Journal of Bone and Joint Infection最新文献

{"title":"\"ID-ing\" the value: how are orthopaedic infectious disease physicians compensated for their time? A national survey.","authors":"Jessica C O'Neil, Bethany Lehman, Thorsten Seyler, Nicolas Piuzzi, Sean Ryan, Jessica Seidelman, Julie Reznicek, Poorani Sekar","doi":"10.5194/jbji-11-337-2026","DOIUrl":"10.5194/jbji-11-337-2026","url":null,"abstract":"<p><p><b>Background</b>: Optimal outcomes in periprosthetic joint infection (PJI) and other complex orthopaedic infections depend on longitudinal, multidisciplinary input from infectious disease (ID) specialists. Much of this work is not directly billable, and the financial structures that support it have not been systematically described in any healthcare system. <b>Methods</b>: We distributed an anonymous online cross-sectional survey to ID physician members of the Musculoskeletal Infection Society (MSIS) and the Infectious Diseases Society of America Bone and Joint Interest (IDSA-BOJO) group between 12 December 2025 and 30 January 2026. The survey captured practice setting, clinical and non-clinical orthopaedic ID responsibilities, and sources of compensation and protected time. Data were analysed descriptively; no inferential statistical testing was performed. <b>Results</b>: Fifty-two ID physicians responded, 94 % from US academic medical centres. Median ID clinical effort was 70 % (IQR 60 %-81 %); of this, a median of 55 % (IQR 40 %-90 %) was devoted to orthopaedic infections. Compensation was most commonly a base salary plus productivity incentives (53 %) or base salary alone (40 %) and was funded by medicine/ID in 88 % of cases. Care coordination (90 %), curbside consultation (85 %), trainee education (77 %), and guideline development (71 %) were performed; 83 % of respondents received no protected time or dedicated funding for any of these non-billable activities. <b>Conclusions</b>: In this descriptive, hypothesis-generating national survey of highly subspecialized US ID physicians, compensation structures were dominated by clinical productivity and rarely included protected time for the non-billable coordination work that underpins modern multidisciplinary PJI care. These findings should be interpreted in the context of a small, academic-predominant sample and of substantial international variation in healthcare financing, and they support the need for larger international studies of how orthopaedic ID expertise is funded and protected.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"337-342"},"PeriodicalIF":2.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271726","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":"Primary hip or knee arthroplasty in the setting of chronic suppressive antibiotics for prior periprosthetic joint infection: a scoping review.","authors":"Vincent K Melemai, Ryan J Blake, Christian Barill, Adam E Klein, Matthew J Dietz, Allison M Lastinger","doi":"10.5194/jbji-11-331-2026","DOIUrl":"10.5194/jbji-11-331-2026","url":null,"abstract":"<p><p><b>Background:</b> Total joint arthroplasty (TJA) is an increasingly common intervention in the US, with an expected proportionate rise in periprosthetic joint infection (PJI). As part of the treatment plan, long-term suppressive oral antibiotic therapy is sometimes used in patients who would not benefit from further surgical intervention of their PJI. The aim of this scoping review is to outline the current evidence surrounding PJI incidence in new primary arthroplasty in this patient population. <b>Methods:</b> A search was conducted using the PubMed and Scopus databases with no date restrictions. Studies examining the incidence of developing a PJI after new primary hip or knee arthroplasty in patients receiving chronic suppressive antibiotic therapy for a prior PJI were included. Two authors independently screened the results for inclusion in this review. <b>Results:</b> Three retrospective cohort studies were ultimately included. Across studies, 61 patients with prior PJI receiving chronic suppressive antibiotics undergoing new primary TJA were identified. PJI rates in suppressed patients ranged from 0 % to 21.4 % compared to 0 % to 2.9 % in non-suppressed patients with prior PJI and 0 % to 2.6 % in matched controls without prior PJI. <b>Conclusion:</b> Limited evidence exists regarding PJI risk in new primary arthroplasty among patients on chronic suppression for prior PJI, with a wide range of incidence reported across studies. Due to a lack of direct evidence examining this specific patient population, further research must be conducted in order to support strong recommendations.