Journal of Bone and Joint Infection最新文献

{"title":"Malnutrition affects infection rates and quality of life in patients undergoing primary hip and knee arthroplasty: a retrospective study.","authors":"Domenico De Mauro, Chiara Comisi, Valeria Maccauro, Giovanni Balato, Sebastian Meller, Martina Di Martino, Fabiana Arduini, Giulio Maccauro, Raffaele Vitiello","doi":"10.5194/jbji-11-139-2026","DOIUrl":"10.5194/jbji-11-139-2026","url":null,"abstract":"<p><p><b>Background</b>: Although malnutrition is globally associated with incremental morbidity, mortality, and cost, there has been a fundamental lack of consensus on diagnostic criteria for application in clinical settings. The study aims were (i) to identify the role of malnutrition as an independent risk factor for complications in the total joint arthroplasty (TJA) context; and (ii) to analyse the impact of malnutrition on treatment success, specifically in terms of patient-reported quality of life. <b>Methods</b>: The study retrospectively analysed 1070 patients undergoing total hip or knee arthroplasty between January 2019 and July 2022. Before the surgery, patients' nutritional status were assessed through Nutritional Risk Screening 2002 (NRS-2002) and controlling nutritional status (CONUT) scores. Patients were classified in two different groups: patients with NRS <math><mo>≥</mo></math> 3 were included in the Malnutrition group, and patients with NRS <math><mo><</mo></math> 3 in the Control group. <b>Results</b>: A total number of 682 patients was included in the study. Mean age was 70.1 <math><mo>±</mo></math> 9.6, 53 % women ratio, BMI 28.1 <math><mo>±</mo></math> 4.8 kg m^-2. A univariate regression, adjusted for age and sex, was performed. Both NRS-2002 and the CONUT score were significant risk factors in infectious complications and in EQ5 domains of quality-of-life assessment ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.05</mn></mrow> </math> ). <b>Conclusions</b>: Malnutrition, as identified by both the NRS-2002 and CONUT scores, emerges as an independent risk factor, contributing to worse post-operative outcomes and increased complications, thereby decreasing the potential benefits of TJAs. Pre-operative nutritional assessment and targeted intervention to address malnutrition can play a crucial role in improving clinical outcomes, quality of life, and complication rates.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 2","pages":"139-147"},"PeriodicalIF":2.7,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377647","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":"Septic arthritis and prosthetic joint infections: microbial spectrum and evolving resistance patterns.","authors":"Merve Gürler, Füsun Kırca, Bedia Dinç","doi":"10.5194/jbji-11-123-2026","DOIUrl":"10.5194/jbji-11-123-2026","url":null,"abstract":"<p><p><b>Background</b>: Septic arthritis (SA) and prosthetic joint infection (PJI) are severe musculoskeletal emergencies associated with rapid joint destruction, functional disability, and high mortality. Accurate microbiological diagnosis remains challenging, particularly in PJIs where biofilm formation reduces culture sensitivity. Local epidemiological data are essential to optimize empirical therapy and stewardship strategies. This study aimed to determine the distribution of microorganisms isolated from synovial fluid cultures and to evaluate antimicrobial resistance trends, with a direct comparison between native SA and PJI over a 5-year period. <b>Methods</b>: We retrospectively analyzed 3171 synovial fluid specimens collected between January 2020 and December 2024 at a tertiary referral hospital. Microorganisms were identified by MALDI-TOF MS, and antimicrobial susceptibility was tested with VITEK-2 according to EUCAST criteria. Resistance trends were assessed for major pathogens. <b>Results</b>: Overall, 651 samples (20.5 %) yielded growth, with significantly higher positivity in blood culture bottles than sterile containers (29.6 % vs. 16.1 %, <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ). PJIs accounted for 47.8 % of positive cultures. The most frequent pathogens were <i>Staphylococcus aureus</i> (33.6 %), coagulase-negative staphylococci (CoNS) (24.9 %), and <i>Pseudomonas aeruginosa</i> (8.6 %). CoNS ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.017</mn></mrow> </math> ) and <i>E. faecalis</i> ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.009</mn></mrow> </math> ) were significantly more common in PJIs. Methicillin resistance increased among <i>S. aureus</i> (20.0 % <math><mo>→</mo></math> 30.8 %) and remained high among CoNS (51 %-85 %). Extended-spectrum <math><mi>β</mi></math> -lactamase (ESBL) prevalence rose in <i>K. pneumoniae</i> (14.3 % <math><mo>→</mo></math> 42.1 %) and remained high in <i>E. coli</i> (57 %-80 %). All staphylococcal isolates remained susceptible to glycopeptides, linezolid, and daptomycin. <b>Conclusions</b>: Staphylococci remain the dominant pathogens in joint infections, with CoNS and <i>E. faecalis</i> strongly associated with PJIs. Rising methicillin resistance and ESBL-producing Enterobacterales highlight the need for careful empirical coverage, while preserved activity of last-line agents is reassuring. Routine inoculation into blood culture bottles significantly improves diagnostic yield.