Skeletal infections: microbial pathogenesis, immunity and clinical management

Osteomyelitis remains one of the greatest risks in orthopaedic surgery. Although many organisms are linked to skeletal infections, Staphylococcus aureus remains the most prevalent and devastating causative pathogen. Important discoveries have uncovered novel mechanisms of S. aureus pathogenesis and...

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Bibliographic Details
Published in:Nature reviews. Microbiology Vol. 20; no. 7; pp. 385 - 400
Main Authors: Masters, Elysia A, Ricciardi, Benjamin F, Bentley, Karen L de Mesy, Moriarty, T Fintan, Schwarz, Edward M, Muthukrishnan, Gowrishankar
Format: Journal Article
Language:English
Published: England Nature Publishing Group 01.07.2022
Subjects:
Abscesses
Algorithms
Biofilms
Biomedical materials
Bone implants
Bone surgery
Bones
Humans
Immune Evasion
Immunity
Microorganisms
New technology
Orthopedics
Osteomyelitis
Osteomyelitis - drug therapy
Osteomyelitis - microbiology
Pathogenesis
Pathogens
Skeletal system
Staphylococcal Infections - therapy
Staphylococcus aureus
Staphylococcus infections
Surgery
ISSN:1740-1526, 1740-1534, 1740-1534
Online Access:Get full text
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Summary:Osteomyelitis remains one of the greatest risks in orthopaedic surgery. Although many organisms are linked to skeletal infections, Staphylococcus aureus remains the most prevalent and devastating causative pathogen. Important discoveries have uncovered novel mechanisms of S. aureus pathogenesis and persistence within bone tissue, including implant-associated biofilms, abscesses and invasion of the osteocyte lacuno-canalicular network. However, little clinical progress has been made in the prevention and eradication of skeletal infection as treatment algorithms and outcomes have only incrementally changed over the past half century. In this Review, we discuss the mechanisms of persistence and immune evasion in S. aureus infection of the skeletal system as well as features of other osteomyelitis-causing pathogens in implant-associated and native bone infections. We also describe how the host fails to eradicate bacterial bone infections, and how this new information may lead to the development of novel interventions. Finally, we discuss the clinical management of skeletal infection, including osteomyelitis classification and strategies to treat skeletal infections with emerging technologies that could translate to the clinic in the future.
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ISSN:1740-1526
1740-1534
1740-1534
DOI:10.1038/s41579-022-00686-0