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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
PubMed

Insights

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.
Keywords:
Gram-negative bacteriaantibioticsbone and joint infectionsmultidrug resistant

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