The 2023 Orthopaedic Research Society’s International Consensus Meeting on musculoskeletal infection: Summary from the host immunity section.

Dec 18, 2023

Experts: Edward M Schwarz,Nathan K Archer,Gerald J Atkins,Karen L de Mesy Bentley,Mina Botros,James E Cassat,Emanuele Chisari,Débora C Coraça-Huber,John L Daiss,Steven R Gill,Stuart B Goodman,Janette Harro,Christopher J Hernandez,Lionel B Ivashkiv,Stephen L Kates,Cláudia N H Marques,Elysia A Masters,Gowrishankar Muthukrishnan,John R Owen,Dina Raafat,Motoo Saito,Deborah J Veis,Chao Xie

Musculoskeletal infections (MSKI), which are a major problem in orthopedics, occur when the pathogen eludes or overwhelms the host immune system. While effective vaccines and immunotherapies to prevent and treat MSKI should be possible, fundamental knowledge gaps in our understanding of protective, nonprotective, and pathogenic host immunity are prohibitive. We also lack critical knowledge of how host immunity is affected by the microbiome, implants, prior infection, nutrition, antibiotics, and concomitant therapies, autoimmunity, and other comorbidities. To define our current knowledge of these critical topics, a Host Immunity Section of the 2023 Orthopaedic Research Society MSKI International Consensus Meeting (ICM) proposed 78 questions. Systematic reviews were performed on 15 of these questions, upon which recommendations with level of evidence were voted on by the 72 ICM delegates, and another 12 questions were voted on with a recommendation of “Unknown” without systematic reviews. Two questions were transferred to another ICM Section, and the other 45 were tabled for future consideration due to limitations of available human resources. Here we report the results of the voting with internet access to the questions, recommendations, and rationale from the systematic reviews. Eighteen questions received a consensus vote of ≥90%, while nine recommendations failed to achieve this threshold. Commentary on why consensus was not achieved on these questions and potential ways forward are provided to stimulate specific funding mechanisms and research on these critical MSKI host defense questions.
© 2023 Orthopaedic Research Society.

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ABOUT THE EXPERTS

Edward M Schwarz,Nathan K Archer,Gerald J Atkins,Karen L de Mesy Bentley,Mina Botros,James E Cassat,Emanuele Chisari,Débora C Coraça-Huber,John L Daiss,Steven R Gill,Stuart B Goodman,Janette Harro,Christopher J Hernandez,Lionel B Ivashkiv,Stephen L Kates,Cláudia N H Marques,Elysia A Masters,Gowrishankar Muthukrishnan,John R Owen,Dina Raafat,Motoo Saito,Deborah J Veis,Chao Xie

Edward M Schwarz

Department of Orthopaedics, University of Rochester, Rochester, New York, USA.

Nathan K Archer

Department of Dermatology, Johns Hopkins University, Baltimore, Maryland, USA.

Gerald J Atkins

Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia.

Karen L de Mesy Bentley

Department of Orthopaedics and Pathology and Laboratory Medicine, University of Rochester, Rochester, New York, USA.

Mina Botros

Department of Orthopaedics, University of Rochester, Rochester, New York, USA.

James E Cassat

Departments of Pediatrics, Pathology, Microbiology, and Immunology, and Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Emanuele Chisari

Department of Adult Hip and Knee Joint Reconstruction, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.

Débora C Coraça-Huber

ResearchLaboratory for Implant Associated Infections (Biofilm Lab) – University Hospital for Orthopedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.

John L Daiss

Department of Orthopaedics, University of Rochester, Rochester, New York, USA.

Steven R Gill

Department of Microbiology & Immunology, University of Rochester, Rochester, New York, USA.

Stuart B Goodman

Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA.

Janette Harro

Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, Maryland, USA.

Christopher J Hernandez

Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA.

Lionel B Ivashkiv

Department of Medicine and Immunology, Weill Cornell Medicine, Hospital for Special Surgery, New York, New York, USA.

Stephen L Kates

Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.

Cláudia N H Marques

Department of Biological Sciences, Binghamton Biofilm Research Center, Binghamton University, Binghamton, New York, USA.

Elysia A Masters

Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA.

Gowrishankar Muthukrishnan

Department of Orthopaedics, University of Rochester, Rochester, New York, USA.

John R Owen

Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.

Dina Raafat

Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.

Institute of Immunology, University Medicine Greifswald, Greifswald, Germany.

Motoo Saito

Department of Orthopaedics, University of Rochester, Rochester, New York, USA.

Deborah J Veis

Departments of Medicine, Pathology & Immunology, Washington University, St. Louis, Missouri, USA.

Chao Xie

Department of Orthopaedics, University of Rochester, Rochester, New York, USA.