Managing Bone Infections Beyond Systemic Antibiotics: A Scoping Review

Area of Science:

• Orthopedics
• Infectious Diseases
• Biomaterials Science

Background:

• Bone infections (osteomyelitis, prosthetic joint infections, fracture-related infections) pose significant clinical challenges.
• Limited bone vascularization, biofilm formation, and antibiotic resistance complicate treatment.
• Conventional therapies (surgery, systemic antibiotics) have limitations, driving interest in novel approaches.

Purpose of the Study:

• To review current and emerging therapeutic strategies for bone infections.
• To highlight advancements in local antibiotic delivery and immunomodulatory treatments.
• To discuss the role of diagnostics and AI in personalized bone infection management.

Main Methods:

• Review of literature on bone infection treatments.
• Analysis of local antibiotic delivery systems (e.g., PMMA, hydrogels, nanoparticles).
• Exploration of immunomodulatory strategies (e.g., stem cells, bacteriophages) and advanced diagnostics.

Main Results:

• Local antibiotic delivery systems achieve high concentrations at infection sites with reduced systemic exposure.
• Immunomodulatory therapies and non-antibiotic antimicrobials show potential for infection control and bone regeneration.
• Biomarker profiling, molecular diagnostics, and AI aid personalized treatment strategies.

Conclusions:

• Innovative local delivery systems and immunotherapies offer promising adjunctive and alternative treatments for bone infections.
• Personalized medicine approaches, supported by advanced diagnostics and AI, are crucial for optimizing patient outcomes.
• Overcoming clinical translation challenges requires integrated and innovative therapeutic strategies.