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"331-336"},"PeriodicalIF":2.7,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199082","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":"High intra- and inter-observer reliability of the PJI-TNM classification in acute and chronic periprosthetic hip joint infection.","authors":"Dominic Simon, Jonas Tumler, Lennart M Schroeder, Florian Pachmann, Eduardo Suero, Boris M Holzapfel, Gautier Beckers, Kathrin Pfahl","doi":"10.5194/jbji-11-323-2026","DOIUrl":"10.5194/jbji-11-323-2026","url":null,"abstract":"<p><p><b>Background</b>: Periprosthetic joint infections (PJIs) remain a significant complication following total hip arthroplasties (THAs), affecting patient outcomes and healthcare costs. The accurate classification of PJIs is crucial for guiding treatment decisions and improving patient management. The TNM classification system, commonly used in oncology, has previously been adapted for PJI to enhance our understanding of infection severity and is progressively used as PJI-TNM. <b>Purpose</b>: This study evaluates the applicability of the PJI-TNM classification in a cohort of 185 periprosthetic hip joint infections, including 84 acute and 101 chronic cases. <b>Methods</b>: In this retrospective study, we analyzed 84 cases of acute and 101 cases of chronic periprosthetic hip joint infections. Each case was independently classified according to the PJI-TNM framework by three observers. A second round of scoring was performed 90 d later to assess the intra-observer concordance. The objective was to evaluate the utility of this classification in distinguishing between acute and chronic infections, predicting outcomes, and informing treatment strategies. Furthermore, intra- and inter-observer reliability were evaluated. <b>Results</b>: For acute PJIs we found a high inter-observer and intra-observer reliability for both the first and second evaluation ( <math><mi>κ</mi></math> 0.78 and 0.89, respectively). In addition, the intra-observer analysis showed a very good correlation ( <math><mi>κ</mi></math> 0.86-0.96). For chronic PJIs the intra-observer reliability was <math><mi>κ</mi></math> of 0.85-0.96, whereas inter-observer reliability was lower with <math><mi>κ</mi></math> of 0.75-0.85. <b>Conclusion</b>: The PJI-TNM classification demonstrated strong intra-observer and substantial inter-observer reliability across both acute and chronic infections, supporting its use as a robust and reproducible framework for PJI classification.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"323-330"},"PeriodicalIF":2.7,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199134","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":"Tapping our resources: do preoperative aspirations add diagnostic value in hip and knee periprosthetic joint infection?","authors":"Anne Spichler-Moffarah, Lauren Daddi, Ilda Molloy, Tyler Luu, Duc Nguyen, Marjorie Golden","doi":"10.5194/jbji-11-315-2026","DOIUrl":"10.5194/jbji-11-315-2026","url":null,"abstract":"<p><p><b>Background</b>: Discrepancies exist between preoperative synovial aspirations and intraoperative cultures. It is unclear whether the results of preoperative arthrocentesis add diagnostic value for patients with possible prosthetic joint infection (PJI). <b>Methods</b>: We retrospectively identified adult patients treated surgically for hip and knee PJI who underwent both preoperative aspiration and intraoperative sampling. Synovial and intraoperative culture results were analyzed. Cultures were defined as concordant if they yielded the same organism(s) or if both were negative. Cultures were considered to be discordant if different organisms were isolated or if one had growth and the other was sterile. Demographic, clinical, and laboratory variables between groups were compared. <b>Results</b>: Among 75 patients, 54 (72 %) had concordant results, and 21 (28 %) had discordant results. In the discordant group, 7 of 21 patients (33 %) had negative synovial cultures with positive intraoperative cultures. Among culture-positive concordant patients, staphylococci and streptococci were the most common isolates, with 20 % gram negatives. True culture-negative PJI was uncommon ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>1</mn></mrow> </math> ). Preoperative antibiotic exposure was frequent ( <math><mrow><mo>></mo> <mn>50</mn></mrow> </math> %) in both groups. <b>Conclusion</b>: In a cohort of hip and knee PJI patients treated surgically, preoperative synovial aspiration cultures were concordant with intraoperative cultures in 72 % of cases, but negative synovial aspirations did not reliably exclude infection. Given the observed discordance, our findings support the obtainment of preoperative synovial aspiration and the collection of multiple intraoperative specimens at the time of surgery.