Proper Use of Antibiotic Agents in the Management of Musculoskeletal Infection.

Musculoskeletal infections have plagued all creatures for millions of years. The ability to manage infection via antibiotic agents has emerged only in the past 100 years. The use of antibiotic agents has not always been appropriate and judicious, which has led to widespread microbial resistance to certain antibiotic agents. Although antibiotic resistance is a considerable consequence of inappropriate antibiotic use, the systemic adverse effects of chronic antibiotic use on patients have largely been ignored. These systemic adverse effects may have been prevented if surgeons had a better understanding of the microbiology of the pathogens involved in musculoskeletal infections. Most importantly, the formation of biofilm as an infection becomes chronic makes bacteria relatively impervious to systemic antibiotic agents. Therefore, surgeons must understand the difference between and how to appropriately manage acute and chronic musculoskeletal infections. This dichotomous approach in the management of infection also must be applied in patients with periprosthetic joint infection. The appropriate use of antibiotic agents in the management of musculoskeletal infections may help mitigate the spread of antibiotic resistance and the adverse effects of inappropriate antibiotic use.