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 1","pages":"123-137"},"PeriodicalIF":2.7,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12937089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326099","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":"Treatment of periprosthetic joint infection - outcomes following algorithm-guided treatment at a multidisciplinary referral centre.","authors":"Christian Merz, Jan Klaas, Rik Osinga, Parham Sendi, Richard Alexander Kuehl, Mario Morgenstern, Martin Clauss","doi":"10.5194/jbji-11-113-2026","DOIUrl":"10.5194/jbji-11-113-2026","url":null,"abstract":"<p><p><b>Introduction</b>: This study evaluated early treatment outcomes and the management of complications in patients with periprosthetic joint infection (PJI) of the hip and knee treated at a specialized centre using an algorithm-guided multidisciplinary team (MDT) approach. <b>Methods</b>: This prospective cohort includes all consecutive patients treated for acute or chronic PJI between December 2019 and December 2022, with a minimum 1-year follow-up. PJI was defined according to the criteria of the European Bone and Joint Infection Society (EBJIS). Surgical decisions were based on a published treatment algorithm. The primary outcome was treatment success at 1 year after the last PJI surgery. <b>Results</b>: 106 patients were included according to prespecified criteria, with a median age of 74 years (IQR 66-82) and follow-up of 24 months (IQR 15-28). 79 patients (75 %) were referred from other institutions. 44 patients (42 %) were treated with debridement, antibiotics, and implant retention (DAIR); 17 (16 %) were treated with one-stage revision; and 45 (42 %) were treated with two-stage revision. 9 patients (8 %) needed plastic surgery for soft tissue reconstruction. The 1-year infection-free survival (Delphi-based consensus criteria) was 69 % (95 % CI: 60 %-78 %). Within 1 year, 14 (13.2 %) septic and 12 (11.3 %) aseptic failures occurred after a median of 0.5 months (IQR 0.4-1) and were successfully treated in most patients. 12 patients (11 %) died after a median of 0.8 months (IQR 0.3-2.8). <b>Conclusion</b>: Our results demonstrate the value of an algorithm-driven MDT approach as an effective strategy for managing complex PJI patients and PJI-surgery-related complications in a specialized referral centre for bone and joint infections.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 1","pages":"113-121"},"PeriodicalIF":2.7,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271106","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":"Safety of locally applied antibiotics in orthopaedic trauma surgery: descriptive results from a prospective cohort study.","authors":"Niels Vanvelk, Esther M M Van Lieshout, Leendert H T Nugteren, A Cornelis Plaisier, Rosalya Van der Pot, Corine Bethlehem, Willem-Jan Metsemakers, William T Obremskey, Michael H J Verhofstad","doi":"10.5194/jbji-11-95-2026","DOIUrl":"10.5194/jbji-11-95-2026","url":null,"abstract":"<p><p>Antibiotic therapy holds an integral role in the prevention and treatment of fracture-related infection (FRI). Because local concentrations after systemic administration are limited by the potential for side effects, the local application of antibiotics serves as a valuable adjunct. One concern with the local administration of high amounts of aminoglycosides and vancomycin is the absorption into the systemic circulation, leading to detrimental effects on renal function. In this study, serum antibiotic concentration and renal function were measured in patients treated for open fractures or FRI using local antibiotics at 6, 24 and 48 h postoperatively. Afterwards, laboratory analyses were continued daily until the concentration dropped beneath the lower limit of quantification (LLOQ) (0.22 mg L^-1 for gentamicin, 0.70 mg L^-1 for vancomycin). Gentamicin concentration, vancomycin concentration and glomerular filtration rate were measured 272, 60 and 277 times in 52 patients after 82 surgeries, respectively. The LLOQ for gentamicin was exceeded in 14 surgeries (17 %, median concentration 0.3 mg L^-1). The highest measured antibiotic level was 1.0 mg L^-1, well below the generally accepted toxic trough level of 2.0 mg L^-1. Although the total quantity of antibiotics delivered via beads was less than that provided by an antibiotic spacer, the use of beads more frequently yielded measurements exceeding the established threshold. None of the vancomycin measurements surpassed the LLOQ. The results of this study suggest that the current clinical use of locally applied antibiotics in orthopaedic trauma surgery is safe in the context of nephrotoxicity. The type of antibiotic carrier might affect local release and subsequent systemic absorption, which must be considered.