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Microorganisms
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Prosthetic and Bone Infections: A Multidisciplinary Approach
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Prosthetic and Bone Infections: A Multidisciplinary Approach

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Medical Microbiology".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 21404

Special Issue Editors

Dr. Andrea Sambri

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Guest Editor
IRCCS Policlinico di Sant’Orsola, Bologna, 40138 Bologna, Italy
Interests: orthopedic and trauma surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Massimiliano De Paolis

E-Mail Website
Guest Editor
Orthopaedics and Traumatology Unit—IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
Interests: orthopaedics; traumatology; custom-made bone reconstruction; muscoloskeletal infections; bone and soft-tissue sarcomas
Special Issues, Collections and Topics in MDPI journals
Dr. Michele Fiore

E-Mail Website
Guest Editor
Orthopaedics and Traumatology Unit, IRRCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
Interests: orthopaedics; traumatology; custom-made bone reconstruction; muscoloskeletal infections; bone and soft-tissue sarcomas; spine surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Marco Pignatti

E-Mail Website
Guest Editor
IRCCS Policlinico di Sant’Orsola, Bologna, 40138 Bologna, Italy
Interests: plastic and reconstructive surgery
Dr. Sara Tedeschi

E-Mail Website
Guest Editor
IRCCS Policlinico di Sant’Orsola, Bologna, 40138 Bologna, Italy
Interests: infectious disease

Special Issue Information

Dear Colleagues,

As is widely known, the treatment of musculoskeletal and joint prosthesis infections represents a real challenge for patients, healthcare providers and the healthcare system itself, because of the high number of treatment failures and the high economic impact of managing these diseases. A continuous collaboration between orthopaedists and infectivologists should be the cornerstone for optimising the management processes of all the musculoskeletal infections. However, for some very complex pathological scenarios, a further multidisciplinary integration is desirable, or even indispensable, both in clinical and pre-clinical settings. Therefore, several specialists—in particular, plastic surgeons, vascular surgeons and general surgeons—are asked to provide a primary contribution to the clinical assessment and treatment choice, which is often personalised. At the same time, microbiologists, clinical pharmacologists and pathologists can play a key role in clinical decision making and contribute to the introduction of new methods and techniques.

This Special Issue, “Prosthetic and Bone Infections: A Multidisciplinary Approach“, aims to collect data and experience from clinical and pre-clinical activities arising from the management of patients with bone, joint, periprosthetic or hardware-related infections. Special attention will be paid to the issue of multidisciplinary teamwork in the management of these patients.

We are pleased to invite you to participate in the production of this Special Issue. We strongly believe that only the increased dissemination of knowledge can contribute to the optimisation of the management of such complex matters. In this Special Issue, original research articles and reviews are welcome. Research areas may include, but are not limited to, the following:

  • Orthoplastic approach;
  • Prosthetic joint infection;
  • Diagnosis and management of PJI;
  • Chronic osteomyelitis;
  • Antibiotic therapy in bone and joint infections.

We look forward to receiving your contributions.

Dr. Andrea Sambri
Dr. Massimiliano De Paolis
Dr. Michele Fiore
Dr. Marco Pignatti
Dr. Sara Tedeschi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Microorganisms is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • bone infections
  • periprosthetic joint infections
  • infectious diseases
  • bone reconstruction
  • multidisciplinary surgery
  • multidisciplinary approach

Published Papers (11 papers)

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Editorial

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2 pages, 135 KiB  
Editorial
Highlighting New Perspectives on Musculoskeletal Infections
by Michele Fiore and Andrea Sambri
Microorganisms 2024, 12(1), 226; https://doi.org/10.3390/microorganisms12010226 - 22 Jan 2024
Viewed by 546
Abstract
The treatment of musculoskeletal and prosthetic joint infections represents a considerable challenge for patients, healthcare providers, and the healthcare system because of the high number of treatment failures and the significant economic burden [...] Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
4 pages, 173 KiB  
Editorial
The Need for Multidisciplinarity in Modern Medicine: An Insight into Orthopaedic Infections
by Andrea Sambri, Michele Fiore, Sara Tedeschi and Massimiliano De Paolis
Microorganisms 2022, 10(4), 756; https://doi.org/10.3390/microorganisms10040756 - 31 Mar 2022
Cited by 9 | Viewed by 1265
Abstract
As knowledge broadens, clinical practice becomes more elaborate, resulting in a variety of subspecialties and advanced health services [...] Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)

