Skeletal infections: microbial pathogenesis, immunity and clinical management

Area of Science:

• Orthopaedic Surgery
• Infectious Diseases
• Microbiology

Background:

• Osteomyelitis poses a significant risk in orthopaedic surgery, with Staphylococcus aureus being the primary pathogen.
• Despite understanding S. aureus pathogenesis (biofilms, abscesses, osteocyte invasion), clinical treatment of skeletal infections has seen minimal advancement.
• Host immune responses are insufficient for eradicating bacterial bone infections.

Purpose of the Study:

• To review mechanisms of S. aureus persistence and immune evasion in osteomyelitis.
• To discuss other pathogens involved in bone infections and host failure in eradication.
• To explore novel interventions and current clinical management strategies for skeletal infections.

Main Methods:

• Literature review of S. aureus pathogenesis in bone.
• Analysis of host immune response failures in skeletal infections.
• Discussion of current and emerging clinical management strategies.

Main Results:

• S. aureus employs complex mechanisms for persistence within bone, including biofilms and invasion of the osteocyte network.
• Host immune systems struggle to clear bacterial bone infections effectively.
• Limited clinical progress has been made in preventing and eradicating osteomyelitis over the past 50 years.

Conclusions:

• Understanding pathogen persistence and host immune evasion is crucial for developing new osteomyelitis treatments.
• Novel interventions targeting bacterial mechanisms and enhancing host immunity are needed.
• Advancements in clinical management and emerging technologies hold promise for future skeletal infection treatment.