Journal of Bone and Joint Infection最新文献

{"title":"Periprosthetic fractures around chronically infected total hip arthroplasties: a case series and pragmatic two-stage treatment framework.","authors":"Georges F Vles, Willem-Jan Metsemakers, Laurens Aerden, Jan Geurts, Oliver Borens, Stijn Ghijselings","doi":"10.5194/jbji-11-547-2026","DOIUrl":"10.5194/jbji-11-547-2026","url":null,"abstract":"<p><p>Three periprosthetic femoral fractures around chronically infected total hip arthroplasties (THAs) were treated according to a pragmatic two-stage treatment framework. Infection control and fracture healing were achieved. This may serve as a reference for surgeons confronted with these complex and technically demanding situations.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"547-554"},"PeriodicalIF":2.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887615","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":"Feasibility of a rat femoral-defect model for immediate perioperative and delayed post-implantation implant-associated bone infections.","authors":"Pardis Keikhosravani, Michiel Croes, Nada Ristya Rahmani, Flurina Stabuli, Leonardo Cecotto, H Charls Vogely, Bart C H van der Wal, Marianne Koolen, Debby Gawlitta, Harrie Weinans, Azin Khodaei, Saber Amin Yavari","doi":"10.5194/jbji-11-535-2026","DOIUrl":"10.5194/jbji-11-535-2026","url":null,"abstract":"<p><p><b>Background</b>: Implant-associated bone infections (IAIs) represent a major clinical challenge, causing implant failure, prolonged morbidity, and costly revision surgeries. Infection risk is highest in the immediate perioperative period, but delayed post-implantation contamination, occurring weeks after surgery in a partially healed host, represents an equally important and underappreciated clinical scenario. Bacteria rapidly colonize implant surfaces and form biofilms that resist both antibiotics and host immune responses, making prevention critical. Well-characterized small-animal models that capture both early and delayed post-implantation infections are therefore essential to develop and test antibacterial implants and coatings. <b>Methods</b>: We developed a rat femoral-segmental-defect model stabilized with a polyether-ether-ketone plate and a 3D-printed porous titanium implant. Three studies were performed using a total of 28 animals (3 excluded due to early humane endpoints; <math><mrow><mi>n</mi> <mo>=</mo> <mn>25</mn></mrow> </math> in final analysis): (i) early inoculation during surgery with planktonic <i>Staphylococcus aureus</i> (ATCC 49230) at 10⁴ or 10⁶ CFU (colony-forming units) per rat, (ii) delayed inoculation 28 d after surgery with planktonic <i>S. aureus</i> at 10⁴ or 10⁶ CFU per rat, and (iii) delayed inoculation with 10⁸ CFU per rat delivered as planktonic or ruptured-biofilm inoculum. Controls received phosphate-buffered saline at implantation. The primary endpoint was infection at day 14, quantified by CFU enumeration from homogenized bone and from a sonicated implant, plate, and screws. Micro-computed tomography (micro-CT) was used to visualize fixation and hardware position. <b>Results</b>: Early inoculation with 10⁴ or 10⁶ CFU per rat produced consistent infections across bone, implants, and screws. The same doses given 28 d later yielded low and inconsistent colonization. Escalation to 10⁸ CFU per rat in the delayed setting produced consistent infections; the ruptured-biofilm inoculum generated higher implant-associated bacterial burdens than planktonic suspensions, while bone burdens were consistently high in both arms. <b>Conclusions</b>: This femoral-implant rat model demonstrates feasibility for studying both immediate perioperative and delayed post-implantation infections, providing a platform for preclinical evaluation of anti-infection strategies. Timing, inoculum magnitude, and bacterial state critically determine infection establishment.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"535-546"},"PeriodicalIF":2.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865068","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":"Socioeconomic burden of septic re-revision surgeries for periprosthetic joint infections in Europe - a comprehensive analysis of re-revision costs.","authors":"Dominik Szymski, Susanne Baertl, Nike Walter, Markus Rupp, Katja Hierl, Volker Alt","doi":"10.5194/jbji-11-523-2026","DOIUrl":"10.5194/jbji-11-523-2026","url":null,"abstract":"<p><p><b>Introduction:</b> Periprosthetic joint infection (PJI) is a major cause of failure after total hip arthroplasty (THA) and total knee arthroplasty (TKA). While primary PJI treatment costs are increasingly recognized, the economic burden of septic re-revision surgery remains poorly defined. This study estimated septic re-revisions and the reimbursement burden across