Research

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15 pages, 1382 KiB  
Article
Phenotypic and Genotypic Characterization of Cutibacterium acnes Isolated from Shoulder Surgery Reveals Insights into Genetic Diversity
by Mariana Neri Lucas Kurihara, Ingrid Nayara Marcelino Santos, Ana Karolina Antunes Eisen, Giovana Santos Caleiro, Jansen de Araújo, Romário Oliveira de Sales, Antônio Carlos Pignatari and Mauro José Salles
Microorganisms 2023, 11(10), 2594; https://doi.org/10.3390/microorganisms11102594 - 20 Oct 2023
Viewed by 1265
Abstract
Specific virulence factors that likely influence C. acnes invasion into deep tissues remain to be elucidated. Herein, we describe the frequency of C. acnes identification in deep tissue specimens of patients undergoing clean shoulder surgery and assess its phenotypic and genetic traits associated [...] Read more.
Specific virulence factors that likely influence C. acnes invasion into deep tissues remain to be elucidated. Herein, we describe the frequency of C. acnes identification in deep tissue specimens of patients undergoing clean shoulder surgery and assess its phenotypic and genetic traits associated with virulence and antibiotic resistance patterns, compared with isolates from the skin of healthy volunteers. Multiple deep tissue specimens from the bone fragments, tendons, and bursa of 84 otherwise healthy patients undergoing primary clean-open and arthroscopic shoulder surgeries were aseptically collected. The overall yield of tissue sample cultures was 21.5% (55/255), with 11.8% (30/255) identified as C. acnes in 27.3% (23/84) of patients. Antibiotic resistance rates were low, with most strains expressing susceptibility to first-line antibiotics, while a few were resistant to penicillin and rifampicin. Phylotypes IB (73.3%) and II (23.3%) were predominant in deep tissue samples. Genomic analysis demonstrated differences in the pangenome of the isolates from the same clade. Even though strains displayed a range of pathogenic markers, such as biofilm formation, patients did not evolve to infection during the 1-year follow-up. This suggests that the presence of polyclonal C. acnes in multiple deep tissue samples does not necessarily indicate infection. Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
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11 pages, 442 KiB  
Article
Clinical Features and Outcomes of Enterococcal Bone and Joint Infections and Factors Associated with Treatment Failure over a 13-Year Period in a French Teaching Hospital
by Aurélie Martin, Paul Loubet, Florian Salipante, Paul Laffont-Lozes, Julien Mazet, Jean-Philippe Lavigne, Nicolas Cellier, Albert Sotto and Romaric Larcher
Microorganisms 2023, 11(5), 1213; https://doi.org/10.3390/microorganisms11051213 - 05 May 2023
Viewed by 1841
Abstract
Enterococcal bone and joint infections (BJIs) are reported to have poor outcomes, but there are conflicting results. This study aimed to describe the clinical characteristics and outcomes of patients with enterococcal BJI and to assess the factors associated with treatment failure. We conducted [...] Read more.
Enterococcal bone and joint infections (BJIs) are reported to have poor outcomes, but there are conflicting results. This study aimed to describe the clinical characteristics and outcomes of patients with enterococcal BJI and to assess the factors associated with treatment failure. We conducted a retrospective cohort study at Nimes University Hospital from January 2007 to December 2020. The factors associated with treatment failure were assessed using a Cox model. We included 90 consecutive adult patients, 11 with native BJIs, 40 with prosthetic joint infections and 39 with orthopedic implant-associated infections. Two-thirds of patients had local signs of infection, but few (9%) had fever. Most BJIs were caused by Enterococcus faecalis (n = 82, 91%) and were polymicrobial (n = 75, 83%). The treatment failure rate was 39%, and treatment failure was associated with coinfection with Staphylococcus epidermidis (adjusted hazard ratio = 3.04, confidence interval at 95% [1.31–7.07], p = 0.01) and with the presence of local signs of inflammation at the time of diagnosis (aHR = 2.39, CI 95% [1.22–4.69], p = 0.01). Our results confirm the poor prognosis of enterococcal BJIs, prompting clinicians to carefully monitor for local signs of infection and to optimize the medical-surgical management in case of coinfections, especially with S. epidermidis. Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
