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Antimicrobial Treatment Options for Multidrug Resistant Gram-Negative Pathogens in Bone and Joint Infections
Maria Tsilika1, Fotinie Ntziora2, Efthymia Giannitsioti2
11st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece.
Pathogens (Basel, Switzerland)
|February 26, 2025
Summary
Multidrug-resistant Gram-negative bacteria (GNB) are a growing threat in bone and joint infections. Treatment requires debridement, implant removal, and combination antibiotic therapy, including novel agents for extensive drug resistance.
Area of Science:
- Infectious Diseases
- Orthopedics
- Pharmacology
Background:
- Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB) pose a global health challenge.
- While Gram-positive bacteria typically cause bone and joint infections, MDR GNB are increasingly implicated, especially in hospitalized patients with prior antibiotic exposure.
Purpose of the Study:
- To review the epidemiology, current data, and therapeutic options for difficult-to-treat (DTR) GNB in bone and joint infections.
- To highlight the role of debridement, implant removal, and antimicrobial strategies.
Main Methods:
- Narrative review of epidemiological trends, experimental data, and clinical experience.
- Analysis of available therapeutic options for DTR GNB bone and joint infections.
Main Results:
- Radical debridement and implant removal are key. Prompt, prolonged combination antibiotic therapy is essential.
- Fluoroquinolones show good bone penetration for DTR GNB. Carbapenems are an option for MDR GNB.
- For XDR GNB, combination therapies with colistin, fosfomycin, tigecycline, and novel β-lactam/β-lactamase inhibitors are suggested, alongside local antibiotic elution.
Conclusions:
- Effective management of DTR GNB bone and joint infections necessitates a multimodal approach.
- Novel antibiotics and combination therapies show promise, but further large-scale studies are crucial.
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