Low-Virulence Organisms and Periprosthetic Joint Infection-Biofilm Considerations of These Organisms

Abstract

Purpose of review: The purpose of this manuscript is to provide a critical review of peer-reviewed literature over the last 5 years related to low virulent organisms associated with periprosthetic joint infection (PJI). We evaluated the most common organisms, the diagnostic challenges, and the novel tools available in the perioperative workup of PJI as well as the current understanding of how biofilm potentiates the indolent clinical presentation and explore a possible shift in the surgical management of these patients.

Recent findings: Biofilm actively prevents macrophage phagocytosis by suppressing proinflammatory activity through the recruitment of myeloid-derived suppressor cells. Given the appropriate host and organism conditions, increased utilization of one-stage exchange arthroplasty in the surgical treatment of these low virulent infections may be on the rise. Biomarkers and molecular techniques offer encouraging results to diagnose low virulent organisms and future research focused on the disruption of biofilm may ultimately give rise to improved treatment strategies.

Keywords: Biofilm; Low-virulent organisms; Periprosthetic infection.

Fig. 1

P. acnes strains 77 and 87 on Brucella Blood Agar plates demonstrating the hemolytic phenotype as defined by greater than 2 mm of clearance surrounding the bacteria

Fig. 2

P acnes strains 83 and 84 on Brucella Blood Agar plates not demonstrating the hemolytic phenotype as shown by no evidence of clearance around the bacteria

Fig. 3

P. acnes strain 64 on the left demonstrating resistance to clindamycin by showing the bacteria growing up to the e test strip at the highest minimum inhibitory concentration (MIC). P. acnes strain 64 on the right showing an MIC of 0.25 for cephalothin (first-generation cephalosporin), which is considered susceptible based on EUCAST (European Committee on Antimicrobial Susceptibility Testing) standards

Fig. 4

S. epidermidis biofilm formation when evaluating microfluidic devices for studying growth and detachment of S. epidermidis biofilms. Reprinted with permission from Lee, JH., Kaplan, J.B., and Lee, W.Y. Biomed Microdevices (2008) 10: 489. 10.1007/s10544-007-9157-0. Please note that this photo originally appeared in a multi-paneled figure. The “(b)” on the image is not relevant to this review

Fig. 5

a, b MRSA (clinical isolate NRS70) biofilm image by scanning electron microscope (SEM) grown on titanium in vitro. Courtesy of Caelen Clark, PhD University at Buffalo