Journal of Bone and Joint Infection最新文献

{"title":"Bromelain and N-acetylcysteine (BromAc) as novel adjunctive therapy for prosthetic joint infection: a narrative review.","authors":"Brendan Parnell, David Morris","doi":"10.5194/jbji-11-441-2026","DOIUrl":"10.5194/jbji-11-441-2026","url":null,"abstract":"<p><p><b>Background</b>: Prosthetic joint infection (PJI) complicates 0.5 %-2.0 % of total joint arthroplasties and remains the leading cause of implant failure. Bacterial biofilm confers marked antimicrobial resistance, and current strategies, including debridement, antibiotics, and implant retention (DAIR), carry a pooled failure rate of <math><mo>∼</mo></math> 36 %. Novel biofilm-disrupting adjuncts are urgently needed. <b>Purpose</b>: The aim is to examine preclinical evidence of bromelain and N-acetylcysteine (BromAc) as a combination antibiofilm therapy in PJI management and to critically appraise its translational readiness. <b>Methods</b>: A narrative literature search was conducted for studies examining N-acetylcysteine, bromelain, and BromAc in the context of biofilm disruption on orthopaedic prosthetic materials. Eligible studies were appraised qualitatively for pathogen, substrate, exposure conditions, outcome measures, and methodological limitations to allow comparative interpretation rather than narrative summary alone. <b>Results</b>: N-acetylcysteine demonstrates concentration-dependent antibiofilm activity, achieving approximately 50 % biofilm reduction on polyethylene and 20 % on titanium at minimum inhibitory concentrations, rising to 81.5 % eradication of staphylococcal biofilms at higher concentrations in non-orthopaedic substrates. Bromelain achieves significant biofilm reduction from orthopaedic hardware via proteolytic degradation of extracellular polymeric substance protein scaffolds. In the principal proof-of-concept study on hernia mesh, BromAc achieved <math><mo>></mo></math> 80 % biofilm removal (quantified by crystal violet biomass reduction) across three <i>Pseudomonas aeruginosa</i> strains, exceeding either agent alone; activity against staphylococci has been reported in unpublished sponsor data but is not yet independently replicated in peer-reviewed orthopaedic models. <b>Conclusions</b>: BromAc represents a mechanistically rational adjunctive therapy for PJI, targeting distinct biofilm matrix components. However, current evidence is largely preclinical, much of it derived from non-orthopaedic substrates and pathogens, and several supporting datasets are unpublished sponsor data. Important translational gaps remain in peer-reviewed staphylococcal validation on prosthetic materials, formulation stability (particularly the susceptibility of N-acetylcysteine to oxidation in aqueous solution), intra-articular safety with respect to cartilage and osseointegration, and the absence of an in vivo orthopaedic implant model. These limitations must be resolved before clinical translation can be responsibly considered.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"441-451"},"PeriodicalIF":2.7,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697679","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":"Sonication fluid cultures enhance pathogen identification in fracture-related-infection (FRI).","authors":"Anas Zouitni, Erlangga Yusuf, Jakob van Oldenrijk, Tjebbe Hagenaars, Peter D Croughs, P Koen Bos, Denise Eygendaal, Ewout S Veltman","doi":"10.5194/jbji-11-431-2026","DOIUrl":"10.5194/jbji-11-431-2026","url":null,"abstract":"<p><p><b>Background</b>: Sonication fluid culture (SFC) of osteosynthesis material may be a valuable adjunct tool to diagnose fracture-related infection (FRI). This study aims to evaluate the added diagnostic value of SFC as a diagnostic tool. The diagnostic value of SFC was assessed by evaluating its impact on confirming microbiological results and changing diagnosis. <b>Methods</b>: We analysed patients undergoing osteosynthesis hardware removal between 2012 and 2021. We categorized patients using FRI consensus criteria: suspected FRI or confirmed FRI. The sensitivity and specificity of tissue cultures and SFC were assessed. The added value of SFC was determined as the number of cases where SFC was essential for confirming FRI and the influence on antibiotic therapy selection. <b>Results</b>: We included 96 patients with three or more tissue cultures. Based on diagnosis without SFC, we found 14 aseptic, 35 suggestive FRI cases, and 47 confirmed FRI cases. Following SFC results, four cases changed diagnosis from aseptic to suggestive FRI, and three cases changed from suggestive FRI to confirmed FRI. The sensitivity of tissue culture was 74 %, and the specificity was 98 %. The sensitivity of SFC was 84 %, and the specificity was 83 %. Combining