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 1","pages":"95-103"},"PeriodicalIF":2.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12917603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271115","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 failure rate in <i>Pseudomonas aeruginosa</i>-associated periprosthetic hip and knee joint infections.","authors":"Ece Akcicek, Jennyfer A Mitterer, Veronika Achatz, Tamino Szirmay, Sujeesh Sebastian, Jochen G Hofstaetter","doi":"10.5194/jbji-11-83-2026","DOIUrl":"10.5194/jbji-11-83-2026","url":null,"abstract":"<p><p><b>Introduction</b>: <i>Pseudomonas aeruginosa</i> is one of the most common Gram-negative (GN) pathogens in periprosthetic joint infections (PJIs). However, not many data are available on them. This study aimed to evaluate the prevalence of <i>P. aeruginosa</i> in hip and knee PJIs, patient characteristics, types of infection, resistance patterns, treatments, and outcomes. <b>Methods</b>: We retrospectively analyzed culture-positive revision total hip and knee arthroplasties (rTHA and rTKA) from 2008 to 2023. Cases were evaluated according to the International Consensus Meeting (ICM) 2018 and European Bone and Joint Infection Society (EBJIS) criteria 2021. The success rate was calculated according to Tier classification. <b>Results</b>: Among 1640 revision procedures performed on 1286 patients, 195 revisions in 160 patients were positive for GN microorganisms, including 50 <i>P. aeruginosa</i> cases (3.1 %, hip/knee: 39/11) in 38 patients. Most were chronic (64 %), monomicrobial (74 %) infections, particularly infected rTHA (63.8 %). <i>Proteus mirabilis</i> was the main co-pathogen (23.1 %) in polymicrobial infections. The mean follow-up time was 65.4 months. The most frequent surgical intervention was two-stage exchange (48 %). Chronic infections required significantly more total revisions than acute cases. Success rates decreased with each additional revision. Antibiotic resistance developed in three patients during subsequent revisions. The overall success rate was 46 %. Reinfection-free survival decreased from 95 % at 12 months to 22.4 % after 10 years. <b>Conclusion</b>: In our patient cohort, <i>Pseudomonas aeruginosa</i> accounted for one-third of hip and knee GN PJIs, was mostly found in infected rTHA, and was monomicrobial. Changes in antimicrobial resistance, high failure rates, and low long-term infection-free survival underline that <i>Pseudomonas aeruginosa</i> is a challenging PJI pathogen.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 1","pages":"83-94"},"PeriodicalIF":2.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12917492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270940","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":"How much are we willing to do for the ones we love - impact on caregivers of patients suffering from periprosthetic joint infections: a qualitative study.","authors":"Franz-Joseph Dally, Franziska Prüßner, Frederic Bludau, Sascha Gravius, Ali Darwich, Marcel Betsch","doi":"10.5194/jbji-11-105-2026","DOIUrl":"10.5194/jbji-11-105-2026","url":null,"abstract":"<p><p><b>Introduction</b>: We aimed to identify and explore the psychological and physical strains that caregivers of patients suffering from a periprosthetic joint infection (PJI) experience. <b>Methods</b>: Twenty-four qualitative semi-structured interviews with people giving care to patients suffering from a PJI were conducted by a single trained interviewer. The interviews were used to identify physical and emotional challenges that caregivers were confronted with. <b>Results</b>: The psychological and physical strains caregivers reported were wide-ranging and included suffering from stress and anxieties, and feelings of hopelessness and helplessness while having to function all the time to the point where, subjectively, caregivers felt as if they gave themselves up. Caregivers were suffering from mental and physical exhaustion as mainly family members and close ones provided the caregiving. Oftentimes an elaborate team effort approach was needed to lighten the caregiving burden. <b>Conclusions</b>: This study shows that caregivers are willing to go above and beyond for their loved ones, while exhausting and exceeding their individual resources. Caregivers of PJI patients deal with major issues. Specifically, we identified (1) conflicts regarding the hospital stay, (2) novel personal challenges, (3) nursing, (4) emotional and psychological consequences, and (5) effects on the relationship. Our research shows that there is a profound need for support during and after hospitalisation, and caring for a PJI patient seems surprisingly similar to caring for a cancer patient. We recommend including the caregivers of PJI patients, and how to better support them, into the PJI treatment guidelines.