Europe. <b>Methods:</b> A payor-perspective health-economic model was applied to 30 European countries, combining 2023 Eurostat arthroplasty data with published infection rates to estimate PJIs and septic re-revisions (including after aseptic revisions), categorized as DAIR (debridement, antibiotics, and implant retention), one-stage, or two-stage procedures. Reimbursement used 13-country survey data plus GDP-based extrapolation; sensitivity analyses varied key parameters by <math><mo>±</mo></math> 20 %. <b>Results:</b> In 2023, 2.29 million primary arthroplasties were performed in Europe, resulting in an estimated 22 794 PJIs and 8629 septic re-revisions. Total reimbursement costs were estimated at EUR 123.6 million (EUR 74.1 million THA; EUR 49.5 million TKA), split into EUR 111.6 million after primary PJI treatment and EUR 12.0 million after initially aseptic revision. Two-stage exchanges accounted for 82.8 % of expenditures and were the main cost driver; Germany had the highest national costs. A Monte Carlo probabilistic sensitivity analysis yielded a 95 % credibility interval of EUR 102.0-156.2 million. <b>Conclusion:</b> Septic re-revision surgery after arthroplasty represents a substantial economic burden in Europe, largely driven by two-stage exchange procedures. Reducing infection and treatment failure rates may provide major clinical and financial benefits: a 25 % reduction in PJI incidence could save EUR 27.9 million annually (22.6 %), and shifting half of two-stage cases to one-stage a further EUR 22.6 million (18.3 %).</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"523-533"},"PeriodicalIF":2.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865128","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":"Reinfection and complication rates in two-stage revision for chronic hip periprosthetic joint infections using the direct anterior approach.","authors":"Sebastian Simon, Jennyfer A Mitterer, Bernhard J H Frank, Stephanie Huber, Sujeesh Sebastian, Susana Gardete-Hartmann, Jochen G Hofstaetter","doi":"10.5194/jbji-11-513-2026","DOIUrl":"10.5194/jbji-11-513-2026","url":null,"abstract":"<p><p><b>Introduction:</b> The direct anterior approach (DAA) used in primary total hip arthroplasty (THA) is gaining popularity and has infection rates comparable to other surgical approaches. While two-stage revision remains the gold standard for chronic periprosthetic joint infection (PJI), little data exist on the DAA. This study evaluated reinfection, and complication rates of two-stage septic revisions performed using the DAA. <b>Methods:</b> This retrospective single-center study included data from 8476 patients who underwent primary THA using the DAA between 2013 and 2024. All patients who underwent a two-stage procedure for chronic PJI were included. Clinical outcomes, complication rates, and microbiological spectrum were assessed. All patients received an antibiotic-loaded cement spacer at first stage, followed by antimicrobial therapy. <b>Results:</b> We identified 36 <math><mo>/</mo></math> 8476 (0.4 %) patients (female: 41.7 %, male: 58.3 %) who underwent septic two-stage revision after primary DAA THA. Infection-free survival was 83.4 % at a median 6.2-year follow-up. Successful second-stage reimplantation occurred in 28 <math><mo>/</mo></math> 36 patients (77.8 %), while 2 <math><mo>/</mo></math> 36 (5.6 %) remained infection free after a 1.5-stage procedure due to being clinically unfit for reimplantation. Four patients (11.1 %) underwent a second stage but developed reinfection, requiring septic revision. Two patients (5.6 %) had failed first stage and underwent a Girdlestone procedure. The reinfection rate was 11.1 %, all culture positive at the second stage. Spacer-related complications occurred in 2 <math><mo>/</mo></math> 36 (5.6 %), including one dislocation (2.8 %) and one spacer fracture (2.8 %). Revision for dislocation after the second stage was required in 3 <math><mo>/</mo></math> 36 (8.3 %). Patients with successful reimplantation were younger ( <math><mrow><mi>P</mi> <mo><</mo></mrow> </math> 0.001). Most common microorganisms were <i>Cutibacterium</i> spp. (28.8 %) and coagulase-negative <i>Staphylococci</i> (26.9 %). <b>Conclusions:</b> Two-stage septic revision using the DAA shows reinfection rates comparable to other approaches, with low rates of spacer dislocation and postoperative dislocation after reimplantation.