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"315-321"},"PeriodicalIF":2.7,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199123","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":"Sinus tract and purulence as clinical criteria for periprosthetic joint infection: diagnostic accuracy, microorganisms, and clinical outcomes.","authors":"Markus Luger, Martin McNally, Lukas Rabitsch, Reinhard Windhager, Richard Lass, Irene Katharina Sigmund","doi":"10.5194/jbji-11-305-2026","DOIUrl":"10.5194/jbji-11-305-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Clinical criteria are included in all current periprosthetic joint infection (PJI) definitions, with sinus tract and purulence among the most unequivocal indicators of infection. However, evidence regarding their diagnostic accuracy remains limited. This study evaluated their diagnostic performance, associated microbial profile, and clinical outcomes. <b>Methods</b>: This retrospective study included 463 revision hip and knee arthroplasties between 2015 and 2023. A total of 245 (52.9 %) were classified as infected according to the 2021 European Bone and Joint Infection Society (EBJIS) definition. Receiver-operating-characteristic (ROC) curves and their areas under the curve (AUCs) were used for diagnostic accuracy calculations. Follow-up analysis was conducted using the Kaplan-Meier survival estimator. <b>Results</b>: Sensitivities for sinus tract and purulence were 12.7 % (95 % CI: 8.8-17.5) and 35.1 % (29.1-41.4), with specificities of 100 % (98.3-100) for both. AUCs were 0.546 (0.521-0.571) and 0.695 (0.653-0.737). The highest prevalence of sinus tract was observed in <i>Candida albicans</i> (50 %), polymicrobial infection (33 %), and <i>Cutibacterium acnes</i> (30 %), whereas purulence was most prevalent in <i>Streptococcus</i> spp. (73 %), <i>Staphylococcus aureus</i> (72 %), Enterobacteriaceae (50 %), and polymicrobial infections (43 %). Both were associated with lower 3-year infection-free survival; this was significant for sinus tract ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.011</mn></mrow> </math> ) and showed a trend for purulence ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.068</mn></mrow> </math> ). <b>Conclusion</b>: A sinus tract can be considered a confirmatory criterion for PJI due to its excellent specificity. Although highly specific, purulence remains subjective, with limited sensitivity, and should, if considered, be regarded only as a suggestive criterion. Both parameters were associated with lower survival rates and a consistent trend towards treatment failure.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"305-313"},"PeriodicalIF":2.7,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150032","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":"Nasal decolonization in total joint arthroplasty: current state of evidence.","authors":"Andrea Zampoli, Ghazal Pourbozorg, Goksel Dikmen, Ibrahim Tuncay, Javad Parvizi","doi":"10.5194/jbji-11-299-2026","DOIUrl":"10.5194/jbji-11-299-2026","url":null,"abstract":"<p><p>Periprosthetic joint infection is a major cause of morbidity and economic cost after total joint arthroplasty, with <i>Staphylococcus aureus</i> consistently identified as the most common pathogen causing surgical site infection (SSI) and periprosthetic joint infections (PJIs). Nasal mucosa is one of the principle reservoirs for <i>S. aureus</i>. Molecular epidemiology investigations have found concordance between nasal organisms and infecting strains, implying that many postoperative infections arise endogenously. Over the last decade, various clinical trials, institutional protocols, and meta-analyses have evaluated the efficacy of nasal screening and decolonization of <i>Staph aureus</i>. Recent evidence suggests that the success of infection prevention procedures is dependent on the reliability and consistency of decolonization rather than screening alone. This narrative review summarizes current evidence on nasal decolonization in total joint arthroplasty, including epidemiological data, methods of screening, and accessible therapy choices to suggest practical and reproducible infection control measures.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"299-304"},"PeriodicalIF":2.7,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042503","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":"Can we identify which patients are likely to have septic arthritis with borderline synovial fluid cell counts?","authors":"Boshen Liu, Michael Raffetto, Eric J Abbenhaus, Gavin S Hautala, William R Taylor, Lucy Bowers, Paul Edward Matuszewski","doi":"10.5194/jbji-11-287-2026","DOIUrl":"10.5194/jbji-11-287-2026","url":null,"abstract":"<p><p><b>Objective</b>: Septic arthritis (SA) is a clinical emergency that requires prompt diagnosis and surgical treatment to minimize morbidity and mortality. A synovial fluid cell count (SFCC) greater than 50 000 mm^-3 has been a threshold used to diagnose SA. However, patients with lower cell counts may have culture-positive septic arthritis, resulting in missed or delayed diagnoses. The purpose of this study was to assess the risk of culture-positive SA in patients with synovial fluid analyses that would typically be considered inconclusive and determine what factors may increase the risk of SA. <b>Methods</b>: Patients with SFCC <math><mo><</mo></math> 50 000 mm^-3 were retrospectively assessed at a single academic institution