Bioengineering Approaches to Fight against Orthopedic Biomaterials Related-Infections

Abstract

One of the most serious complications following the implantation of orthopedic biomaterials is the development of infection. Orthopedic implant-related infections do not only entail clinical problems and patient suffering, but also cause a burden on healthcare care systems. Additionally, the ageing of the world population, in particular in developed countries, has led to an increase in the population above 60 years. This is a significantly vulnerable population segment insofar as biomaterials use is concerned. Implanted materials are highly susceptible to bacterial and fungal colonization and the consequent infection. These microorganisms are often opportunistic, taking advantage of the weakening of the body defenses at the implant surface–tissue interface to attach to tissues or implant surfaces, instigating biofilm formation and subsequent development of infection. The establishment of biofilm leads to tissue destruction, systemic dissemination of the pathogen, and dysfunction of the implant/bone joint, leading to implant failure. Moreover, the contaminated implant can be a reservoir for infection of the surrounding tissue where microorganisms are protected. Therefore, the biofilm increases the pathogenesis of infection since that structure offers protection against host defenses and antimicrobial therapies. Additionally, the rapid emergence of bacterial strains resistant to antibiotics prompted the development of new alternative approaches to prevent and control implant-related infections. Several concepts and approaches have been developed to obtain biomaterials endowed with anti-infective properties. In this review, several anti-infective strategies based on biomaterial engineering are described and discussed in terms of design and fabrication, mechanisms of action, benefits, and drawbacks for preventing and treating orthopaedic biomaterials-related infections.

Bacterial Biofilm Formation on Biomaterials and Approaches to Its Treatment and Prevention

“…Colonization of biomaterials by pathogens leads to the formation of biofilms, which greatly increases the potential for clinical infection [100]. This includes devices such as mechanical heart valves, prosthetic joints, endotracheal tubes, and contact lenses with biofilm-related infection [101] (Table 1). Once biofilms are formed on medical devices, eradicating microbes becomes extremely difficult and can be costly due to the lengthy hospital stays, surgery, and long-term antibacterial treatments that are often required [102].…”

Effect of Camel Peptide on the Biofilm of Staphylococcus epidermidis and Staphylococcus haemolyticus Formed on Orthopedic Implants

“…Biofilm can lead to tissue destruction, failure of the surgery and the need for revision surgery, as well as carrying the risk of systemic infection. Staphylococci, including S. epidermidis and S. haemolyticus, are predominant in these types of infections [45][46][47].…”

“…It is also significant in the case of infections accompanied by biofilm formation. Antimicrobial peptides are a valuable group of compounds with therapeutic potential [45,49].…”

A Cyclam Salt as an Antifungal Agent: Interference with Candida spp. and Cryptococcus neoformans Mechanisms of Virulence

“…Compound 1 was able to inhibit the biofilm formation of C. albicans, C. krusei, and C. neoformans at concentration values corresponding to 2 MIC (MIC = 128, 8, and 4 μg/mL, respectively, [9]), showing a higher antibiofilm capacity for C. krusei and C. neoformans. C. albicans, C. krusei, and C. neoformans are all able to form biofilms, defined as threedimensional organized structures constituted by clusters of microorganisms (bacteria or fungi) adhered in either biotic (e.g., host tissue) or abiotic (e.g., inert material) surfaces or interfaces and encased in a protective self-produced hydrated extracellular matrix composed mainly of proteins, polysaccharides, and extracellular DNA [13]. Although biofilm formation in vivo usually involves a combination of bacterial and fungal species, it is important to note that a single microbial species can also create a biofilm [14,15].…”