Recent Strategies to Combat Infections from Biofilm-Forming Bacteria on Orthopaedic Implants

Biofilm is the trigger for the majority of infections caused by the ability of microorganisms to adhere to tissues and medical devices. Microbial cells embedded in the biofilm matrix are highly tolerant to antimicrobials and escape the host immune system. Thus, the refractory nature of biofilm-related infections (BRIs) still represents a great challenge for physicians and is a serious health threat worldwide. Despite its importance, the microbiological diagnosis of a BRI is still difficult and not routinely assessed in clinical microbiology. Moreover, biofilm bacteria are up to 100–1000 times less susceptible to antibiotics than their planktonic counterpart. Consequently, conventional antibiograms might not be representative of the bacterial drug susceptibility in vivo. The timely recognition of a BRI is a crucial step to directing the most appropriate biofilm-targeted antimicrobial strategy.

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“…Implant-related infection occurs following approximately 5% of all elective and emergency orthopedic procedures [ 77 ].…”

Section: Biofilm and Device-related Infectionsmentioning

confidence: 99%

The Current Knowledge on the Pathogenesis of Tissue and Medical Device-Related Biofilm Infections

2022

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“…Biofilms are three-dimensional complex structures that confer significant survival advantages to microorganism communities, which can lead to the recurrence of biofilm-related implant infection. This is a huge concern in the orthopedic field, especially since these communities are highly resilient to host immunity and to conventional anti-microbial therapies [ 24 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”

Section: Pathogenesis Of Implant-related Infectionsmentioning

confidence: 99%

“…These adhesins mediate initial biofilm attachment and intercellular adhesion during maturation-enhancing cohesion. Autolysins (like At1E) mediated the adhesion of S. epidermidis to polymeric surfaces, whereas fibronectin-binding proteins, e.g., FnBPA and FnBPB, induce S. aureus invasion into epithelial cells, endothelial cells, and keratinocytes [ 20 , 36 , 40 , 42 , 43 ].…”

Section: Pathogenesis Of Implant-related Infectionsmentioning

confidence: 99%

Bioengineering Approaches to Fight against Orthopedic Biomaterials Related-Infections

Barros

Monteiro

Ferraz

2022

IJMS

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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.

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“…In addition, it must be mentioned that each surgery to replace failed implants has a higher risk of recurrence (up to 30%) than that of the initial operation [ 14 ]. To solve these problems, great research progress has been made in the therapeutic approaches of biofilm, such as the studies on surface modification of implants, phage therapy, vaccine technology, and nanomedicines, but these new treatment methods need further preclinical and clinical validation before they are widely promoted for clinical use [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Staphylococcal Biofilm on the Surface of Implants in Orthopedic Infection

Han

Ren

et al. 2022

Microorganisms

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Despite advanced implant sterilization and aseptic surgical techniques, implant-associated infection remains a major challenge for orthopedic surgeries. The subject of bacterial biofilms is receiving increasing attention, probably as a result of the wide acknowledgement of the ubiquity of biofilms in the clinical environment, as well as the extreme difficulty in eradicating them. Biofilm can be defined as a structured microbial community of cells that are attached to a substratum and embedded in a matrix of extracellular polymeric substances (EPS) that they have produced. Biofilm development has been proposed as occurring in a multi-step process: (i) attachment and adherence, (ii) accumulation/maturation due to cellular aggregation and EPS production, and (iii) biofilm detachment (also called dispersal) of bacterial cells. In all these stages, characteristic proteinaceous and non-proteinaceous compounds are expressed, and their expression is strictly controlled. Bacterial biofilm formation around implants shelters the bacteria and encourages the persistence of infection, which could lead to implant failure and osteomyelitis. These complications need to be treated by major revision surgeries and extended antibiotic therapies, which could lead to high treatment costs and even increase mortality. Effective preventive and therapeutic measures to reduce risks for implant-associated infections are thus in urgent need.

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Recent Strategies to Combat Infections from Biofilm-Forming Bacteria on Orthopaedic Implants

Cited by 41 publications

References 131 publications

The Current Knowledge on the Pathogenesis of Tissue and Medical Device-Related Biofilm Infections

The Current Knowledge on the Pathogenesis of Tissue and Medical Device-Related Biofilm Infections

Bioengineering Approaches to Fight against Orthopedic Biomaterials Related-Infections

The Role of Staphylococcal Biofilm on the Surface of Implants in Orthopedic Infection

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