Osteomyelitis: Recent advances in pathophysiology and therapeutic strategies

Abstract

This review article summarizes the recent advances in pathogenic mechanisms and novel therapeutic strategies for osteomyelitis, covering both periprosthetic joint infections and fracture-associated bone infections. A better understanding of the pathophysiology including the mechanisms for biofilm formation has led to new therapeutic strategies for this devastating disease. Research on novel local delivery materials with appropriate mechanical properties, lower exothermicity, controlled release of antibiotics, and absorbable scaffolding for bone regeneration is progressing rapidly. Emerging strategies for prevention, early diagnosis of low-grade infections, and innovative treatments of osteomyelitis such as biofilm disruptors and immunotherapy are highlighted in this review.

Inflammatory osteolysis: a conspiracy against bone

“…Bacteria may cause bone necrosis through direct killing of osteoblasts, but the inflammatory response is likely the major event by which infection induces osteoclastogenesis and bone degradation. The most frequently identified microorganism in OM is Staphylococcus aureus, which is seeded into bone through both hematogenous and direct (e.g., trauma, implant) routes in children and adults (149). Bacterial products of Staphylococcus aureus, which grows primarily in the extracellular bone microenvironment and forms biofilms, induce an inflammatory response.…”

Exebacase in Addition to Daptomycin Is More Active than Daptomycin or Exebacase Alone in Methicillin-Resistant Staphylococcus aureus Osteomyelitis in Rats

“…O steomyelitis is a devastating infection that can be challenging to treat and that may be associated with morbidity, including damage to bone tissue and metastatic infection. Staphylococcus aureus is the most common cause of osteomyelitis (1). S. aureus has the ability to form biofilms and to enter and survive within osteoblasts, both of which may allow it to evade the immune system and be resistant to many traditional antimicrobials (2).…”

“…S. aureus has the ability to form biofilms and to enter and survive within osteoblasts, both of which may allow it to evade the immune system and be resistant to many traditional antimicrobials (2). Current therapeutic options include surgical irrigation and debridement and long-term therapy with antimicrobials such as daptomycin or vancomycin (1,3,4). Compounding the challenge of the virulence of S. aureus itself is the increasing antimicrobial resistance of S. aureus.…”

CCR5 and CCR5Δ32 in bacterial and parasitic infections: Thinking chemokine receptors outside the HIV box

“…Osteomyelitis may develop acutely or chronically (Lew & Waldvogel, 2004). Furthermore, osteomyelitis can be classified into 12 different clinical stages, combining the anatomical type affected by the disease (medullary, superficial, localized or diffuse) with the patient's physiological state (Birt, Anderson, Bruce Toby, & Wang, 2017). The disease encompasses a wide range of symptoms: chills, fever, fatigue, irritability, pain, local swelling, lethargy and malaise (Chihara & Segreti, 2010; Lew & Waldvogel, 2004).…”