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10 pages, 2259 KiB  
Article
Osteopenia and Sarcopenia as Potential Risk Factors for Surgical Site Infection after Posterior Lumbar Fusion: A Retrospective Study
by Alberto Ruffilli, Marco Manzetti, Tosca Cerasoli, Francesca Barile, Giovanni Viroli, Matteo Traversari, Francesca Salamanna, Milena Fini and Cesare Faldini
Microorganisms 2022, 10(10), 1905; https://doi.org/10.3390/microorganisms10101905 - 26 Sep 2022
Cited by 4 | Viewed by 2107
Abstract
Surgical site infection (SSI) is a feared complication in spinal surgery, that leads to lower outcomes and increased healthcare costs. Among its risk factors, sarcopenia and osteopenia have recently attracted particular interest. The purpose of this article is to evaluate the influence of [...] Read more.
Surgical site infection (SSI) is a feared complication in spinal surgery, that leads to lower outcomes and increased healthcare costs. Among its risk factors, sarcopenia and osteopenia have recently attracted particular interest. The purpose of this article is to evaluate the influence of sarcopenia and osteopenia on the postoperative infection rate in patients treated with posterior fusion for degenerative diseases of the lumbar spine. This retrospective study included data from 308 patients. Charts were reviewed and central sarcopenia and osteopenia were evaluated through magnetic resonance images (MRI), measuring the psoas to lumbar vertebral index (PLVI) and the M score. Multivariate linear regression was performed to identify independent risk factors for infection. The postoperative SSI rate was 8.4%. Patients with low PLVI scores were not more likely to experience postoperative SSI (p = 0.68), while low M-score patients were at higher risk of developing SSI (p = 0.04). However, they did not generally show low PLVI values (p = 0.5) and were homogeneously distributed between low and high PLVI (p = 0.6). Multivariate analysis confirmed a low M score to be an independent risk factor for SSI (p = 0.01). Our results suggest that osteopenia could have significant impact on spinal surgery, and prospective studies are needed to better investigate its role. Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
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10 pages, 1190 KiB  
Article
Combined Orthoplastic Approach in Fracture-Related Infections of the Distal Tibia
by Andrea Sambri, Marco Pignatti, Sara Tedeschi, Maria Elisa Lozano Miralles, Claudio Giannini, Michele Fiore, Matteo Filippini, Riccardo Cipriani, Pierluigi Viale and Massimiliano De Paolis
Microorganisms 2022, 10(8), 1640; https://doi.org/10.3390/microorganisms10081640 - 12 Aug 2022
Cited by 4 | Viewed by 2802
Abstract
This series reports on the treatment of distal tibia (DT) fracture-related infections (FRI) with a combined orthoplastic approach. Thirteen patients were included. In eight patients with extensive bone involvement and in those with a non-healed fracture, the DT was resected (“staged approach”). In [...] Read more.
This series reports on the treatment of distal tibia (DT) fracture-related infections (FRI) with a combined orthoplastic approach. Thirteen patients were included. In eight patients with extensive bone involvement and in those with a non-healed fracture, the DT was resected (“staged approach”). In five cases, the DT was preserved (“single-stage approach”). A wide debridement was performed, and the cavity was filled with antibiotic-loaded PerOssal beads. All patients had a soft-tissue defect covered by a free vascularized flap (anterolateral thigh perforator flap in eight cases, latissimus dorsi flap in five). At the final follow-up (mean 25 months, range, 13–37), no infection recurrence was observed. In one patient, the persistence of infection was observed, and the patient underwent a repeated debridement. In two cases, a voluminous hematoma was observed. However, none of these complications impacted the final outcome. The successful treatment of FRI depends on proper debridement and obliteration of dead spaces with a flap. Therefore, when dealing with DT FRI, debridement of infected bone and soft tissues must be as radical as required, with no fear of the need for massive reconstructions. Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
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Review

