title: Treating periprosthetic joint infections as biofilms: key diagnosis and management strategies.
abstract: Considerable evidence suggests that microbial biofilms play an important role in periprosthetic joint infection (PJI) pathogenesis. Compared to free-floating planktonic bacteria, biofilm bacteria are more difficult to culture and possess additional immune-evasive and antibiotic resistance mechanisms, making infections harder to detect and eradicate. This article reviews cutting-edge advances in biofilm-associated infection diagnosis and treatment in the context of current PJI guidelines and highlights emerging technologies that may improve the efficacy and reduce costs associated with PJI. Promising PJI diagnostic tools include culture-independent methods based on sequence comparisons of the bacterial 16S ribosomal RNA gene, which offer higher throughput and greater sensitivity than culture-based methods. For therapy, novel methods based on disrupting biofilm-specific properties include quorum quenchers, bacteriophages, and ultrasound/electrotherapy. Since biofilm infections are not easily detected or treated by conventional approaches, molecular diagnostic techniques and next-generation antibiofilm treatments should be integrated into PJI clinical practice guidelines in the near future.
authors.affiliation: Koch Institute for Integrative Cancer Research, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Tzeng
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9679, USA.
authors.forename: Tony H
authors.initials: TH
authors.lastname: Tzeng
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9679, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Vasdev
authors.affiliation: Rush University Medical College, Chicago, IL 60612, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Korth
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9679, USA.
authors.forename: Travis
authors.initials: T
authors.lastname: Healey
authors.affiliation: Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.affiliation: Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9679, USA. Electronic address: ksaleh@siumed.edu.
authors.forename: Khaled J
authors.initials: KJ
authors.lastname: Saleh
mesh_terms: D001168:Arthritis / Q000175:diagnosis* / Q000628:therapy*; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000628:therapy; D018441:Biofilms / Q000254:growth & development*; D001691:Biological Therapy / Q000379:methods; D004269:DNA, Bacterial / Q000235:genetics; D004275:DNA, Ribosomal / Q000235:genetics; D004599:Electric Stimulation Therapy / Q000379:methods; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000628:therapy*; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D014464:Ultrasonic Therapy / Q000379:methods
chemical_list: D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S
keywords: Bacterial 16S rRNA; Bacteriophage; Culture-negative; Implant-associated infection; Quantitative PCR; Quorum sensing/quenching