Editorial: Exploring clinical outcomes and treatment predictors in septic arthritis

Septic arthritis (SA) and periprosthetic joint infection (PJI) are challenging complications characterized by substantial morbidity, risk of joint degradation, and significant mortality. While surgical techniques, antimicrobial therapy, and diagnostic tools have known major progress in the last decade, numerous hurdles remain related to accurate diagnosis and optimal management, especially in regard to comorbidities, evolving pathogen profiles, and heterogeneous clinical presentations [1,2]. Recent guidelines and consensus definitions have brought significant improvements to the diagnosis structure by promoting combined methods over single-test approaches but a real gold standard is yet to be defined [3]. The present Research Topic brings together a collection of studies that address key aspects of diagnosis, treatment optimization, and prognostic stratification in septic arthritis and related joint infections.A main aspect becoming evident from this collection is the ongoing challenge represented by accurate and prompt diagnosis and the scientific interest in standardizing diagnostic pathways. Traditional microbiological methods are essential for etiological diagnosis, but their limitations are increasingly recognized. Wu et al. investigated whether extending culture duration improves diagnostic yield in PJI and found that prolonged incubation did not significantly increase culture positivity or improve clinical outcomes. These findings question the clinical utility of extended culture protocols and point out the need for more efficient diagnostic strategies. However, while extended incubation may not be helpful for acute or typical infections, it may remain a valid strategy for slower-growing organisms and bacteria adapted to biofilm in chronic infections or cases previously exposed to 34 antibiotics [4,5]. At