[Update bone infections].

Abstract

Bone and joint infections are becoming of great concern in an elderly population with growing numbers of prosthetic joints and comorbidities. This paper summarizes recently published literature on periprosthetic joint infections, vertebral osteomyelitis and diabetic foot infections. According to a new study, in the presence of a hematogenous periprosthetic infection and other inserted joint prostheses that are unremarkable on clinical examination, further invasive or imaging diagnostics may not be necessary. Periprosthetic infections that occur late (> 3 months after joint installation) have a worse outcome. New studies tried to identify factors when prosthesis preservation might still be an option. A new randomized landmark trial from France failed to show non-inferiority for 6 versus 12 weeks of therapy length. Thus, it can be assumed that this will currently become the standard therapy length for all surgical modalities (retention or replacement). Vertebral osteomyelitis is a rather rare bone infection, but the incidence has continued to rise sharply in recent years. A retrospective study from Korea provides information on the distribution of pathogens in different age groups and with selected comorbidities; this could help in the selection of an empiric therapy when pathogen identification is not successful before starting the treatment. The guidelines by the "International Working Group on the Diabetic Foot (IWGDF)" have been updated with a slightly different classification. New practice recommendations of the German society of diabetology emphasize an early interdisciplinary interprofessional management. Empirical therapy continues to be based on the severity of the infection and other risk factors (such as previous therapies or ischemia). Microbiological diagnosis from tissue samples is described as superior to smears. According to a randomized pilot study, 3 weeks therapy length for osteomyelitis after debridement appears to be noninferior to 6 weeks.

• Authors: Charlotte Meyer-Schwickerath, Dorothee Jochimsen, Norma Jung
• Journal: Deutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr) Vol. 148 Issue 6 Pg. 313-317 (03 2023) ISSN: 1439-4413 [Electronic] Germany
• Vernacular Title: Update Knocheninfektionen.
• PMID: 36878230 (Publication Type: English Abstract, Journal Article)
• Copyright: Thieme. All rights reserved.

Topics

• Aged
• Humans
• Diabetic Foot
• Osteomyelitis (diagnosis, therapy)
• Pilot Projects
• Retrospective Studies