Jeyaraman Madhan, Jayakumar Tarun, Jeyaraman Naveen, Nallakumarasamy Arulkumar, Ramasubramanian Swaminathan, Muthu Sathish, Jain Vijay Kumar
Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600077, Tamil Nadu, India.
Department of Orthopaedics, KIMS-Sunshine Hospital, Hyderabad, 500032, Telangana, India.
J Clin Orthop Trauma. 2024 Nov 2;58:102791. doi: 10.1016/j.jcot.2024.102791. eCollection 2024 Nov.
The emergence of antimicrobial resistance (AMR) has profoundly impacted the management of osteoarticular infections (OAIs), presenting significant challenges for healthcare systems worldwide. This review provides a comprehensive overview of the current landscape of AMR in OAIs, emphasizing the necessity for assertive and innovative strategies to combat this escalating health threat. It discusses the evolution of resistance among key pathogens, including ESKAPEE organisms, and the implications for treatment protocols and healthcare outcomes. The importance of antibiotic stewardship programs (ASPs) is highlighted as a core strategy to optimize antibiotic use and mitigate the development of resistance. Additionally, the review explores the potential of pharmacological approaches, including novel antibiotic regimens and combination therapies, alongside surgical interventions and alternative therapies such as bacteriophage-based treatments and probiotics, in managing these complex infections. The role of rapid diagnostic methods in improving treatment accuracy and the critical need for global surveillance to track AMR trends are also examined. By integrating insights from recent literature and expert recommendations, this review underscores the multifaceted approach required to address the challenge of AMR in OAIs effectively. It calls for a concerted effort among clinicians, researchers, and policymakers to foster innovation in treatment strategies, enhance diagnostic capabilities, and implement robust stewardship and surveillance programs. The goal is to adapt to the evolving landscape of OAIs and ensure optimal patient care in the face of rising AMR.
抗菌药物耐药性（AMR）的出现对骨关节炎感染（OAIs）的管理产生了深远影响，给全球医疗系统带来了重大挑战。本综述全面概述了OAIs中AMR的当前状况，强调了采取果断和创新策略应对这一日益严重的健康威胁的必要性。它讨论了包括ESKAPEE病原体在内的关键病原体的耐药性演变，以及对治疗方案和医疗结果的影响。抗生素管理计划（ASPs）的重要性被强调为优化抗生素使用和减轻耐药性发展的核心策略。此外，该综述还探讨了药物治疗方法的潜力，包括新型抗生素方案和联合疗法，以及手术干预和诸如基于噬菌体的治疗和益生菌等替代疗法在管理这些复杂感染中的作用。还研究了快速诊断方法在提高治疗准确性方面的作用以及全球监测以跟踪AMR趋势的迫切需求。通过整合近期文献的见解和专家建议，本综述强调了有效应对OAIs中AMR挑战所需的多方面方法。它呼吁临床医生、研究人员和政策制定者共同努力，促进治疗策略的创新，提高诊断能力，并实施强有力的管理和监测计划。目标是适应OAIs不断变化的形势，并在AMR不断上升的情况下确保为患者提供最佳护理。
