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  • Author: Willem-Jan Metsemakers x
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Martin McNally The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK

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Geertje Govaert Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands

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Maria Dudareva The Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK

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Mario Morgenstern Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland

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Willem-Jan Metsemakers Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium

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  • Fracture-related infection (FRI) is common and often diagnosed late.

  • Accurate diagnosis is the beginning of effective treatment.

  • Diagnosis can be difficult, particularly when there are no outward signs of infection.

  • The new FRI definition, together with clear protocols for nuclear imaging, microbiological culture and histological analysis, should allow much better study design and a clearer understanding of infected fractures.

  • In recent years, there has been a new focus on defining FRI and avoiding non-specific, poorly targeted treatment. Previous studies on FRI have often failed to define infection precisely and so are of limited value. This review highlights the essential principles of making the diagnosis and how clinical signs, serum tests, imaging, microbiology, molecular biology and histology all contribute to the diagnostic pathway.

Cite this article: EFORT Open Rev 2020;5:614-619. DOI: 10.1302/2058-5241.5.190072

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Tristan Ferry Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
Université Claude Bernard Lyon 1, Villeurbanne, France
Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, Lyon, France
StaPath team, Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
Education and Clinical Officer of the ESCMID Study Group for Non-traditional Antibacterial Therapy (ESGNTA)

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Jolien Onsea Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
Department of Development and Regeneration, KU Leuven, Oude Markt 13, Leuven, Belgium

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Tiphaine Roussel-Gaillard Institut des Agents Infectieux, Centre de Biologie et de Pathologie du Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France

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Cécile Batailler Service de Chirurgie Orthopédique et de Médecine du Sport, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France

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Thomas Fintan Moriarty AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, Switzerland

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Willem-Jan Metsemakers Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
Department of Development and Regeneration, KU Leuven, Oude Markt 13, Leuven, Belgium

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  • The treatment of musculoskeletal infections (MSIs), including periprosthetic joint infection (PJI) and fracture-related infection (FRI), is often complicated by biofilm-related challenges necessitating multiple revision surgeries and incurring substantial costs.

  • The emergence of antimicrobial resistance (AMR) adds to the complexity of the problem, leading to increased morbidity and healthcare expenses.

  • There is an urgent need for novel antibacterial strategies, with the World Health Organization endorsing non-traditional approaches like bacteriophage (phage) therapy.

  • Phage therapy, involving the targeted application of lytic potent phages, shows promise in the treatment of MSIs.

  • Although historical clinical trials and recent case studies present significant milestones in the evolution of phage therapy over the past century, challenges persist, including variability in study designs, administration protocols and phage selection. Efforts to enhance treatment efficacy consist of personalized phage therapy and combination with antibiotics.

  • Future perspectives entail addressing regulatory barriers, standardizing treatment protocols, and conducting high-quality clinical trials to establish phage therapy’s efficacy for the treatment of MSIs.

  • Initiatives like the PHAGEFORCE study and the PHAGEinLYON Clinic programme aim to streamline phage therapy, facilitating personalized treatment approaches and systematic data collection to advance its clinical utility in these challenging infections.

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T. Fintan Moriarty AO Research Institute Davos, Switzerland

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Richard Kuehl University Hospital of Basel, Switzerland

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Tom Coenye Ghent University, Belgium

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Willem-Jan Metsemakers University Hospitals Leuven, Belgium

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Mario Morgenstern Trauma Centre, Murnau, Germany

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Edward M. Schwarz University of Rochester Medical Center, New York, USA

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Martijn Riool AMC, University of Amsterdam, The Netherlands

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Sebastian A.J. Zaat AMC, University of Amsterdam, The Netherlands

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Nina Khana University Hospital of Basel, Switzerland

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Stephen L. Kates Virginia Commonwealth University, Virginia, USA

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R. Geoff Richards AO Research Institute Davos, Switzerland

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  • Orthopaedic and trauma device-related infection (ODRI) remains one of the major complications in modern trauma and orthopaedic surgery.

  • Despite best practice in medical and surgical management, neither prophylaxis nor treatment of ODRI is effective in all cases, leading to infections that negatively impact clinical outcome and significantly increase healthcare expenditure.

  • The following review summarises the microbiological profile of modern ODRI, the impact antibiotic resistance has on treatment outcomes, and some of the principles and weaknesses of the current systemic and local antibiotic delivery strategies.

  • The emerging novel strategies aimed at preventing or treating ODRI will be reviewed. Particular attention will be paid to the potential for clinical impact in the coming decades, when such interventions are likely to be critically important.

  • The review focuses on this problem from an interdisciplinary perspective, including basic science innovations and best practice in infectious disease.

Cite this article: Moriarty TF, Kuehl R, Coenye T, et al. Orthopaedic device related infection: current and future interventions for improved prevention and treatment. EFORT Open Rev 2016;1:89-99. DOI: 10.1302/2058-5241.1.000037.

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