The role of biofilm on orthopaedic implants: the "Holy Grail" of post-traumatic infection management?
The development of post-traumatic infection is potentially a limb threatening condition. The orthopaedic trauma literature lags behind the research performed by our arthroplasty colleagues on the topic of implant-related infections. Surgical site infections in the setting of a recent ORIF are notoriously hard to eradicate due to biofilm formation around the implant. This bacteria-friendly, dynamic, living pluri-organism structure has the ability to morph and adapt to virtually any environment with the aim to maintain the causative organism alive. The challenges are twofold: establishing an accurate diagnosis with speciation/sensitivity and eradicating the infection. Multiple strategies have been researched to improve diagnostic accuracy, to prevent biofilm formation on orthopaedic implants, to mobilize/detach or weaken the biofilm or to target specifically bacteria embedded in the biofilm. The purpose of our paper is to review the patho-physiology of this mysterious pluri-cellular structure and to summarize some of the most pertinent research performed to improve diagnostic and treatment strategies in biofilm-related infections.
Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA. Cyril.mauffrey@dhha.org.
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Mauffrey
Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
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Herbert
Division of Infectious Diseases, Department of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
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Young
Department of Pathology, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
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Wilson
Department of Orthopaedics, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
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Hake
Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
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Stahel
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects* / Q000254:growth & development; D006801:Humans; D015918:Infusion Pumps, Implantable; D009985:Orthopedics; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*; D019736:Prostheses and Implants / Q000382:microbiology*; D013010:Sonication; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D014947:Wounds and Injuries / Q000382:microbiology / Q000601:surgery*
D000900:Anti-Bacterial Agents
Biofilm; Biofilm-related infections; Osteomyelitis; Post-traumatic osteomyelitis