Update on osteo-articular infections and severe skin and soft tissue infections

The present article is an update on bone, joint, skin and soft-tissue infections. A panel of Spanish clinicians including orthopedic surgeons, infectious diseases specialists and microbiologists with extensive experience in these fields have commented on the most relevant medical articles published during the last two years. In the next section, we review and discuss 10 articles on pathogenesis (1), diagnostic methods (1), epidemiology (1) and general management of prosthetic joint infections (8) and three on severe and necrotizing soft tissue infections. Although the rate of joint arthroplasty infection is about 1-3%, the infection of an orthopedic implant is particularly devastating since it requires several interventions, prolonged hospitalization and antibiotic treatment for weeks or months. Taking into account the increasing number of arthroplasties performed each year, a parallel increase is expected in the number of prosthetic joint infections. In the absence of well-designed prospective, randomized, controlled studies, the diagnosis and treatment of prosthetic joint infections is based mainly on personal experience. For these reasons, the authors consider particularly interesting a critical review of the most important references in this field. Recently, emergent pathogens such as community-acquired methicillin-resistant Staphylococcus aureus have been involved in necrotizing fasciitis. In addition, new tools for the diagnosis and treatment of these infections have been described and are now reviewed in the present article.