Open Forum Infect Dis May 2026 V.13 N.6

GSK, Wavre, Belgium.

FISABIO, Valencia, Spain.

Catholic University of Valencia, Valencia, Spain.

IMA Clinical Research San Antonio, San Antonio, Texas, USA.

Centro Medico Sao Francisco, Curitiba, Brazil.

Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.

The Chinese University of Hong Kong, Hong Kong, China.

Centre for Virus Research, Westmead Institute for Medical Research, Sydney, Australia.

University of Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.

Hakata Clinic, Fukuoka, Japan.

Hygiene Unit, IRCCS San Martino Policlinico Hospital, Genoa, Italy.

Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Canadian Center for Vaccinology, IWK Health, NS Health, Halifax, Nova Scotia, Canada.

Dalhousie University, Halifax, Nova Scotia, Canada.

Tartu University Hospital, Tartu, Estonia.

Department of Infectious Diseases, Charles University Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.

Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.

Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany.

Hospital General de Durango, Durango, Mexico.

National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.

GSK, Rockville, Maryland, USA.

GSK, London, UK.

GSK, Rixensart, Belgium.

Background

A phase 3b extension of the ZOE-50/70 trials evaluated long-term efficacy, immunogenicity, and safety of the recombinant zoster vaccine (RZV) in participants ≥50 years, with a 6-year follow-up after completion of the primary studies. A subset of participants was evaluated for immunogenicity and safety of 1 or 2 additional doses administered 5-6 years after primary vaccination.

Methods

Participants were randomized to 1 additional dose (1-additional dose group, n = 61), 2 additional doses (revaccination group, n = 60), or no additional vaccination (control, n = 119). Humoral and cell-mediated immunity were evaluated by antiglycoprotein E (gE) antibodies, gE-specific CD4[2+] T-cells, and memory B-cells. Reactogenicity was evaluated for 7 days postvaccination and overall safety was evaluated throughout the study. NCT02723773.

Results

Anti-gE geometric mean concentrations (GMCs) were 10 000-11 500 mIU/mL in all groups preadditional vaccination. Geometric mean concentrations peaked at 1 month after 1 dose (73 834.4 and 79 419.8 mIU/mL in the 1-additional dose and revaccination groups, respectively), declined at Year 1, but remained above preadditional vaccination levels thereafter. Geometric mean concentration was 64 603.0 mIU/mL 1 month after the second dose in the revaccination group. Geometric mean concentrations in the control group were 8825.4 mIU/mL at Year 1 and 6858.8 mIU/mL at Year 6. The frequency of gE-specific CD4[2+] T-cells and memory B-cells followed a similar pattern. Pain and fatigue were the most common solicited adverse events. No serious adverse events related to RZV were reported.

Conclusions

A single additional RZV dose elicited strong and durable humoral and cell-mediated anamnestic responses, with a reactogenicity and safety profile as established in primary studies.

Clinical trial registration: NCT02723773.

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https://pmc.ncbi.nlm.nih.gov/articles/PMC13232749/pdf/ofag282.pdf

J Infect June 2026 V.93 N.1

Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China; Department of Pathogen Biology, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China.

Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China; Department of Pathogen Biology, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China. Electronic address: armzhang@hotmail.com

Highlights

• Significant relaxed selection observed in ANDV M segment before spillover.

• ANDV L segment exhibits strong purifying selection across evolutionary branches.

• S segment aids ANDV’s adaptation to humans but lacks pre-zoonotic adaptation.

• HTNV shows no pre-zoonotic adaptation, relying on passive adaptation post-infection.

• Pre-zoonotic adaptation identified as key for ANDV’s human-to-human transmission.

Dear Editor,

A recent study published in the Journal of Infection highlighted the zoonotic threat posed by a novel H6N2 avian influenza virus.1 This year, an outbreak of Andes virus (ANDV), a member of the hantavirus, occurred on a cruise ship.2 ANDV is carried by the long-tailed colilargo and is the only hantavirus with limited human-to-human transmission.3 A recent investigation proposed that most circulating zoonotic viruses do not undergo pre-zoonotic adaptation prior to spilling over into new hosts.4 However, it remains unclear whether ANDV experiences pre-zoonotic adaptation before host spillover.