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"513-521"},"PeriodicalIF":2.7,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13509041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828799","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 inflammatory markers and surgical wound infection after elective short-segment lumbar fusion: the importance of surgical context.","authors":"Jay Chung, Ta'ir Rocker, Regina Golding, Sachin Mehta, Madison McFarland, Arjun Gupta, Xiuyi Yang, Priya Singh, Evan Olsen, Shreya Balusu, Yungtai Lo, Pamela Zuckerman, Jeremy D Shaw, Mitchell S Fourman","doi":"10.5194/jbji-11-503-2026","DOIUrl":"10.5194/jbji-11-503-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Postoperative white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR) are routinely available after lumbar fusion, but early elevations may reflect surgical stress. We evaluated associations of postoperative day (POD) 1 and POD3 WBC/NLR with 90 d surgical wound infection (SWI) after elective short-segment lumbar fusion. <b>Methods</b>: This retrospective cohort included adults undergoing elective one- to three-level lumbar fusion from 2022 to 2024 at one academic center. SWI was a pragmatic electronic-health-record-based endpoint encompassing clinically documented wound-related events, not a uniformly culture-confirmed deep, implant-associated, or surveillance-defined infection. Complete-case univariable and parsimoniously adjusted logistic regressions examined WBC/NLR associations with SWI. <b>Results</b>: Among 380 outcome-eligible patients, 18 (4.7 %) developed SWI. POD1 analyses included 368 patients (18 events), POD3 analyses 336 (17 events), and paired analyses 327 (17 events). After adjustment for body mass index and operative duration, POD1 associations were attenuated; POD3 WBC (odds ratio 1.17, 95 % confidence interval 1.00-1.37; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.049</mn></mrow> </math> ) and NLR (odds ratio 1.12, 95 % confidence interval 1.01-1.23; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.026</mn></mrow> </math> ) remained associated with SWI. However, these associations weakened after adjustment for corresponding POD1 values. Absolute and percentage POD1-to-POD3 changes were not significantly associated with SWI. <b>Conclusions</b>: POD1 WBC/NLR elevations were associated with patient and operative context. POD3 values showed exploratory associations with SWI after limited adjustment but did not establish diagnostic thresholds, clinical utility, or a validated prediction model.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"503-511"},"PeriodicalIF":2.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828834","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":"In vitro analysis of antiseptic solution effects on <i>Staphylococcus aureus</i> biofilms on orthopedic implant materials.","authors":"Madison Balagtas, Kenneth Chrulski, Marina Feffer, Matthew Baldridge, Ashley E Levack","doi":"10.5194/jbji-11-493-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-493-2026","url":null,"abstract":"<p><p>Implant-related biofilm infections remain a major challenge in orthopedic surgery. Prior in vitro comparisons have focused on arthroplasty surfaces using static models; fracture fixation implants remain unstudied. We compared six antiseptic solutions against mature <i>S. aureus</i> biofilms on stainless steel, the most common fracture fixation metal, using a continuous-flow CDC biofilm reactor, more closely approximating hydrodynamic surgical conditions than static systems. Mature biofilms were created on stainless steel coupons using a continuous-flow reactor for 72 h, then washed for 3 min with one of six irrigation solutions: normal saline, 10 % PI (povidone-iodine), 0.35 % PI, a 10 % PI <math><mo>+</mo></math> 3 % hydrogen peroxide mixture, hypochlorous acid, or 0.05 % chlorhexidine gluconate. Colony-forming units (CFUs) were quantified following standardized sonication and plating, and mixed-effects negative binomial regression was used to estimate treatment effects. All antiseptic solutions produced statistically significant reductions in biofilm-associated CFUs relative to untreated controls. Ten percent PI demonstrated the greatest reduction (3.46- <math> <mrow><msub><mi>log⁡</mi> <mn>10</mn></msub> </mrow> </math> ), with 0.35 % PI producing a similar 3.42- <math> <mrow><msub><mi>log⁡</mi> <mn>10</mn></msub> </mrow> </math> reduction. The PI-hydrogen peroxide mixture achieved a 3.24- <math> <mrow><msub><mi>log⁡</mi> <mn>10</mn></msub> </mrow> </math> reduction without evidence of synergistic activity. Hypochlorous acid and chlorhexidine produced 2.95- <math> <mrow><msub><mi>log⁡</mi> <mn>10</mn></msub> </mrow> </math> and 2.46- <math> <mrow><msub><mi>log⁡</mi> <mn>10</mn></msub> </mrow> </math> reductions, respectively, while saline demonstrated minimal effect. These findings indicate that PI solutions, even at dilute concentrations, are highly effective at disrupting established biofilms on stainless steel. As an in vitro single-organism model, these findings establish a comparative efficacy baseline on a fracture-fixation-relevant surface but require validation in multispecies, multi-material, and mechanically realistic irrigation systems before clinical translation.