tissue cultures with SFC significantly increased sensitivity compared with tissue cultures alone, from 74 % to 88 % ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ). In 21 confirmed FRIs (42 %), SFC results were concordant with tissue cultures and would not alter FRI management. SFC detected an additional virulent pathogen in three confirmed FRIs (6 %) and low-virulent pathogens in eight confirmed FRIs (16 %) which could influence the antibiotic regimen. <b>Conclusions:</b> SFC plays a significant role in diagnosing FRI by enhancing pathogen detection. SFC may influence FRI management in approximately 6 % to 16 % of confirmed FRI. In every FRI, an adequate number of cultures according to protocol should be obtained, and SFC should also be performed.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"431-440"},"PeriodicalIF":2.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689313","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":"Management and outcomes of culture-negative periprosthetic joint infection: a systematic review and meta-analysis.","authors":"Farzad Pourghazi, Seyed Mohammad Amin Alavi, Takahiro Matsuo, Georges Baaklini, Matthew P Abdel, Aaron J Tande, Elie F Berbari","doi":"10.5194/jbji-11-413-2026","DOIUrl":"10.5194/jbji-11-413-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Culture-negative periprosthetic joint infection (CN-PJI) remains a major diagnostic and therapeutic challenge because antimicrobial and surgical management are often empirical. <b>Methods</b>: We performed a systematic review and meta-analysis to evaluate treatment strategies and outcomes of CN-PJI. MEDLINE and Scopus were searched through 3 July 2025, and 27 cohort studies including 1399 CN-PJI patients were included. <b>Results</b>: Random-effect meta-analyses showed a pooled treatment success proportion of 83.6 % (95 % CI, 78.2-87.9), a pooled failure proportion of 17.2 % (95 % CI, 12.6-22.9), and a pooled mortality proportion of 2.4 % (95 % CI, 1.3-4.6). Subgroup analyses demonstrated lower success and higher failure with debridement, antibiotics, and implant retention compared with one-stage and two-stage exchange arthroplasty. Hip CN-PJI showed higher reported success than knee CN-PJI. Antimicrobial regimens were highly heterogeneous and were not suitable for pooled analysis. <b>Conclusion</b>: Overall, CN-PJI may have favorable outcomes, particularly with exchange arthroplasty, but prospective studies with standardized definitions and treatment reporting are needed.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"413-430"},"PeriodicalIF":2.7,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689290","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":"Management of fracture-related infection in low-resource settings in Africa: recommendations and guidelines from an international expert group.","authors":"Loïc Fonkoué, Elizabeth K Tissingh, Leonard C Marais, Mbonisi Malaba, Kidanemariam Abrha, Jamie Ferguson, Mario Morgenstern, Olivier Cornu, Maritz Laubscher, Randy Buzisa Mbuku, George W Galiwango, Matthijs Botman, Justyna Wojno, Mtebe Venance Majigo, Claude Martin, William James Harrison, Alexander Thomas Schade, Kebba Marenah, Malvern Nyamutora, Phiona E Namale, Vuyisa Mdingi, Martin McNally","doi":"10.5194/jbji-11-401-2026","DOIUrl":"10.5194/jbji-11-401-2026","url":null,"abstract":"<p><p><b>Background:</b> Fracture-related infection (FRI) represents one of the most challenging complications in trauma care and disproportionately affects patients in low-resource settings, where diagnostic capacity, surgical infrastructure, and access to microbiology and reconstructive expertise are limited. <b>Methods:</b> An expert group was convened through the African Bone and Joint Infection Network (ABJIN) under the auspices of the European Bone and Joint Infection Society (EBJIS) and with support from the AO Alliance. Recommendations were developed through a three-step process: (1) a two-part survey assessing current practice and priority needs among clinicians from African countries, (2) an in-person multidisciplinary consensus meeting during the COSECSA Congress (Harare, 2024), and (3) an iterative collaborative review by a wider panel of clinicians from 14 countries. <b>Results:</b> The group produced context-adapted recommendations covering prevention, terminology, diagnosis, investigations, holistic patient optimization, antimicrobial therapy, local antibiotic delivery, and surgical management of FRI in low-resource settings. Key themes include the following: management of open fractures; diagnostic pathways prioritizing clinical criteria and intra-operative sampling; antimicrobial strategies reflecting local microbiology and drug availability; affordable local antibiotic