We selected publicly available sequences from GenBank prior to the recent cruise outbreak to investigate interspecies changes during the evolution of ANDV. Our analysis included a total of 169 sequences: 49 from the M segment, 67 from the S segment, and 53 from the L segment (Table S1). The branches associated with rodent samples represented selection within the natural host reservoir, while the stem branch leading to human outbreaks served as our focal test branch. For comparative analysis with Hantaan virus (HTNV), we selected 88 sequences of the M segment from this virus (Table S2) and applied the same methodologies. Meanwhile, we performed rigorous screening and ultimately included 19 sequences for the ANDV L segment, 31 for the ANDV S segment, 18 for the ANDV M segment, and 66 for the M segment of HTNV (Table S3). The analysis results are shown in Table S4.

The phylogenetic tree of the ANDV L segment is shown in Fig. 1A. The RELAX model analysis5 revealed that the ANDV L segment is under strong purifying selection across all four evolutionary branches, showing stability without relaxation or intensification of selection. For the human branch, we observed K = 0.87 (p = 0.11, not significant), with ω reference = 0.00813 and ω test = 0.01233. For the human-stem branch, K = 0.94 (p = 0.36, not significant), ω reference = 0.00842, and ω test = 0.0102; and for the stem branch, K = 1.03 (p = 0.91, not significant), ω reference = 0.00915, and ω test = 0.00135. The K values for all branches were close to 1, p values exceeded 0.05, and ω values remained extremely low (Figs. 1B and 1C). These findings indicate that the ANDV L segment is constrained by stringent natural selection, maintaining highly conserved replication functions and accumulating no adaptive variations during steady-state evolution in the host reservoir, transitional evolution before cross-host spillover, or subsequent colonization in humans. Thus, it does not engage in pre-zoonotic adaptation prior to spillover or adapt to human environments. . . . .

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Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada (CICATA), Unidad Morelos del Instituto Politécnico Nacional (IPN), Xochitepec, Mexico.

Computer Science Department, Universidad Católica de Murcia (UCAM), Murcia, Spain.

Dengue fever represents an escalating global health threat, as unprecedented outbreaks expose significant limitations of current vaccine strategies. Conventional live-attenuated dengue vaccines, while partially efficacious, face critical hurdles including serotype imbalances and antibody-dependent enhancement (ADE). This review critically assesses virus-like particle (VLP) vaccines as a promising alternative, providing safer, non-replicating platforms that mimic viral structure without risks associated with live replication. Technological advancements in recombinant expression systems have improved VLP yield, stability, and scalability, addressing deployment obstacles. Recent preclinical studies demonstrate that tetravalent dengue VLP vaccines induce balanced neutralizing antibodies across all serotypes, effectively circumventing ADE in animal models. These findings suggest superior safety and robust immune responses, potentially surpassing live-attenuated and mRNA-based vaccines. We emphasize advancements in VLP vaccine technology, including novel tetravalent particle designs engineered to exclude ADE-related immunopathogenic components (prM protein), innovative stability-enhancing formulation techniques, and cost-effective recombinant production platforms (yeast and plant-based systems). Additionally, this review proposes novel deployment strategies, such as regional manufacturing hubs, standardized modular VLP platforms, adaptive clinical trial frameworks leveraging surrogate endpoints, and strengthened international coordination for equitable vaccine distribution. Integrating these scientific innovations and practical strategies positions dengue VLP vaccines as pivotal next-generation solutions for global dengue prevention.

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https://pmc.ncbi.nlm.nih.gov/articles/PMC12206880/pdf/fcimb-15-1614805.pdf

Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Johns Hopkins Encephalitis Center, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.

Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.

Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.

Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Department of Infectious Diseases, Sjælland University Hospital, Roskilde, Denmark.

Department of Pulmonary- and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark.

Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark.

Department of Infectious Diseases, Herlev-Gentofte Hospital, Herlev, Denmark.

European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Diagnostic Infectious Disease preparedness, Statens Serum Institut, Copenhagen S, Denmark.

Department of Neurology, Odense University Hospital, Odense, Denmark.

Johns Hopkins Encephalitis Center, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.

Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.

Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland. Electronic address: Jacob.bodilsen@rn.dk

Objectives

To examine the incidence, clinical presentation, and prognosis of infectious encephalitis among adults in Denmark.

