The DOI matches its Crossref record; 213 of the 213 references it cites were found in a registry or an index.
Skeletal infections: microbial pathogenesis, immunity and clinical management
Open accessAbstract
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. Osteomyelitis is an infection of bone that arises when a pathogen colonizes bone tissue owing to injury or surgery. In this Review, Masters and colleagues explore the microbial pathogenesis, immunity and clinical management of bone infections.
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“Infected bone defects (IBDs) pose an arduous orthopedic healthcare challenge due to their complex pathophysiology: resilient biofilms and intracellular pathogens that evade conventional antibiotics, an immunosuppressive microenvironment that impairs bone regeneration, and large defects that are difficult to heal following surgical debridement [1,2].”
From Nanocatalytic magnesium osteoimplants with biodegradable self-adaptive interfaces for therapeutic repair of infected bone defects (2026) · cites this paper as [1]
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1 retracted
Genetic requirements for Staphylococcus aureus abscess formation and persistence in host tissues
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RetractedPathogen Recognition and Innate Immunity
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MSCRAMM-MEDIATED ADHERENCE OF MICROORGANISMS TO HOST TISSUES
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Research works printed but not linked: 1
- Schwarz, E. M. et al. Adjuvant antibiotic-loaded bone cement: concerns with current use and research to make it work. J. Orthop. Res. 39, 227–239 (2021). · DOI
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Cui, B., Wen, M., Cai, Z., Si, Y., Liu, F., Zheng, Y., Zhang, C., & Jia, Z. (2025) · Advanced Functional Materials · doi:10.1002/adfm.202418092 · Cited by 31
Li, Y., Li, J., Zhong, Y., Zhang, Q., Wu, Y., Huang, J., Pang, K., Zhou, Y., Xiao, T., Wu, Z., et al. (2025) · Biomaterials · doi:10.1016/j.biomaterials.2024.122762 · Cited by 25
Wu, Y., Cai, Z., Zhang, Y., Zheng, Y., Liao, L., & Jia, Z. (2026) · Bioactive Materials · doi:10.1016/j.bioactmat.2025.12.018 · Cited by 7
“In orthopedics, implant-centered infections pose arduous clinical challenges such as persistent inflammation and compromised osseoin-tegration, often culminating in implantation failure [1,27].”
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Metadata
- Authors
- Masters, E. A., Ricciardi, B. F., Bentley, K. L. D. M., Moriarty, T. F., Schwarz, E. M., & Muthukrishnan, G.
- Affiliations
- University of Rochester Medicine (US)
- AO Foundation (CH)
- Corresponding author
- Schwarz, Edward M.
- ORCID
- Venue
- Nature Reviews Microbiology
- Published
- 2022-02-15
- Volume
- 20
- Issue
- 7
- Pages
- 385-400
- ISSN
- 1740-1526 (ISSN-L)
- 1740-1534
- PMC
- PMC8852989
- OpenAlex
- W4212885218
- Semantic Scholar
- fea546c64bde2b8b3e8f7ba8b09894e8cabde064
- Cited by
- 735
- References
- 213
- Citations by year
- 2026: 190 · 2025: 226 · 2024: 171 · 2023: 104 · 2022: 42
- FWCI
- 32.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Nature Reviews Microbiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- AO Foundation
- National Institutes of Health (AR069655, AR072000)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR072000, AR069655, P50AR072000, P30AR069655)
- Topics
- Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
- Keywords
- osteomyelitis, skeletal infection, Staphylococcus aureus, implant-associated infection, biofilm, immune evasion, bacterial persistence, host immune response, orthopedic implants
- MeSH terms
- Humans, Osteomyelitis, Staphylococcal Infections, Staphylococcus aureus, Biofilms, Immune Evasion
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