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 1","pages":"105-112"},"PeriodicalIF":2.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12917602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271054","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":"Lyme in the prosthetic joint: two cases and a review of the literature.","authors":"Hussam Tabaja, Matteo Passerini, Irene G Sia, Elena Beam, Gina A Suh","doi":"10.5194/jbji-11-77-2026","DOIUrl":"10.5194/jbji-11-77-2026","url":null,"abstract":"<p><p>Lyme periprosthetic joint infection (PJI) is rare, with only 8 cases reported in the literature. In this paper, we describe 2 cases and review the prior 8 cases to better characterize its diagnosis and management. All 10 cases presented with culture-negative PJI in Lyme-endemic regions and were confirmed to have Lyme PJI via a positive <i>Borrelia</i>-targeted polymerase chain reaction (PCR) run on joint specimens. Treatment strategies varied: 5 underwent debridement, antibiotics, and implant retention (DAIR); 1 had exchange arthroplasty; and 4 were managed non-operatively. Antimicrobial treatment also varied considerably. All patients achieved clinical cure. Lyme disease should be considered a potential cause of culture-negative PJI occurring in endemic regions. Because <i>Borrelia</i>-targeted PCR is not routinely included in standard PJI diagnostic workup, diagnosis may be delayed; therefore, clinicians should consider ordering this test when Lyme PJI is part of the differential.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 1","pages":"77-82"},"PeriodicalIF":2.8,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12891817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146179646","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":"Gentamicin fails to eradicate <i>Staphylococcus aureus</i> biofilm in vitro, even in combination with rifampin.","authors":"Willemijn Boot, Michel Schläppi, Virginia Post, T Fintan Moriarty, Peter Wahl","doi":"10.5194/jbji-11-65-2026","DOIUrl":"10.5194/jbji-11-65-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Biofilm formation is one of the key elements making orthopaedic device-related infections (ODRIs) difficult to eradicate. Aminoglycosides such as gentamicin are frequently applied via local carriers, and systemic rifampin is added for its anti-biofilm activity. However, robust in vitro evidence of their ability to eradicate mature biofilm is limited. This study assessed whether gentamicin, alone or in combination with rifampin, can eradicate established <i>Staphylococcus aureus</i> biofilm in vitro. <b>Methods</b>: A clinical methicillin-susceptible <i>S. aureus</i> isolate was grown as a 5 d old biofilm on a peg lid microtiter plate. Three exposure regimens were tested: (i) continuous exposure to gentamicin (15-2000 mg L^-1) for 28 d, (ii) intermittent 2 h exposures twice daily (at 15, 250 and 2000 mg L^-1) for 28 d to reflect systemic twice-daily dosing and (iii) a 14 d burst release starting at 2000 mg L^-1 with stepwise decline to model release from local carriers. Rifampin was either absent or added at 3.3 mg L^-1, approximating peri-implant concentrations from preclinical pharmacokinetic studies. Biofilm viability was quantified as colony-forming units (CFUs) from sonicated pegs, and selected surviving isolates underwent susceptibility testing. <b>Results</b>: Across all regimens, concentration- and time-dependent decreases in CFU counts were observed, but no regimen resulted in bacterial counts falling below the lower limit of detection (LLOD). The addition of rifampin did not result in the sustained enhancement of biofilm killing, and, in some regimens, resulted in higher CFU counts. Isolates recovered from culture-positive pegs remained largely susceptible to gentamicin, whereas rifampin resistance arose sporadically. <b>Conclusion</b>: High-dose gentamicin exposures failed to eradicate 5 d old <i>S. aureus</i> biofilm in vitro, whatever the administration regimen. Rifampin co-administration did not alter the final outcome of biofilm persistence, despite its well-recognised anti-biofilm activity. These findings challenge the reliance on aminoglycoside-loaded carriers as curative strategies for ODRIs and suggest that persistent viability may reflect antibiotic tolerance that may not be overcome by antibiotics alone.