title: Drug treatments for prosthetic joint infections in the era of multidrug resistance.
abstract: BACKGROUND
  Despite many advances, the management of prosthetic joint infection is still a complex issue. Moreover, in recent years the problem of antimicrobial resistance has emerged as an important challenge.
  
  
  METHODS
  We analysed recent advances in different aspects of prosthetic joint infections. The importance of biofilms needs to be considered for antibiotic selection because, when embedded in these structures, bacteria acquire resistant behaviour. Moreover, the presence of resistance mechanisms in some species of organisms increases the difficulty of management. In this sense, the growing importance of methicillin-resistant staphylococci, multidrug-resistant Enterobacteriaceae or Pseudomonas aeruginosa is of increasing concern. Together with these organisms, others with constitutive resistance against most antibiotics (like Enterococcus sp., mycobacteria or fungi) represent a similar problem for selection of therapy. Research into new materials that can be used as drug carriers opens a new field for management of these infections and will likely come to the front line in the coming years.
  
  
  CONCLUSIONS
  Individualised therapies should carefully consider the aetiology, pathogenesis and antimicrobial susceptibility. Satisfactory clinical outcome could be further fostered by enhancing the multidisciplinary approach, with better collaboration in the antibiotic selection and the surgical management.
authors.affiliation: a Bone and Joint Infection Unit, Department of Clinical Microbiology , IIS-Fundacion Jimenez Diaz, UAM , Madrid , Spain.
authors.forename: Concepcion
authors.initials: C
authors.lastname: Perez-Jorge
authors.affiliation: b Department of Orthopaedic Surgery , IdiPaz-Hospital La Paz Institute for Health Research, UAM , Madrid , Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gomez-Barrena
authors.affiliation: c Service of Infectious Diseases, Hospital del Mar, CEXS Universitat Pompeu Fabra , Institut Hospital del Mar d'Investigacions Mèdiques , Barcelona , Spain.
authors.forename: Juan-Pablo
authors.initials: JP
authors.lastname: Horcajada
authors.affiliation: d Department of Orthopaedic Surgery , Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques , Barcelona , Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Puig-Verdie
authors.affiliation: a Bone and Joint Infection Unit, Department of Clinical Microbiology , IIS-Fundacion Jimenez Diaz, UAM , Madrid , Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Esteban
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial / Q000187:drug effects; D018432:Drug Resistance, Multiple / Q000187:drug effects; D004755:Enterobacteriaceae / Q000187:drug effects; D004756:Enterobacteriaceae Infections / Q000188:drug therapy; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D057285:Precision Medicine / Q000379:methods / Q000639:trends; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D011552:Pseudomonas Infections / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D013203:Staphylococcal Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Prosthetic joint infection; biomaterial; carbapenemase; methicillin-resistant; multidrug-resistance; resistance; treatment