Pathogen Spectrum and Drug Resistance in Bone and Joints Infections: A Literature Review

We reviewed the available literature on the spectrum of bone and joint infection (BJI) pathogens and their drug resistance. A systematic search of publications was performed in the international PubMed database and the Russian scientific electronic library eLIBRARY.RU for the period of 2006-2026. The review included 79 studies containing data on the microbiological structure of BJI pathogens and antibacterial drug resistance rates in osteomyelitis, prosthetic joint infection, septic arthritis, and spondylodiscitis. The selection was performed in line with the PRISMA 2020 guidelines.

Results. Staphylococcus aureus and coagulase-negative staphylococci, primarily Staphylococcus epidermidis, remain the leading BJIs pathogens, particularly in implant-associated infections. Gram-negative microorganisms, including Pseudomonas aeruginosa, members of the order Enterobacterales, and polymicrobial associations, also play a significant role. An increasing prevalence of methicillin-resistant staphylococci, ESBL-producing, and carbapenem-resistant gram-negative bacteria has been noted which substantially limits the options for empirical antibacterial therapy. The structure of BJI pathogens and their resistance profiles vary depending on the clinical forms of infection, geographical region, and diagnostic approach used. In some regions, a high prevalence of bone and joint tuberculosis caused by Mycobacterium tuberculosis persists. This pathology is characterized by delayed diagnosis and high rates of drug resistance.

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