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 1","pages":"65-76"},"PeriodicalIF":2.8,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12891982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146179713","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":"Diagnosis and management of fracture-related infections in a low-income country: a prospective study comparing current practice to international consensus guidelines.","authors":"Loïc Fonkoué, Elizabeth K Tissingh, Cilia Ngang, Olivier Kennedy Muluem, Jasmine Sibatcheu Simo, Richard Douvamai, Jean Bahebeck, Olivier Cornu, Martin McNally","doi":"10.5194/jbji-11-53-2026","DOIUrl":"10.5194/jbji-11-53-2026","url":null,"abstract":"<p><p>Data on the implementation of international consensus guidelines for fracture-related infection (FRI) in low- and middle-income countries (LMICs) are scarce. This study assessed whether FRI diagnosis and management in an LMIC align with these recommendations. <b>Methods:</b> We conducted a prospective multicenter study across four tertiary hospitals in Yaoundé, Cameroon (September 2022-July 2025). All consecutive patients with a working FRI diagnosis were included. Confirmatory/suggestive diagnostic criteria and treatment strategies were assessed against consensus guidelines. <b>Results:</b> A total of 169 patients were included (mean age 39.4 <math><mo>±</mo></math> 15.4 years; 72.7 % male). In 34.3 % of cases, FRI occurred without prior surgery, limiting applicability of the Willenegger and Roth classification. Clinical confirmatory criteria were present in 97 % of cases. Microbiological standards were seldom achieved: none fulfilled sampling quantity, and only 46.6 % met sampling method recommendations. A microbiological confirmatory criterion was documented in 36 patients (21.3 %); histopathology was rarely performed (1.2 %), and nuclear imaging was not used. Most patients (81.1 %) were on antibiotics before admission or surgery. The most common treatment strategies were suppressive antibiotic therapy (44.4 %); one-stage (11.2 %) or two-stage (10.7 %) debridement, antibiotics, and implant exchange (DAIEX); and debridement, antibiotics, and implant retention (DAIR; 9.5 %). Overall, 62.7 % of treatments deviated from consensus guidelines. <b>Conclusion:</b> Nearly two-thirds of FRIs in this LMIC setting were managed outside international consensus guidelines. While the consensus definition is applicable, diagnostic capacity remains limited and microbiological standards are often impractical. Context-adapted, evidence-based guidelines are urgently needed to improve outcomes where the burden is highest.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 1","pages":"53-63"},"PeriodicalIF":2.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113219","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":"Osteomyelitis in peri-implant bone of hip prosthetic joint infection: prevalence and clinical impact.","authors":"Ernesto Muñoz-Mahamud, Melissa Rivera, Ana Belén Larque, Laura Morata, Andrés Combalia, Alfonso Alías, Jenaro Ángel Fernández-Valencia, Álex Soriano","doi":"10.5194/jbji-11-43-2026","DOIUrl":"10.5194/jbji-11-43-2026","url":null,"abstract":"<p><p><b>Introduction</b>: Periprosthetic joint infection (PJI) after hip revision surgery shows variable failure rates, with the impact of osteomyelitis in the surrounding bone on outcomes remaining unclear. This study aims to examine bone osteomyelitis prevalence and its impact on hip PJI revision outcomes. <b>Material and methods</b>: This retrospective study reviewed 75 cases of chronic hip PJI patients undergoing hip revisions performed at a single center between January 2019 and June 2023. Only cases with peri-implant bone samples submitted for histology evaluation were included. Bone samples were assessed for osteomyelitis using histological criteria. Risk factors, including demographic data, preoperative infections, and previous revisions, were analyzed. Statistical significance was determined using Chi-square and Kaplan-Meier survival analysis ( <math><mrow><mi>p</mi> <mo>≤</mo> <mn>0.05</mn></mrow> </math> ). <b>Results</b>: A total of 52 cases of chronic hip PJI were included for final analysis. Up to 30.8 % of the cases ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>16</mn></mrow> </math> ) presented histological signs of osteomyelitis. The success rate among those 36 cases where no signs of osteomyelitis were observed was 88.9 %, whereas, in the 16 cases where it was present, the rate dropped to 37.5 %. Histological signs of osteomyelitis were significantly associated with a prior history of multiple surgeries and unsuccessful antibiotic treatments ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.01</mn></mrow> </math> ), the presence of a sinus tract ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.01</mn></mrow> </math> ), and the need for additional debridement with spacer exchange after the first stage of a two-stage revision ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.001</mn></mrow> </math> ). <b>Conclusion</b>: Patients with signs of osteomyelitis demonstrated a higher failure rate. Histological evaluation of periprosthetic bone should ideally be performed during the first stage of revision surgery to guide second-stage management and to improve outcomes.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"11 1","pages":"43-52"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12823157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029716","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}