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13 pages, 332 KiB  
Review
Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature
by Andrea Sambri, Renato Zunarelli, Michele Fiore, Marta Bortoli, Azzurra Paolucci, Matteo Filippini, Eleonora Zamparini, Sara Tedeschi, Pierluigi Viale and Massimiliano De Paolis
Microorganisms 2023, 11(1), 84; https://doi.org/10.3390/microorganisms11010084 - 28 Dec 2022
Cited by 4 | Viewed by 1514
Abstract
Fungal prosthetic joint infection (fPJI) is a rare complication; nonetheless, it represents a significant diagnostic and therapeutic challenge. There are no official guidelines on the most effective approach to identify and treat fPJIs. This systematic review aims to review the current literature on [...] Read more.
Fungal prosthetic joint infection (fPJI) is a rare complication; nonetheless, it represents a significant diagnostic and therapeutic challenge. There are no official guidelines on the most effective approach to identify and treat fPJIs. This systematic review aims to review the current literature on fPJI management and provide a comprehensive overview of this topic, especially from an epidemiologic point of view. Studies eligible for this systematic review were identified through an electronic systematic search of PubMed, Scopus, and Web of Science until 30 September 2022. Further references were obtained by cross-referencing. Sixty-three studies met the inclusion criteria, reporting on 372 cases of fPJI; such cases were described mostly in case reports and small case series with only a few larger cohort studies. Diagnosis of fPJI is challenging because of its chronic and indolent clinical course; it is further complicated by the technical difficulty of harvesting fungal cultures. A two-stage revision was the primary procedure in 239 (64.2%) patients whereas DAIR and one-stage approaches were reported in 30 (8.0%) and 18 (4.8 %) cases. In conclusion, our study highlights the heterogeneity of the reported treatments of fPJI, particularly in terms of medical management. With concern to a surgical approach, a two-stage revision arthroplasty is generally suggested, considering fPJI a delayed or late infection. The need for multicenter, prospective studies to provide standardized protocols and improve the treatment of fungal PJI clearly emerges. Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
21 pages, 3244 KiB  
Review
Imaging of Musculoskeletal Soft-Tissue Infections in Clinical Practice: A Comprehensive Updated Review
by Paolo Spinnato, Dakshesh B. Patel, Maddalena Di Carlo, Alessandra Bartoloni, Luca Cevolani, George R. Matcuk and Amandine Crombé
Microorganisms 2022, 10(12), 2329; https://doi.org/10.3390/microorganisms10122329 - 25 Nov 2022
Cited by 14 | Viewed by 3364
Abstract
Musculoskeletal soft-tissue infections include a wide range of clinical conditions that are commonly encountered in both emergency departments and non-emergency clinical settings. Since clinical signs, symptoms, and even laboratory tests can be unremarkable or non-specific, imaging plays a key role in many cases. [...] Read more.
Musculoskeletal soft-tissue infections include a wide range of clinical conditions that are commonly encountered in both emergency departments and non-emergency clinical settings. Since clinical signs, symptoms, and even laboratory tests can be unremarkable or non-specific, imaging plays a key role in many cases. MRI is considered the most comprehensive and sensitive imaging tool available for the assessment of musculoskeletal infections. Ultrasound is a fundamental tool, especially for the evaluation of superficially located diseases and for US-guided interventional procedures, such as biopsy, needle-aspiration, and drainage. Conventional radiographs can be very helpful, especially for the detection of foreign bodies and in cases of infections with delayed diagnosis displaying bone involvement. This review article aims to provide a comprehensive overview of the radiological tools available and the imaging features of the most common musculoskeletal soft-tissue infections, including cellulitis, necrotizing and non-necrotizing fasciitis, foreign bodies, abscess, pyomyositis, infectious tenosynovitis, and bursitis. Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
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10 pages, 296 KiB  
Review
Molecular Approach for the Laboratory Diagnosis of Periprosthetic Joint Infections
by Giulia Gatti, Francesca Taddei, Martina Brandolini, Andrea Mancini, Agnese Denicolò, Francesco Congestrì, Martina Manera, Valentina Arfilli, Arianna Battisti, Silvia Zannoli, Maria Michela Marino, Anna Marzucco, Manuela Morotti, Laura Grumiro, Agata Scalcione, Giorgio Dirani, Monica Cricca and Vittorio Sambri
Microorganisms 2022, 10(8), 1573; https://doi.org/10.3390/microorganisms10081573 - 05 Aug 2022
Cited by 8 | Viewed by 1920
Abstract
The incidence of total joint arthroplasty is increasing over time since the last decade and expected to be more than 4 million by 2030. As a consequence, the detection of infections associated with surgical interventions is increasing and prosthetic joint infections are representing [...] Read more.
The incidence of total joint arthroplasty is increasing over time since the last decade and expected to be more than 4 million by 2030. As a consequence, the detection of infections associated with surgical interventions is increasing and prosthetic joint infections are representing both a clinically and economically challenging problem. Many pathogens, from bacteria to fungi, elicit the immune system response and produce a polymeric matrix, the biofilm, that serves as their protection. In the last years, the implementation of diagnostic methodologies reduced the error rate and the turn-around time: polymerase chain reaction, targeted or broad-spectrum, and next-generation sequencing have been introduced and they represent a robust approach nowadays that frees laboratories from the unique approach based on culture-based techniques. Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)