between 2010 and 2019. Laboratory measures such as white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), SFCC polymorphonuclear leukocyte percent (PMN), and patient factors and comorbidities were evaluated to determine a threshold for diagnosing SA in this patient population. <b>Results</b>: A total of 199 of 849 patients met inclusion criteria. There were 31 (15.6 %) cases of SA. SFCC and PMN thresholds of 20 000 cell mm^-3 and 70 %, respectively, maximized sensitivity and specificity of SA detection. Prior history of SA, inflammatory arthritis and/or crystalline arthropathy was associated with increased risk of SA. <b>Conclusion</b>: The traditional SFCC threshold of 50 000 cells mm^-3 may not be a reliable diagnostic criterion for all patients. Prior history of SA, inflammatory arthritis, or crystalline arthropathy is associated with increased risks of SA. It may be more appropriate to have lower diagnostic thresholds to clinically diagnose SA in these subsets of patient populations.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"287-297"},"PeriodicalIF":2.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987634","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 use of debridement, antibiotic pearls, and implant retention (DAPRI) in the management of acute periprosthetic joint infections: a systematic review.","authors":"Doriana Di Costa, Giacomo Capece, Donato Coppola, Elena Matteini, Pierluigi Del Vecchio, Francesco Taccari, Giuseppe Maccagnano, Carlo Torti, Giulio Maccauro, Raffaele Vitiello","doi":"10.5194/jbji-11-277-2026","DOIUrl":"10.5194/jbji-11-277-2026","url":null,"abstract":"<p><p><b>Background</b>: Periprosthetic joint infection (PJI) represents one of the most severe complications following joint arthroplasty, largely due to bacterial biofilm formation on implant surfaces. While debridement, antibiotics and implant retention (DAIR) is commonly used for acute infections, its effectiveness remains variable. Debridement, antibiotic pearls and implant retention (DAPRI) has been proposed as a modified technique aimed at improving local antibiotic delivery and biofilm eradication. This systematic review evaluates the current evidence on the effectiveness and safety of DAPRI in PJI management. <b>Materials and methods</b>: A systematic review was conducted according to PRISMA guidelines. PubMed, Scopus and Web of Science databases were searched for studies reporting the use of DAPRI in adult patients with PJI. Eligible studies included retrospective studies and case series reporting surgical details and postoperative outcomes. Methodological quality was assessed using the MINORS score. Demographic data, microbiology, antibiotic regimens and clinical outcomes were analysed. <b>Results</b>: Five studies involving 128 patients met the inclusion criteria. The mean patient age was 69.4 years, with a mean follow-up of 22.4 months. PJIs involved the knee ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>78</mn></mrow> </math> ), hip ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>44</mn></mrow> </math> ) and shoulder ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>6</mn></mrow> </math> ). Gram-positive organisms predominated, with <i>Staphylococcus aureus</i> (32 %) and <i>S. epidermidis</i> (28.9 %) being the most frequently isolated pathogens. Infection eradication was achieved in 105 cases, corresponding to an overall success rate of 82 %. Twenty-three patients (18 %) required further surgical intervention. Reported complications were limited and included wound dehiscence, renal dysfunction and heterotopic ossification. <b>Conclusions</b>: DAPRI appears to be a promising implant-retention strategy for the treatment of PJI, showing encouraging infection eradication rates with a low incidence of complications. However, the current evidence is limited by small sample sizes, heterogeneity in patient selection, surgical technique and antibiotic protocols, as well as the lack of comparative studies. High-quality prospective trials are needed to better define the role of DAPRI relative to established surgical approaches.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"277-285"},"PeriodicalIF":2.7,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987600","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":"Adverse events and tolerability of long-term suppressive antibiotic therapy for periprosthetic joint infection: a prospective cohort study.","authors":"Pia Reinecke, Svetlana Karbysheva, Stavros Goumenos, Anna Conen, Olga Pidgaiska, Carsten Perka, Andrej Trampuz, Thilo Khakzad, Sebastian Meller","doi":"10.5194/jbji-11-267-2026","DOIUrl":"10.5194/jbji-11-267-2026","url":null,"abstract":"<p><p><b>Background</b>: Long-term suppressive antibiotic therapy (SAT) is a management strategy for periprosthetic joint infection (PJI) when eradication is unattainable. However, SAT is often associated with adverse events (AEs) that may impact quality of life. This study aimed