Methods

Prospective, population-based cohort study using the Danish Study group for Infections of the Brain database to identify all Danish residents ≥18 years of age hospitalized with infectious encephalitis from 2015 to 2023. Cases were defined in alignment with the International Encephalitis Consortium criteria. Multivariable modified Poisson regression was used to compute adjusted relative risks (adj. RRs) with 95% CIs for intensive care unit admission and 6-month mortality. Continuous variables were modelled using restricted cubic splines. Multicollinearity between variables was not found.

Results

A total of 495 patients were included yielding an annual mean incidence of 1.18 per 100 000 (95% CI 1.01-1.35). The median age was 70 years (interquartile range 54-78 years) and 240 of 495 (48%) were female. The aetiology comprised Varicella zoster virus in 156 of 495 (32%), Herpes simplex virus type 1 (HSV-1) in 154 of 495 (31%), tick-borne encephalitis in 23 of 495 (5%), other viruses in 40 of 495 (8%), and remained unknown in 122 of 495 (24%). Common symptoms at admission included confusion 391 of 488 (80%), headache 234 of 397 (59%), and personality changes 183 of 439 (42%). Intensive care unit admission occurred in 111 of 495 (22%) and was associated with Glasgow Coma Scale (GCS) <12 (adj. RR 2.52 95% CI 1.58-4.02) and seizures (adj. RR 2.17 95% CI 1.52-3.09). All-cause mortality at 30 days was 41 of 495 (8%) and increased to 76 of 495 (15%) after 6 months. Risk of 6-month mortality was higher in patients with immunocompromise (adj. RR 2.91, 95% CI 1.97-4.31), HSV-1 encephalitis (adj. RR 2.34, 95% CI 1.17-4.72), and GCS <12 (adj. RR 2.03, 95% CI 1.01-4.11).

Conclusions

Infectious encephalitis remains rare with HSV-1 and Varicella zoster virus as common causes. The clinical presentation is unspecific, and the diagnosis remains challenging. Poor outcome is frequent throughout a prolonged follow-up, especially in those with immunocompromising conditions, HSV-1 encephalitis, or a low GCS at admission.

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Open Forum Infect Dis May 2026 V.13 N.5

Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Department of Dermatology, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Department of Pathology and Laboratory Science, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Background

16S bacterial identification is a molecular diagnostic test that can aid in the diagnosis and management of orthopedic infections. The study aims to describe the diagnostic value of 16S for orthopedic infections and whether results of 16S impact antibiotic de-escalation.

Methods

This retrospective cohort study included all patient encounters with 16S performed for evaluation of orthopedic infections at 1 Midwest academic center over a 5-year prepandemic period. Qualitative descriptions of the clinical cases, antibiotics, and 16S results were evaluated.

Results

Four hundred fifty-two episodes were included for analysis. Overall, 9.5% of 16S tests detected bacteria. The most common indication for testing was for evaluation of septic arthritis. For diagnosing infectious episodes, 16S had a sensitivity of 15.5%, a specificity of 98%, a positive predictive value of 90.7%, and a negative predictive value of 47.9%. Analysis of all episodes demonstrated antibiotic de-escalation from pre-16S to post-16S time points. However, antibiotics were continued for a large number of episodes with negative 16S when judged as infectious by the treating clinician.

Conclusions

16S bacterial identification aided in the diagnosis and treatment of only a minority of orthopedic infections and results did not serve as a useful tool for antimicrobial de-escalation.

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https://pmc.ncbi.nlm.nih.gov/articles/PMC13187843/pdf/ofag262.pdf

Open Forum Infect Dis May 2026 V.13 N.5

Department of Microbiology, Oxford University Hospitals NHS Trust, Oxford, UK.

Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Department of Spinal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK.

Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.

Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.

Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.

Background

Postoperative spine infection (PSI) after surgery occurs in approximately 1%-2% of cases and is associated with significant morbidity. High-quality evidence to guide optimal prevention and management of PSI is limited.

Methods

We retrospectively identified all adult patients over a 3-year period (2020-2023) who required reoperation for deep PSI. Clinical, microbiological therapy, and 24-month outcome data were collected. Treatment failure was defined as unplanned return to the operating room secondary to persistent infection or infection-related implant failure requiring removal. Descriptive statistics and univariate logistic regression were used to identify factors associated with failure.

