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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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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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“In orthopedics, implant-centered infections pose arduous clinical challenges such as persistent inflammation and compromised osseoin-tegration, often culminating in implantation failure [1,27].”
Influential
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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