Skeletal infections: microbial pathogenesis, immunity and clinical management

• Published in: Nature reviews. Microbiology Vol. 20; no. 7; pp. 385 - 400
• Main Authors: Masters, Elysia A., Ricciardi, Benjamin F., Bentley, Karen L. de Mesy, Moriarty, T. Fintan, Schwarz, Edward M., Muthukrishnan, Gowrishankar
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-07-2022; Nature Publishing Group
• Subjects: 631/250/255/1318; 631/326/41/2531; 631/326/41/2534; 631/326/421; 692/699/255/1318; Abscesses; Algorithms; Biofilms; Biomedical and Life Sciences; Biomedical materials; Bone implants; Bone surgery; Bones; Humans; Immune Evasion; Immunity; Infectious Diseases; Life Sciences; Medical Microbiology; Microbiology; Microorganisms; New technology; Orthopedics; Osteomyelitis; Osteomyelitis - drug therapy; Osteomyelitis - microbiology; Parasitology; Pathogenesis; Pathogens; Review; Review Article; Skeletal system; Staphylococcal Infections - therapy; Staphylococcus aureus; Staphylococcus infections; Surgery; Virology
• ISSN: 1740-1526; 1740-1534; 1740-1534
• DOI: 10.1038/s41579-022-00686-0

Osteomyelitis remains one of the greatest risks in orthopaedic surgery. Although many organisms are linked to skeletal infections,
Staphylococcus aureus
remains the most prevalent and devastating causative pathogen. Important discoveries have uncovered novel mechanisms of
S. aureus
pathogenesis and persistence within bone tissue, including implant-associated biofilms, abscesses and invasion of the osteocyte lacuno-canalicular network. However, little clinical progress has been made in the prevention and eradication of skeletal infection as treatment algorithms and outcomes have only incrementally changed over the past half century. In this Review, we discuss the mechanisms of persistence and immune evasion in
S. aureus
infection of the skeletal system as well as features of other osteomyelitis-causing pathogens in implant-associated and native bone infections. We also describe how the host fails to eradicate bacterial bone infections, and how this new information may lead to the development of novel interventions. Finally, we discuss the clinical management of skeletal infection, including osteomyelitis classification and strategies to treat skeletal infections with emerging technologies that could translate to the clinic in the future.
Osteomyelitis is an infection of bone that arises when a pathogen colonizes bone tissue owing to injury or surgery. In this Review, Masters and colleagues explore the microbial pathogenesis, immunity and clinical management of bone infections.