber, Bernhard J H Frank, Jochen G Hofstaetter","doi":"10.5194/jbji-10-51-2025","DOIUrl":"10.5194/jbji-10-51-2025","url":null,"abstract":"<p><p><b>Aims</b>: It remains unclear if postoperative antibiotic (AB) treatment is advantageous in presumed aseptic revision arthroplasties of the hip (rTHA) and knee (rTKA) with unexpected positive intraoperative cultures (UPIC). The aim of this study is to evaluate if there is a difference in the re-revision rate in patients with UPIC when treated with postoperative AB or when postoperative AB is withheld. <b>Methods</b>: In this retrospective matched cohort study we compared the re-revision rates in rTHA and rTKA with (AB group: 45 rTHA, 25 rTKA) and without (non-AB group: 45 rTHA, 25 rTKA) AB treatment in patients with UPIC. Baseline covariates for matching were the microorganism (likely or not likely to be a contaminant), patient demographics, joint, revision type, surgical site infection score, American Society of Anesthesiologists classification, serum C-reactive protein (CRP). <b>Results</b>: After a median follow-up of 4.1 (inter-quartile range, IQR: 2.9-5.5) years after rTHA and rTKA, the re-revision rate between the AB group and the non-AB group was 14.3 % versus 15.7 % (<i>P</i>=0.81). In the AB group, 4.3 % (3/70) of patients underwent revision due to septic complications compared to 5.7 % (4/70) in the non-AB group (<i>P</i>=0.69). None of the patients were diagnosed with a confirmed periprosthetic joint infection (PJI) according to the PJI diagnostic criteria of European Bone and Joint Infection Society (EBJIS). In 22/70 (31.4 %) of the patients in the AB group and in 15/70 (21.4 %) of the patients in the non-AB group, a diagnosis of \"infection likely\" was made according to the EBJIS criteria (<i>P</i>=0.18). All UPICs with low virulent microorganisms were considered to be contamination (coagulase-negative <i>Staphylococci</i>; <i>Corynebacterium</i>; anaerobic Gram-positive bacilli and cocci, e.g., <i>Finegoldia magna</i>, <i>Cutibacterium acnes</i>). <b>Conclusion</b>: Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPIC in presumed aseptic rTHA and rTKA. Patients diagnosed with pathogens classified as a likely contaminant can be safely ignored.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"51-59"},"PeriodicalIF":1.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670019","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":"Synovial glucose and serum-to-synovial-glucose ratio perform better than other biomarkers for the diagnosis of acute postoperative prosthetic knee infection.","authors":"Marta Sabater-Martos, Oscar Garcia, Laia Boadas, Laura Morata, Alex Soriano, Juan Carlos Martínez-Pastor","doi":"10.5194/jbji-10-41-2025","DOIUrl":"10.5194/jbji-10-41-2025","url":null,"abstract":"<p><p><b>Introduction</b>: In native septic arthritis, synovial glucose is a well-established diagnostic marker. However, its diagnostic utility in periprosthetic joint infection (PJI) remains unexplored. Given the diagnostic challenges of acute postoperative PJI, we hypothesized that synovial glucose could serve as a valuable biomarker and aimed to evaluate its diagnostic accuracy. <b>Material and methods</b>:  This is a retrospective diagnostic study in acute postoperative PJI in total knee arthroplasty (TKA). We reviewed all TKA surgeries performed in the past 10 years and cross-checked those patients that consulted to our emergency room during the first 90 d after TKA surgery for knee-related symptoms. We calculated the serum-to-synovial-glucose ratio for each patient (serum-to-synovial-glucose ratio = [(serological glucose - synovial glucose) / serological glucose]), and we formed the receiver operating characteristic (ROC) curves for synovial glucose, serum-to-synovial-glucose ratio, serum C-reactive protein (CRP), synovial white blood cell (s-WBC) count, and polymorphonuclear cell percentage (PMN%); then we extracted the optimal cutoff values. <b>Results</b>: The optimal cutoffs for diagnosing acute postoperative PJI were < 44 mg dL^-1 for synovial glucose and > 0.69 for serum-to-synovial-glucose ratio. The area under the curve (AUC) values were 0.861 and 0.889, respectively. ROC curves for serum CRP, s-WBC count, and PMN% showed AUC values of 0.69, 0.714, and 0.66, respectively. The combined ROC curve analysis for serum CRP, s-WBC count, and PMN% showed an AUC of 0.722. When adding synovial glucose, the AUC was 0.859 and with serum-to-synovial-glucose ratio we achieved an AUC of 0.876. <b>Conclusion</b>: Synovial glucose and serum-to-synovial-glucose ratio demonstrated good diagnostic potential for acute postoperative PJI following TKA. These biomarkers exhibited superior accuracy compared to the combination of serum CRP, s-WBC count, and PMN%.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"41-49"},"PeriodicalIF":1.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670020","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":"Rethinking antibiotic prophylaxis in orthopaedic oncology: insights from a cohort study of endoprosthetic infections.","authors":"Tariq Azamgarhi, Craig Gerrand, Simon Warren","doi":"10.5194/jbji-10-33-2025","DOIUrl":"https://doi.org/10.5194/jbji-10-33-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Endoprosthetic replacement (EPR) is the preferred limb salvage method for musculoskeletal tumours involving bone; however, infection rates range from 8 % to 12 %. We investigated the impact of antibiotic prophylaxis at primary implantation on the development of prosthetic joint infection (PJI). <b>Methods</b>: We conducted a retrospective analysis of patients who underwent primary EPRs between 2010 and 2021. Prosthetic joint infections were identified and classified according to criteria from the European Bone and Joint Infection Society (EBJIS). The follow-up period extended until an infection was identified, subsequent surgery for non-infectious reasons occurred or the last known follow-up was conducted. For all primary procedures, we collected details of postoperative complications at the surgical site, including superficial wound infections, delayed wound healing and wound dehiscence. PJIs were divided into two groups. The first group included patients with an uncomplicated postoperative course, while the second comprised those with either postoperative wound problems or infections from an identifiable source. <b>Results</b>: Out of 1064 patients, 73 (6.9 %) developed PJI within a median follow-up of 25.6 months (IQR 8.8-52.7). A total of 26 % of PJIs were attributed to primary implantation, while 74 % of PJIs were due to secondary causes, with 47 % having wound complications and 27 % presenting acutely. The microbiological profiles between groups differed significantly, with infections from skin flora related to primary implantation and a high proportion of other bacteria (Gram-negatives and enterococci) linked to secondary infections. <b>Conclusions</b>: Skin flora are likely responsible for infections related to the primary procedure, and antibiotic prophylaxis should be optimised accordingly. Additional measures are needed to prevent secondary infections.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 1","pages":"33-39"},"PeriodicalIF":1.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010912","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}