carriers; and the importance of soft-tissue management, multidisciplinary collaboration, and centralization of complex cases. Barriers specific to low-resource settings - delayed presentation, restricted microbiology services, limited implant availability, and high burdens of comorbidities - were integrated into the recommendations. <b>Conclusion:</b> These consensus-based, context-specific recommendations provide practical guidance for FRI in low-resource settings. They aim to support clinicians in delivering safe, cost-effective care, accepting structural limitations while promoting standardization and audit. Further clinical research from low- and middle-income countries is needed to strengthen the evidence base and refine these recommendations.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"401-411"},"PeriodicalIF":2.7,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436726","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":"Literature review and case report on the use of rezafungin for spondylodiscitis in an outpatient parenteral antimicrobial therapy (OPAT) setting.","authors":"Alexander J Richards, Ammara Asif, Monica Ivan, Patrick J Lillie, Gavin Barlow, Chloe Walsh","doi":"10.5194/jbji-11-395-2026","DOIUrl":"10.5194/jbji-11-395-2026","url":null,"abstract":"<p><p>Bone and joint infections secondary to <i>Candida</i> species are associated with high morbidity and mortality, requiring extended courses of antifungal therapy, with parenteral medications being first-line therapy. The reported use of antifungals in outpatient parenteral antimicrobial therapy (OPAT) for deep-seated bone and joint infections is limited. We report and discuss the use of rezafungin, a novel long-acting echinocandin, in an OPAT setting for spondylodiscitis secondary to <i>Candida albicans</i>.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"395-400"},"PeriodicalIF":2.7,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436708","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":"Changes in systemic immune-inflammation index predict periprosthetic joint infection after hemiarthroplasty in elderly patients.","authors":"Emre Bilgin, Onur Gultekin, Murat Kilic, Umit Burak Alparslan, Mehmet Berke Yusan, Ahmet Onur Akpolat","doi":"10.5194/jbji-11-387-2026","DOIUrl":"10.5194/jbji-11-387-2026","url":null,"abstract":"<p><p><b>Background</b>: Periprosthetic joint infection (PJI) remains a devastating complication after hemiarthroplasty in elderly patients with femoral neck fractures. Early identification of high-risk patients is important. The systemic immune-inflammation index (SII), calculated as platelet <math><mo>×</mo></math> neutrophil <math><mo>/</mo></math> lymphocyte count, is a marker of systemic inflammation, although its role in this population remains unclear. <b>Methods</b>: This retrospective single-centre study included patients aged <math><mrow><mo>≥</mo> <mn>65</mn></mrow> </math>  years who underwent hemiarthroplasty between 2015 and 2025. Preoperative and postoperative day-5 SII values were calculated from routine blood tests. <math><mi>Δ</mi></math> SII was defined as the difference between postoperative and preoperative values. The primary outcome was PJI within 1 year after surgery. Logistic regression and receiver operating characteristic (ROC) analyses were performed. <b>Results</b>: A total of 976 patients were included, of whom 47 (4.8 %) developed PJI. Postoperative SII values were significantly higher in patients with PJI, whereas preoperative SII was not associated with infection risk. In multivariable analysis, postoperative SII remained independently associated with PJI (OR 1.195, 95 % CI 1.144-1.248, <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ). <math><mi>Δ</mi></math> SII was also independently associated with PJI (OR 1.124, 95 % CI 1.085-1.164, <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ). ROC analysis demonstrated good discriminatory performance for postoperative SII (AUC 0.882), with an optimal cut-off value of 2118. In contrast, <math><mi>Δ</mi></math> SII showed moderate discriminatory performance (AUC 0.764), with an optimal cut-off value of 656. <b>Conclusions</b>: Postoperative SII and <math><mi>Δ</mi></math> SII were independently associated with PJI after hemiarthroplasty. SII may aid early postoperative risk stratification and clinical decision-making when interpreted alongside clinical findings.