Bone and Joint Infections: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research

Dear Colleagues,

Bone and joint infections (BJIs) present a significant and growing challenge, largely due to their increasing incidence in ageing populations. This rise is associated with a higher number of traumatological and orthopaedic surgeries, as well as a growing population of immunocompromised patients. Moreover, timely and definitive diagnosis of BJIs remains challenging. The treatment of BJIs is complex, often requiring surgery and prolonged antibiotic courses, particularly in cases involving orthopaedic implants. Furthermore, significant gaps persist in our understanding of the management and prevention of these infections. Consequently, BJIs contribute to substantial patient suffering and long-term complications, and impose a notable economic burden on healthcare systems and society worldwide.

BJIs encompass a wide spectrum of clinical presentations, influenced by factors such as pathogenesis, the duration of the disease at diagnosis, the specific bone or joint involved, and the presence or absence of orthopaedic implants. These infections can range from acute, rapidly progressing conditions to chronic, indolent diseases that may persist for years with intermittent manifestations, each requiring different therapeutic approaches. The complexity of BJIs is further compounded by the diversity of pathogens involved, including bacteria, fungi, and mycobacteria.

A significant challenge in managing BJIs is the frequent delay in diagnosis. The symptoms of BJIs are often nonspecific and can easily be mistaken for other conditions, such as skin and soft tissue infections, leading to a lack of suspicion among healthcare providers. This delay is exacerbated by the difficulty in obtaining a definitive diagnosis and identifying the microbial aetiology. Consequently, many cases of BJIs are diagnosed late, after the infection has already caused significant damage to the affected bone or joint.

Despite the clinical importance of BJIs, substantial gaps remain in our knowledge regarding their prevention, diagnosis, and treatment. The relative rarity of BJIs in the general population means that many physicians lack experience in recognizing and managing these infections. Additionally, the scarcity of well-designed studies with adequate sample sizes has hindered the development of evidence-based recommendations and guidelines for appropriate treatment. This lack of robust data is particularly evident in the management of different clinical scenarios, including the role of surgery, optimal surgical procedures, and the best antibiotics and duration of antimicrobial therapy.

Given these challenges, there is an urgent need for high-quality research to address the many unanswered questions surrounding BJIs. This Special Issue aims to gather recent research and clinical insights on BJIs, advancing our understanding of these complex infections and, more importantly, improving patient management and outcomes. We invite you to submit your original research or reviews on BJIs. We look forward to your contributions and to the collective effort to advance the field of bone and joint infections.

Dr. Natividad Benito
Guest Editor

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• bone and joint infection
• arthroplasty infection
• definition of bone and joint infection
• bone and joint joint infection prevention
• diagnosis of bone and joint infection
• bone and joint infection management
• antimicrobial therapy of bone and joint infection