Results

Sixty-three deep PSI cases were identified (range 18-91 years, median 59 years, 56% female). Onset of infection ranged from 4 days to 30 weeks postoperatively (median 20 days). Staphylococcus aureus and Enterobacterales were the most common pathogens, followed by coagulase-negative staphylococci and Cutibacterium acnes. Treatment failure occurred in 13 cases (21%). In cases where implants were present (81% of total cohort), planned antibiotic durations of either 12 weeks or 24 weeks demonstrated similar success rates (P = .76). Infections involving Cutibacterium acnes were more likely associated with implant removal (P = .04). No other significant risk factors for failure were identified.

Conclusions

Most PSIs were effectively managed in this cohort with surgical debridement and targeted antibiotics, allowing implant retention in most patients with instrumentation.

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https://pmc.ncbi.nlm.nih.gov/articles/PMC13187830/pdf/ofag267.pdf

Section of Community-Transmitted Infections, Hospital Universitari Germans Trias i Pujol, Badalona 08917, Spain; Department of Medicine, Universitat Autónoma de Barcelona, Bellaterra, Spain; Infectious Diseases Department, Universitat de Vic-Universitat Central de Catalunya, Vic, Spain. Electronic address: omitja@lluita.org

The outbreak of Andes virus aboard the expedition cruise ship MV Hondius with 10 cases, three deaths, and more than 440 contacts including passengers of 23 nationalities, is a stark reminder that neglected zoonotic viruses can rapidly become international public health emergencies.

A WHO-led emergency scientific consultation on May 15, 2026, convened experts to assess the situation and coordinate research priorities.1 The outbreak in the ship might have potentially involved up to three generations of person-to-person transmission from a single index case, with two epidemic peaks during 18 days and one asymptomatic PCR-positive case. The meeting highlighted three urgent realities: the Andes virus can sustain person-to-person transmission, the medical countermeasure pipeline remains immature, and existing scientific networks require urgent support.

The global response is not starting from zero. The International Society of Hantaviruses—established in 1989 and currently led by Nicole Tischler—represents a ready-made collaborative framework that should be strengthened to accelerate diagnostics, therapeutics, and vaccine research.

Chile’s long-standing experience with the Andes virus offers important operational lessons for outbreak control. Between 2021 and 2025, health authorities in the Los Ríos region monitored 106 close contacts with daily symptom checks and serial RT-PCR testing. Six secondary cases were identified (secondary attack rate 5·7%), all among household contacts (Claudia Campillo, Seremi de Salud Valdivia, Chile, personal communication). One contact was PCR-positive while asymptomatic and subsequently developed symptoms, showing that detectable viraemia could occur before symptom onset.2 A highlighted operational strength was the ability to obtain PCR results within 24 h even in dispersed rural populations.

Genomic investigations from Argentina further clarified transmission dynamics. The 1996 El Bolsón outbreak first established person-to-person transmission with 16 cases and nine deaths (56% case fatality rate).3 The 2018 Epuyén outbreak (34 cases, 11 deaths [32% case fatality rate]) started at a birthday party associated with 64% of transmission events, and documented four generations of transmission with an estimated reproductive number of about 2·1 before control measures reduced transmission.4 Viral genomes showed minimal diversity, with only synonymous mutations, suggesting that human behaviour rather than viral adaptation was driving spread.

Key uncertainties nevertheless remain regarding infectivity and timing of transmission. A previous prospective study suggests that transmission risk is greatest during the prodromal and early symptomatic phases, when infectious virus can be detected in oral and respiratory secretions.5 To address these questions, investigators initiated a Collaborative Open Research Consortium-led observational study of quarantined individuals from the MV Hondius outbreak to clarify infectivity, presymptomatic transmission, and disease natural history.

Clinicians from endemic regions highlighted the unpredictable course of Andes virus disease. A wide clinical spectrum has been described, often affecting adults in their 30s and 40s.6 Because deterioration can occur abruptly, Chilean management strategies prioritise early transfer to extracorporeal membrane oxygenation. In humans with Hantavirus Cardiopulmonary Syndrome caused by Sin Nombre virus, neutralising antibody titres at hospital admission correlated inversely with disease severity.7 Similar observations have also been reported in Andes virus infection (Maritza Navarrete, Hospital Base de Valdivia, Chile, personal communication).

