The 2025 International Consensus Meeting on Musculoskeletal Infection: Research Priorities and Future Directions

Musculoskeletal infection (MSKI) is a leading cause of implant failure following orthopedic surgery for trauma or elective procedures and it is associated with catastrophic outcomes for patients and healthcare systems worldwide. International Consensus Meetings (ICM) aim to define state-of-the-art, influencing clinical standards of care and accelerating discoveries by setting research priorities. The 3rd ICM was held on May 8-10, 2025 in Istanbul (Turkey) and included a 2-year-long Delphi process that culminated with in-person voting by 1205 delegates on 102 General and 30 Biofilm-specific MSKI questions. Consistent with prior ICMs, a Research Priorities Workgroup was established after the voting to interpret the results and summarize the most important future directions. Here, the group reports on several critical research priorities that emerged, which should be addressed to advance the field. These include: (1) improving diagnostics through standardized patient sampling, advanced non-invasive imaging technologies, and biofilm-specific biomarkers; (2) developing clinically relevant in-vitro and in-vivo models to rigorously and reproducibly test antibiofilm strategies; (3) identifying high priority immunological research areas, including deciphering the role of T-cell immunity in biofilm persistence, and if T cell targeting therapies can be harnessed to disrupt chronic biofilm-associated infection; (4) clinically evaluating novel anti-biofilm technologies on larger cohorts of patients; and (5) addressing translational barriers through the use of multi-center data collection and large-scale data tools to accelerate clinical application. These research priorities aim to enhance the prevention, diagnosis, and treatment of biofilm-associated MSKI.