to evaluate the prevalence and types of AEs, assess patient-reported tolerability, and identify patient- and antibiotic-related factors associated with AEs during SAT for PJI. <b>Methods</b>: A retrospective analysis of a prospectively established cohort of 30 patients receiving SAT for PJI following DAIR (Debridement, Antibiotics, and Implant Retention) or prosthesis exchange between 2019 and 2022 was conducted at a specialized septic surgery department. SAT was indicated for suboptimal surgery or absence of biofilm-active antibiotics and was administered for <math><mrow><mo>≥</mo> <mn>6</mn></mrow> </math>  months. Structured patient interviews and institutional records were used to capture AEs, treatment modifications, SAT discontinuation, infection-related complications, and subjective tolerability. Patients were stratified by sex, age, BMI, and antibiotic agent. <b>Results</b>: The median SAT duration was 55 weeks (interquartile range (IQR): 40-101). Non-serious AEs occurred in 97 % of patients ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>29</mn></mrow> </math> ), predominantly affecting the gastrointestinal tract ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>63</mn></mrow> </math> ), skin ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>35</mn></mrow> </math> ), and nervous system ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>25</mn></mrow> </math> ). Treatment modifications were required in 23 % of patients, most frequently with amoxicillin or cotrimoxazole. SAT discontinuation occurred in one patient (3 %) due to multiple AEs. Four patients (13 %) experienced SAEs related to persistent or recurrent infection rather than antibiotic toxicity. Median subjective tolerability was 8 out of 10 (IQR 6-8); 57 % of patients rated tolerability as \"good\", 37 % as \"moderate\", and 6 % as \"poor\". <b>Conclusion</b>: SAT for PJI is associated with a high prevalence of mild to moderate AEs, but treatment discontinuation is rare. Most patients report acceptable tolerability, and serious antibiotic-related complications are uncommon. Careful patient selection, individualized monitoring, and management of AEs are essential to optimize long-term outcomes.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"267-275"},"PeriodicalIF":2.7,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13163188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930034","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":"CarboCell G/C provides sustained high local bone antibiotic levels with minimal systemic exposure, supporting its therapeutic potential in orthopedic infection management.","authors":"Nicole Lind Henriksen, Andrea René Jørgensen, Michal Poborsky, Christoph Crocoll, Niranjan G Kotla, Catrine Jyde Berthelsen, Mats Bue, Louise Kruse Jensen, Anders Elias Hansen, Jonas Rosager Henriksen","doi":"10.5194/jbji-11-257-2026","DOIUrl":"10.5194/jbji-11-257-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Achieving sustained local antibiotic concentrations is critical for managing orthopedic infections. This proof-of-concept study evaluated release kinetics, local/systemic concentrations, and histological responses to CarboCell G/C, an injectable gentamicin- and clindamycin-eluting depot in a porcine bone void model. <b>Methods</b>: CarboCell G/C containing 111 mg g^-1 gentamicin-docusate and 70 mg g^-1 clindamycin was injected into and around a tibial bone void in 11 pigs. Antibiotic concentrations in target tissues and systemic spillover were measured at 1-12 h by microdialysis and liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) and in tissue homogenates at 1, 3, and 7 d. Release was quantified by high-performance liquid chromatography (HPLC), and tolerability was assessed histologically. <b>Results</b>: Microdialysis showed high stable antibiotic tissue levels during the first 12 h with minimal systemic spillover. Peak gentamicin and clindamycin concentrations in bone were 730 <math><mo>±</mo></math> 170 and 3700 <math><mo>±</mo></math> 700 <math><mrow><mi>µ</mi> <mi>g</mi></mrow> </math> g^-1 and 42 <math><mo>±</mo></math> 15 and 360 <math><mo>±</mo></math> 120 <math><mrow><mi>µ</mi> <mi>g</mi></mrow> </math> g^-1 in soft tissue, respectively. Tissue half-lives ranged from 43-62 h for clindamycin and 40-46 h for gentamicin. Recovered depots had released <math><mo>∼</mo></math> 30 %-50 % of their antibiotic content at day 1 and <math><mo>∼</mo></math> 60 %-80 % by day 7. Depots elicited a mild-moderate local inflammatory response. <b>Conclusion</b>: CarboCell G/C provides sustained high local antibiotics for at least 7 d with minimal systemic spillover, supporting further evaluation in orthopedic infection management.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 3","pages":"257-265"},"PeriodicalIF":2.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13163189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930047","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}