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"493-501"},"PeriodicalIF":2.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793230","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":"Isolation policies in musculoskeletal infection care: time to move from tradition to evidence.","authors":"Laura Bessems, Jolien Onsea, Marjan Wouthuyzen-Bakker, Irene K Sigmund, Tristan Ferry, Richard Kuehl, Martin Clauss, Alex Soriano, Ricardo Sousa, Annette Schuermans, Willem-Jan Metsemakers","doi":"10.5194/jbji-11-489-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-489-2026","url":null,"abstract":"<p><p>A recent scoping review found no evidence supporting routine ward-level isolation or dedicated septic wards for non-multidrug-resistant organism musculoskeletal infections when standard precautions are applied, whereas targeted measures remain appropriate for multidrug-resistant organisms. An international survey revealed wide variation in attitudes and a persistent belief in supporting evidence, highlighting a gap between evidence and perception and supporting a differentiated, risk-based approach to isolation.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"489-492"},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793450","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":"Culture-negative periprosthetic joint infection: an umbrella review of prevalence, diagnostic strategies, treatment, and methodological limitations.","authors":"Guido Bocchino, Giulio Maccauro, Andrea Zampoli, Rocco Papalia, Pier Francesco Indelli, Daniel Pérez-Prieto, Javad Parvizi","doi":"10.5194/jbji-11-479-2026","DOIUrl":"https://doi.org/10.5194/jbji-11-479-2026","url":null,"abstract":"<p><p><b>Purpose</b>: Culture-negative periprosthetic joint infection (CN-PJI) poses a significant clinical challenge because antimicrobial selection relies on guesswork rather than robust clinical data. This umbrella review summarizes the prevalence of CN-PJI, diagnostic strategies (including molecular assays), treatment approaches, and outcomes. <b>Methods</b>: We conducted an umbrella review of published systematic reviews and meta-analyses on CN-PJI in adult hip and/or knee arthroplasties. Searches of major bibliographic databases were conducted in December 2025; two reviewers screened studies and extracted data on prevalence, reported risk factors, diagnostic criteria, use of molecular tests, specimen matrix (synovial fluid, periprosthetic tissue, and/or sonication fluid), surgical strategy, antimicrobial selection, and clinical outcomes (infection control or failure). Methodological quality was assessed with AMSTAR 2. <b>Results</b>: Nine reviews were included. Reported CN-PJI prevalence varied widely (11.0 %-63.6 %), reflecting substantial heterogeneity in study populations, diagnostic definitions, microbiological workflows, and pre-analytical factors. Prior antibiotic exposure before sampling was repeatedly identified as an important contributor to culture negativity. Molecular diagnostics, predominantly NGS (next-generation sequencing)-based approaches, were evaluated in five out of nine reviews, with highly variable organism detection rates depending on assay type, specimen source, and study context. Where meta-analytic estimates were available, pooled sensitivity ranged from 0.81 to 0.93, and pooled specificity ranged from 0.92 to 0.97. Treatment strategies and outcome definitions were inconsistently reported across reviews; when extractable, two-stage exchange was the most frequently described surgical strategy. <b>Conclusions</b>: CN-PJI remains common and variable across settings. Molecular diagnostics improve pathogen detection but do not eliminate false negatives. Reported failure rates varied across reviews and appeared to be clinically relevant, although differences in outcome definitions, treatment protocols, and follow-up duration limited direct comparison.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"479-488"},"PeriodicalIF":2.7,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793066","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":"Timing from admission to debridement, antibiotic, and implant retention (DAIR) affects mortality risk in total hip prosthetic joint infections.","authors":"Jack Legler, Samuel Morgan, Paul Beaulé, Hesham Abdelbary, George Grammatopoulos, Simon Garceau","doi":"10.5194/jbji-11-463-2026","DOIUrl":"10.5194/jbji-11-463-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Recent work in total knee arthroplasty (TKA) prosthetic joint infection (PJI) suggests that timing from hospital admission to DAIR (debridement, antibiotic, and implant retention) is a modifiable risk factor influencing