The pipeline for medical countermeasures are largely absent. RT-PCR on whole blood is the diagnostic cornerstone, but few commercial assays are available for the Andes virus as most available tests target Old World hantaviruses. WHO interim guidance therefore recommends that when Andes virus-specific assays are unavailable, laboratories use hantavirus-generic RT-PCR targeting conserved genomic regions (S and/or L segments), followed by sequencing for species confirmation.8 The response has largely relied on in-house protocols developed by expert laboratories in Chile and Argentina, with WHO facilitating rapid sharing of primers, controls, and biosafety guidance. Expanding access to validated commercial diagnostics for New World hantaviruses should be a priority.

Approved therapetic options are absent and are likely to depend on the stage of disease. Antivirals are mainly being considered for post-exposure prophylaxis and very early disease. Favipiravir is the most advanced repurposed antiviral under investigation, supported by in-vitro activity, animal models, and human safety data. Ribavirin is not prioritised because efficacy data is inconsistent and safety concerns remain. Other antivirals, including molnupiravir and baloxavir, require urgent in-vitro evaluation, whereas monoclonal antibodies are promising but preclinical.

Once cardiopulmonary disease is established, immunomodulators targeting inflammation or vascular leakage can be more relevant than antivirals. Immunological profiling has suggested that severe disease could involve distinct inflammatory phenotypes. One hypothesis proposed an IL-6-driven inflammatory syndrome, which led to compassionate-use experience with tocilizumab, an IL-6 receptor blocker.9 Frank van de Veerdonk, from Radboud

University, The Netherlands, also discussed alternative mechanisms, based on cytokine profiling of 33 patients with Andes virus,4 including an endothelial interferon-driven hyperinflammatory phenotype (high IP-10, CXCL9, and IL-18) and a bradykinin-mediated vascular-leak pathway associated with platelet and contact-system activation and increased D-dimer that could potentially be targeted with Icatibant, a bradykinin receptor antagonist.

Vaccines are largely in discovery. The most advanced vaccine in development is a multi-dose United States Army Medical Research Institute of Infectious Diseases DNA vaccine targeting the viral Andes virus glycoprotein, which shows antibody-mediated protection in hamster models and has completed phase 1 development.10 Viral vector and mRNA options are in preclinical development. However, major uncertainties remain regarding cross-neutralisation between Andes virus lineages, and the hamster paradox, in which rodent-derived strains are lethal in animals whereas human-derived strains are not, complicating efficacy testing.

The MV Hondius outbreak has exposed how unprepared the global community remains for a pathogen known for decades to cause severe disease and person-to-person transmission. Future outbreaks are inevitable yet, diagnostics, therapeutics, and vaccines remain underdeveloped. This momentum should translate into sustained investment in endemic-country research networks and frontline teams with longstanding experience to guide preparedness and accelerate countermeasure development.

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Br J Hosp Med (Lond) January 2024 V.85 N.1 P.1-9.

Department of Trauma and Orthopaedics, East Suffolk and North Essex NHS Foundation Trust, UK.

Department of Orthopaedics, Schoen Clinic, London, UK.

Management of joint infection is an evolving topic. This article reviews the literature on the management of native and prosthetic joint infection and suggests some areas of improvement in short- and long-term management which could lead to better patient outcomes. Surgical management is the mainstay of treatment for native or prosthetic knee infection and aspiration should only be used for diagnostic purposes. A multidisciplinary team approach and compliance with national guidelines, alongside referral networks and pooling of expertise, should be mandatory to improve patient outcomes.

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https://www.imrpress.com/journal/BJHM/85/1/10.12968/hmed.2023.0219

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https://storage.imrpress.com/IMR/hmed/application/10.12968/hmed.2023.0219.pdf

Clin Microbiol Infect February 2023 V.29 N.2 P.150-159.

Department of Medicine, Division of Infectious Diseases, University of Alabama Heersink School of Medicine, Birmingham, AL, USA; Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA. Electronic address: ralee@uabmc.edu

Department of Medicine, Division of Infectious Diseases, University of Alabama Heersink School of Medicine, Birmingham, AL, USA; Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.

Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.

Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA; Department of Medicine, University of Alabama Heersink School of Medicine, Birmingham, AL, USA.

Background

Over the past 25 years, researchers have performed >120 randomized controlled trials (RCTs) illustrating short courses to be non-inferior to long courses of antibiotics for common bacterial infections.

