Advances in our understanding of the bone and joint pathology caused by Staphylococcus aureus infection

Abstract

There is growing concern that we are entering a bacteriological dark age in which we will no longer be able to treat bacterial infections with antibiotics. This apocalyptic prophecy is fuelled by the increasing incidence of antibiotic‐resistant bacteria, and perhaps the best example of how we are losing the antibiotic battle is provided by Staphylococcus aureus [1], which has been reported recently to have become less susceptible to vancomycin, the antibiotic of last resort [2, 3]. S. aureus causes a range of bone and joint pathologies, such as infections of prostheses, osteomyelitis, septic arthritis and septic bursitis. The reported incidence of infection of prosthetic joints is 1–5%, and although this figure may appear to be low, the consequences of infections are dire [4, 5]. Prosthetic implant infections are usually treated by revision operations because the success rate for treatment without revision, at least for prosthetic hip and knee infections, is less than 10% [5, 6]. After revision operations, the rate of infection of replacement prostheses actually rises. Thus, prosthetic infections place a severe burden on the health service through prolonged hospitalization for antibiotic therapy, prosthesis removal and replacement, and space debridement.