Orthopedics and biofilm--what do we know? A review

Abstract

Bacteria have been found to grow predominantly in biofilms. The initial stage includes the attachment of bacteria to the substratum. Bacterial growth and division then leads to the colonization of the surrounding area and the formation of the biofilm. The environment in a biofilm is not homogeneous; the bacteria in a multispecies biofilm are not randomly distributed, but rather are organized to best meet their needs. Although there is an initial understanding on the mechanisms of biofilm-associated antimicrobial resistance, this topic is still under investigation. A variety of approaches are being explored to overcome biofilm-associated antimicrobial resistance. A greater understanding of biofilm processes should lead to novel, effective control strategies for biofilm control and a resulting improvement in patient management.

Figure 1

Diagram showing the development of a biofilm as a five-stage process. Stage 1: initial attachment of cells to the surface. Stage 2: production of extracellular polymeric substance. Stage 3: early development of biofilm architecture (colonization). Stage 4: maturation of biofilm architecture. Stage 5: dispersion of single cells from the biofilm. In the final stage, when environmental conditions become unfavorable, some of the bacteria may detach and swim away to find a surface in a more favorable environment.

Figure 2

Schematic representation of planktonic bacterial cells, killed by antibiotics and the immune system, and biofilm microorganisms, attached to a surface and protected in an extracellular matrix.