Pathogenesis and treatment concepts of orthopaedic biofilm infections.
Implant-associated infection is caused by surface-adhering bacteria persisting as biofilm. Periprosthetic joint infection is difficult to diagnose and treat. The high susceptibility of implanted devices to infection is because of a locally acquired host defense defect, and persistence is mainly because of the rapid formation of a biofilm resistant to host defense and antimicrobial agents. Successful treatment of periprosthetic joint infection requires the optimal surgical procedure combined with long-term antimicrobial therapy directed against surface-adhering microorganisms. Surgical treatment according to an algorithm has been validated in several observational studies. The role of rifampin against device-associated staphylococcal infection has been evaluated in an animal model, in observational studies and in a controlled trial. Given the limited efficacy of traditional antibiotics in implant-associated infections, novel strategies such as coating of the device, vaccination against biofilms, and quorum-sensing inhibitors are promising future options for prevention and treatment.
Basel University Medical Clinic, Kantonsspital, Liestal, Switzerland. werner.zimmerli@unibas.ch
Werner
W
Zimmerli
Claus
C
Moser
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000472:pathogenicity*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D018407:Bacterial Physiological Phenomena; D018441:Biofilms / Q000254:growth & development*; D004195:Disease Models, Animal; D006801:Humans; D007595:Joint Prosthesis / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D012293:Rifampin / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D012293:Rifampin