Other

12 pages, 2638 KiB  
Case Report
Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature
by Marco Pignatti, Giampiero Dolci, Elena Zamagni, Renato Pascale, Ottavio Piccin, Alessandro Ammar, Flavia Zeneli, Maria Elisa Lozano Miralles, Katia Mancuso, Riccardo Cipriani, Pierluigi Viale, Davide Pacini and Sofia Martin-Suàrez
Microorganisms 2023, 11(11), 2699; https://doi.org/10.3390/microorganisms11112699 - 03 Nov 2023
Cited by 1 | Viewed by 1127
Abstract
Sternal wound complications following cardiac surgery, including sternal dehiscence, mediastinitis, and osteomyelitis, pose significant challenges in terms of management and patient outcomes. We present a case report highlighting the complex management of a patient who underwent open heart surgery for severe aortic valve [...] Read more.
Sternal wound complications following cardiac surgery, including sternal dehiscence, mediastinitis, and osteomyelitis, pose significant challenges in terms of management and patient outcomes. We present a case report highlighting the complex management of a patient who underwent open heart surgery for severe aortic valve stenosis, followed by sternal wound dehiscence and sternum osteomyelitis due to extended spectrum beta lactamase (ESBL) producing Klebsiella aerogenes. A multiple myeloma diagnosis was also suspected at the positron emission tomography (PET) scan and confirmed with bone marrow biopsy. Multidisciplinary evaluation of the case led to a comprehensive treatment plan. To control the sternal osteomyelitis, total sternectomy was performed followed by immediate reconstruction with a bone (tibia) graft from the tissue bank and fixation with the minimal hardware possible. A microsurgical latissimus dorsi free flap was required to reconstruct the soft tissue defect. After 6 weeks of antibiotic treatment with ertapenem and fosfomycin based on a culture of intraoperative material, no clinical, imaging, or laboratory signs of infection were seen. Multiple myeloma treatment was then started. At 1 year of follow up, no recurrence of infection occurred, and the reconstruction was stable and closed. Multiple myeloma is under chronic treatment with novel agent combination, with an excellent haematological response. Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
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9 pages, 669 KiB  
Brief Report
Mid-Term Results of Single-Stage Surgery for Patients with Chronic Osteomyelitis Using Antibiotic-Loaded Resorbable PerOssal® Beads
by Andrea Sambri, Luca Cevolani, Valentina Passarino, Marta Bortoli, Stefania Claudia Parisi, Michele Fiore, Laura Campanacci, Eric Staals, Davide Maria Donati and Massimiliano De Paolis
Microorganisms 2023, 11(7), 1623; https://doi.org/10.3390/microorganisms11071623 - 21 Jun 2023
Cited by 1 | Viewed by 1759
Abstract
This retrospective study reports on the treatment of chronic osteomyelitis with local debridement combined with PerOssal®. The diagnosis of chronic osteomyelitis was confirmed in all cases and classified according to the Cierny–Mader (C-M) classification. The primary outcome was the eradication of [...] Read more.
This retrospective study reports on the treatment of chronic osteomyelitis with local debridement combined with PerOssal®. The diagnosis of chronic osteomyelitis was confirmed in all cases and classified according to the Cierny–Mader (C-M) classification. The primary outcome was the eradication of infection at a minimum of one year after surgery. A total of 93 patients (median age: 40 years) were included. The most represented sites were the femur (24, 25.8%) and tibia (52, 55.9%). Twenty-six patients (28.0%) had significant local or systemic comorbidities (C-M Class B hosts). According to anatomic type, 31 cases were type I, 13 type II, 21 type III and 28 type IV. Vancomycin was added to PerOssal® in most cases (80, 86.0%). In 24 (25.8%) cases, Vancomycin and Rifampicin were combined. In 32 (34.4%) cases, intraoperative cultures were negative. Staphylococcus aureus was isolated in 39 (63.9%) patients, and Gram-negative bacteria were isolated in 12 cases. The median follow-up was 21 months (range 12–84). A total of 21 (22.6%) patients developed an infection recurrence (IR) after a median follow-up of 11 months (range: 1–47). PerOssal® holds several practical advantages compared to other bone void fillers. Thus, due to its good biocompatibility and sufficient antibiotic release, it represents a viable adjuvant treatment in chronic osteomyelitis. Full article
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
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