The Basic Science of Biofilm and Its Relevance to the Treatment of Periprosthetic Joint Infection

Abstract

Throughout the natural environment, bacteria adhere to solid surfaces and form microcolonies surrounded by hydrated polymeric matrices of their own synthesis. First identified in environmental aquatic systems, these adherent bacterial microcolonies, known as biofilms, are now recognized as playing a key role in the pathogenesis and resistance to treatment of periprosthetic joint infections. Recent advances in imaging and molecular diagnostic techniques have allowed closer examination of the complexity of biofilms on prosthetic implants, including investigation of the ability of bacteria in such biofilms to communicate with one another and adapt to changes in their environment. Through transformation from a planktonic to a sessile state, the bacteria in a biofilm become resistant to antibiotics and host defenses, and may not be detected by conventional microbiologic culture techniques. Although some important advances have been made in the understanding and control of periprosthetic biofilms, current research in this field is focused on preventing bacterial adhesion to the surfaces of implants, disrupting biofilms to improve the diagnosis and treatment of periprosthetic joint infections, molecular techniques for detecting biofilms, and the eradication of biofilms in the setting of periprosthetic joint infections.

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