General treatment principles for fracture-related infection: recommendations from an international expert group.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: All authors declare no conflict of interest with respect to the preparation and writing of this article. 2. Infect Dis Clin North Am. 2025 Sep;39(3):361-382. doi: 10.1016/j.idc.2025.02.009. Epub 2025 Apr 11. Optimizing Antibiotic Therapy in Musculoskeletal Infections. Cortés-Penfield NW(1), Justo JA(2), McCreary EK(3), Ryder JH(4). Author information: (1)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: n.cortespenfield@unmc.edu. (2)Department of Pharmacy, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. (3)Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. (4)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA. Research into the optimal antibiotic management of musculoskeletal infections has advanced tremendously over the past quarter century, including over a dozen randomized controlled trials and numerous observational studies. This review examines the rationale for and evidence base supporting modern approaches to antibiotic decision making and stewardship in orthopedic infections. Specific practice advances discussed include the increased and earlier use of oral antibiotics, other principles of antibiotic selection (eg, the notion of "bone penetration" and novel local antimicrobial strategies), individualizing durations of therapy, and increasingly selective approaches to empiric antipseudomonal therapy, suppressive antibiotic therapy, and periprocedural antimicrobial prophylaxis following arthroplasty. Copyright © 2025 Elsevier Inc. All rights reserved. DOI: 10.1016/j.idc.2025.02.009