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 4","pages":"387-394"},"PeriodicalIF":2.7,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436783","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":"Integrating molecular and conventional diagnostics in native vertebral osteomyelitis: a narrative review.","authors":"Farzad Pourghazi, Omar Mahmoud, Francesco Petri, Said El Zein, Gina A Suh, Takahiro Matsuo, Andrea Gori, Audrey N Schuetz, Elie F Berbari","doi":"10.5194/jbji-11-373-2026","DOIUrl":"10.5194/jbji-11-373-2026","url":null,"abstract":"<p><p>Native vertebral osteomyelitis (NVO) remains a diagnostic challenge due to its non-specific presentation and the limited sensitivity of culture-based methods. Blood cultures and image-guided biopsies are considered the diagnostic standards, but their yield is often low, especially in patients who have received prior antibiotics or are infected with fastidious microorganisms. Recent molecular techniques, including polymerase chain reaction (PCR) and next-generation sequencing (NGS), have improved pathogen detection and enabled more targeted antimicrobial therapy. In this narrative review, we summarize the diagnostic methods used in NVO, including conventional microbiological and molecular approaches, and present their strengths and limitations based on previous studies. We particularly focus on situations where molecular diagnostic techniques, such as 16S rRNA PCR, NGS, and microbial cell-free DNA testing, outperform traditional culture-based methods in sensitivity, while their specificity may be comparatively lower. Combining these molecular tools with standard diagnostic procedures may improve pathogen detection, guide targeted treatment, and enhance diagnostic accuracy in culture-negative or antibiotic-pretreated cases. Understanding the advantages and limitations of each diagnostic method can help clinicians to choose the most appropriate testing strategy, reduce diagnostic delays, and improve patient management in suspected NVO.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"373-385"},"PeriodicalIF":2.7,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436768","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":"Neutrophil extracellular trap (NET)-related index as an indicator of periprosthetic joint infection.","authors":"Tingrun Cui, Yongjian Liang, Zeyu Feng, Libo Hao, Guoqiang Zhang, Ming Ni, Jing Sheng, Dihua Shangguan, Jiying Chen, Jun Fu","doi":"10.5194/jbji-11-363-2026","DOIUrl":"10.5194/jbji-11-363-2026","url":null,"abstract":"<p><p><b>Background</b>: Periprosthetic joint infection (PJI) is a devastating complication of arthroplasty and is difficult to diagnose accurately. This study aims to explore the value of neutrophil extracellular traps in synovial fluid (SF-NETs, web-like structures released by neutrophils as a critical innate immune response) for diagnosing PJI. <b>Methods</b>: A retrospective cohort study was conducted, enrolling post-arthroplasty subjects from January 2018 to December 2023. Three components of SF-NETs (cell-free double-strand DNA, SF-dsDNA; citrullinated histone H3, SF-CitH3; SF-Nucleosome) and SF-NETs₁₊ (positive with one out of the three NET components), SF-NETs₂₊ (positive with two out of the three NET components), white blood cell count (SF-WBC), polymorphonuclear cell percentage (SF-PMN %), neutrophil count in SF (SF-PMN), microbiological examinations (Culture) and infection-related systemic indices were evaluated. <b>Results</b>: A total of 64 of 153 included subjects were diagnosed as PJI. SF-dsDNA and SF-CitH3 had significantly higher levels in the PJI group compared to the non-PJI group ( <math><mi>P</mi></math> <math><mo><</mo></math> 0.001) and showed positive correlations with SF-WBC, SF-PMN % and SF-PMN (0.4 <math><mo><</mo></math> <math><mi>ρ</mi></math> <math><mo><</mo></math> 0.7), while SF-Nucleosome had no significant difference. Sensitivity and specificity of SF-NETs₁₊, SF-NETs₂₊ and Culture were 82.2 % and 78.7 %, 59.4 % and 95.5 %, and 54.1 % and 86.8 %, respectively. The NET related index (NETRI) was defined as 10.529 <math><mo>×</mo></math> SF-NETs <math> <mrow><msub><mi></mi> <mrow><mn>1</mn> <mo>+</mo></mrow> </msub> <mo>+</mo></mrow> </math> 28.114 <math><mo>×</mo></math> SF-PMN % <math><mo>+</mo></math> 8.210 <math><mo>×</mo></math> Culture-1.452, with the area under the receiver operating characteristic curve of 0.922, making it a novel indicator. <b>Conclusions</b>: SF-NETs₁₊ and SF-NETs₂₊ may serve respectively in the screening and exclusion of PJI. NETRI represented a new discriminator for PJI diagnosis.