Objective

We sought to determine whether clinical data from RCTs affirm the mantra of ‘shorter is better’ for antibiotic durations in 7 common infections: pneumonia, urinary tract infection, intra-abdominal infection, bacteraemia, skin and soft tissue infection, bone and joint infections, pharyngitis and sinusitis.

Sources

Published RCTs comparing short- versus long-course antibiotic durations were identified through searches of PubMed and clinical guideline documents.

Content

Short-course antibiotic durations consistently result in similar treatment success rates as longer antibiotic courses among patients with community-acquired pneumonia, complicated urinary tract infections in women, gram-negative bacteraemia, and skin and soft tissue infections when the diagnosis is confirmed, appropriate antimicrobials are used, and patients show clinical signs of improvement. For patients with osteomyelitis, 6 weeks of antibiotics is adequate for the treatment of osteomyelitis in the absence of implanted foreign bodies and surgical debridement. Whether durations can be further shortened with debridement is unclear, although small studies are promising.

Implications

With few exceptions, short courses were non-inferior to long courses; future research should focus on appropriately defining the patient population, ensuring the correct choice and dose of antimicrobials and developing meaningful outcomes relevant for frontline clinicians.

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Ann Jt January 2022

IRCCS Istituto Ortopedico Galeazzi, Centre for Reconstructive Surgery and Osteoarticular Infections, Milan, Italy.

Università degli Studi di Milano, Milan, Italy.

IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy.

Periprosthetic joint infection (PJI) is one of the major complications following arthroplasty implantation. Management of PJIs is a challenge for surgeons and various classification systems have been introduced, which consider variables such as onset of symptoms, pathogenesis and clinical manifestation. In an attempt to overcome the shortcomings which may limit their usefulness in borderline cases, a new classification system focusing on the topography of the infectious process has been proposed. This theory relies on the identification of the exact location of the bacterial colonization thus allowing to decide between a conservative or a more radical intervention irrespectively of the timing. The use of nuclear medicine device like radiolabelled white blood cells (WBC) scan could lead the path in identifying pathogenetic processes and their exact location thus guiding orthopaedic surgeons to the most appropriate diagnosis and treatment options. Currently management relies on debridement, antibiotics and implant retention (DAIR), which is traditionally performed at early stages, 1- or 2-stage revision arthroplasty which is commonly limited to chronic cases. Reports have demonstrated similar rates of infection recurrence following one and two-stage revisions, and the use of one-stage revision surgery is gaining popularity. More recently, satisfying results following partial implant retention during revision total arthroplasty for septic failures have been reported. In addition, in severe cases, definitive articulating antibiotic spacer, excision arthroplasty, arthrodesis or amputation can be performed.

La infección periprotésica articular (IPA) es una de las principales complicaciones tras la implantación de una artroplastia.

El manejo de las IPA representa un desafío para los cirujanos, y se han introducido diversos sistemas de clasificación que consideran variables como el inicio de los síntomas, la patogenia y la manifestación clínica.

Para superar las limitaciones que pueden restringir su utilidad en casos límite, se ha propuesto un nuevo sistema de clasificación centrado en la topografía del proceso infeccioso.

Esta teoría se basa en la identificación de la localización exacta de la colonización bacteriana, lo que permite decidir entre una intervención conservadora o una más radical, independientemente del momento de aparición.

El uso de dispositivos de medicina nuclear, como la gammagrafía con leucocitos marcados con radioisótopos, podría facilitar la identificación de los procesos patogénicos y su localización exacta, guiando así a los cirujanos ortopédicos hacia el diagnóstico y las opciones de tratamiento más apropiadas.

Actualmente, el manejo se basa en el desbridamiento, antibióticos y retención del implante (DAIR), que tradicionalmente se realiza en etapas tempranas, y en la artroplastia de revisión en una o dos etapas, que suele limitarse a casos crónicos.

Los informes han demostrado tasas similares de recurrencia de la infección tras revisiones en una y dos etapas, y el uso de la cirugía de revisión en una etapa está ganando popularidad.

Más recientemente, se han reportado resultados satisfactorios tras la retención parcial del implante durante la artroplastia total de revisión por fallos sépticos.

Además, en casos graves, se puede realizar un espaciador antibiótico articular definitivo, una artroplastia de escisión, una artrodesis o una amputación.

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https://pmc.ncbi.nlm.nih.gov/articles/PMC10929296/pdf/aoj-07-3.pdf