treatment outcomes. The study assessed the impact of timing from admission to DAIR on clinical outcomes and treatment success in the total hip arthroplasty (THA) PJI population. <b>Methods</b>: A retrospective review was conducted at a specialized PJI tertiary referral centre. Patients who underwent DAIR for THA PJI between 2008 and 2021 with a minimum 2-year follow-up were included. The primary outcome was reoperation for recalcitrant PJI. Secondary outcomes included 90 d readmission, 90 d and 1-year mortality, and postoperative complications. Multivariate regression analysis identified factors associated with DAIR outcomes. <b>Results</b>: A total of 100 patients satisfied the inclusion criteria. The mean time from admission to DAIR was 46.4 <math><mo>±</mo></math> 45.1 h, and 52.0 % required reoperation for recalcitrant PJI. Prolonged time from admission to DAIR was associated with increased 90 d mortality (odds ratio or OR: 1.02, CI (confidence interval) 95 %: 1.00-1.03, <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.04). Increasing age was associated with greater 1-year mortality (OR: 1.06, CI 95 %: 1.00-1.12, <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.049). McPherson host grade C compared to grade A was associated with both greater 1-year mortality (OR: 12.75, CI 95 %: 1.11-146.09, <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.04) and postoperative complications (OR: 7.59, CI 95 %: 1.22-47.08, <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.03). McPherson extremity grade II versus grade I (OR: 3.28, CI 95 %: 1.21-8.92, <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.02) and revision THAs (OR: 0.15, CI 95 %: 0.03-0.72, <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.02) were associated with postoperative complications. Lower haemoglobin levels (OR: 1.04, CI 95 %: 1.01-1.07, <math><mrow><mi>p</mi> <mo>=</mo></mrow> </math> 0.004) were associated with higher reoperation risk. <b>Conclusion</b>: In a DAIR-treated cohort, increased time from admission to surgery was associated with greater 90 d mortality in THA PJI patients. Timely surgical intervention and optimization of modifiable risk factors are essential to improve outcomes.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"463-477"},"PeriodicalIF":2.7,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697726","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":"Rapid molecular culture versus conventional culture for periprosthetic joint infection: diagnostic performance and clinical relevance.","authors":"Elizabeth Morreel, Paul Savelkoul, Inge van Loo","doi":"10.5194/jbji-11-453-2026","DOIUrl":"10.5194/jbji-11-453-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Periprosthetic joint infection (PJI) remains a major complication of joint arthroplasty, requiring rapid and accurate pathogen identification to guide appropriate antimicrobial therapy. Conventional culture is limited by prolonged turnaround times and reduced sensitivity, particularly following antibiotic exposure. This study evaluated the diagnostic performance and clinical relevance of Molecular Culture^® (MC), a rapid PCR-based assay, using sonication fluid (SF) obtained during revision arthroplasty. <b>Methods</b>: SF samples from patients undergoing hip or knee revision arthroplasty (2019-2023) were retrospectively analysed. Patients were classified as PJI or non-PJI according to European Bone and Joint Infection Society criteria. MC results were compared with conventional SF culture. Positive percentage agreement (PPA) and negative percentage agreement (NPA) were calculated using culture as the reference standard. Clinical agreement was assessed using all available microbiological results and relevant clinical information, including recent antibiotic exposure. <b>Results</b>: A total of 203 SF samples from 172 patients were included. Analytical PPA and NPA of MC were 68.1 % (95 % CI, 59.9-75.3) and 84.6 % (95 % CI, 73.9-91.4), respectively. Following clinical correlation, PPA and NPA at patient level were 73.2 % (95 % CI, 64.9-80.2) and 95.6 % (95 % CI, 85.2-98.8), respectively. MC identified 11 additional clinically relevant pathogens and provided results within approximately 4 h. <b>Conclusions</b>: MC demonstrated high clinically adjusted agreement and faster turnaround times than conventional culture, supporting its role as an adjunctive diagnostic tool for PJI. Its value may be greatest in patients with uncertain infection status or prior antimicrobial exposure, where rapid exclusion of infection could facilitate earlier optimisation of antimicrobial therapy.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"453-462"},"PeriodicalIF":2.7,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697677","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}