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"363-371"},"PeriodicalIF":2.7,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13292152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148329888","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":"Gram-negative prosthetic joint infections: a retrospective multicentre European study of incidence, risk factors, and treatment outcomes.","authors":"Ernest Famada Arboix, Arnaud Fischbacher, Matteo Carlo Maria Ferrari, Olivier Borens, Daniel Pérez-Prieto","doi":"10.5194/jbji-11-355-2026","DOIUrl":"10.5194/jbji-11-355-2026","url":null,"abstract":"<p><p><b>Background</b>: Gram-negative (GN) bacteria are an increasingly recognized cause of prosthetic joint infection (PJI), accounting for 10 %-20 % of cases. However, epidemiological data from European centres remain limited. This study aimed to evaluate the incidence, risk factors, microbiological profile, and treatment outcomes of GN PJI in several European tertiary referral hospitals. <b>Methods</b>: We conducted a retrospective multicentre study including all culture-positive hip and knee PJIs diagnosed between 2014 and 2018 at three tertiary hospitals in Italy, Spain, and Switzerland. Demographic characteristics, comorbidities, surgical management, microbiological data including antimicrobial susceptibility, and treatment outcomes were analysed. Treatment success was defined as absence of persistent or recurrent infection requiring additional surgery, prosthesis removal, infection-related mortality, or long-term suppressive antibiotic therapy. <b>Results</b>: Among 780 confirmed PJIs, 71 (9.1 %) were caused by GN bacteria. The most frequent pathogens were polymicrobial infections (29.6 %), <i>Escherichia coli</i> (25.4 %), and <i>Pseudomonas aeruginosa</i> (19.7 %). GN PJI mainly affected elderly patients (median age 74 years), females (60.6 %), and those with comorbidities such as diabetes mellitus (32.4 %) and those who are overweight/obese (62 %). Hip infections were more common than knee infections (59.2 % vs. 40.8 %). Overall treatment success was 89 %. Two-stage revision showed the highest success rate of 94.8 % compared with one-stage exchange (88 %) and DAIR (81 %). Ciprofloxacin was used in 72 % of cases. <b>Conclusions</b>: GN PJI incidence was comparable to that of previous reports. These infections occur more often in elderly patients with comorbidities. Two-stage revision remains the most effective surgical strategy, and ciprofloxacin continues to be a key component of antimicrobial therapy for susceptible GN infections.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"355-361"},"PeriodicalIF":2.7,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13292068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148329946","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":"Intrawound vancomycin powder in orthopaedic surgery after the VPIP trial: a critical reappraisal of efficacy, dosing, application plane, and antimicrobial stewardship.","authors":"Felix Werneburg, Alexander Zeh, Natalia Gutteck, Karl-Stefan Delank","doi":"10.5194/jbji-11-343-2026","DOIUrl":"10.5194/jbji-11-343-2026","url":null,"abstract":"<p><p>Topical intrawound vancomycin powder has been widely adopted in orthopaedic surgery as an adjunct for the prevention of surgical site infection (SSI) and periprosthetic joint infection (PJI). Retrospective cohorts and derived meta-analyses have long suggested a consistent benefit, and the technique became established practice at many institutions. Over the past 5 years, prospective randomised evidence has added an important corrective to this picture. The VPIP trial (Saba et al., 2025) randomised 1901 high-risk patients undergoing primary hip or knee arthroplasty across 17 US centres and found no benefit of vancomycin, dilute povidone-iodine, or their combination over saline for any 3-month infection endpoint; a biostatistical projection to 80 000 patients left the number needed to treat near 500, and enrolment was closed for statistical futility. The VANCO trial in high-risk tibial fractures (O'Toole et al., 2021) narrowly missed its primary endpoint ( <math><mrow><mi>P</mi> <mo>=</mo> <mn>0.06</mn></mrow> </math> ) but demonstrated a significant post hoc reduction in gram-positive deep infections without gram-negative shift. Mechanistic data indicate that sub-inhibitory vancomycin concentrations increase <i>Staphylococcus aureus</i> biofilm formation and raise infection rates in vivo - an effect not reproduced by cefazolin. Current international guidance does not issue a general recommendation for topical vancomycin, a position consistent with this more differentiated evidence base. The present review integrates these strands into an indication-specific framework that separates prophylactic application in clean surgical fields, where benefit is now in serious doubt, from adjunctive-therapeutic application in established infection, and identifies the settings in which topical vancomycin may still be considered individually and those in which it should be avoided.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"343-354"},"PeriodicalIF":2.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271711","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}