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Review
. 2022 Dec 20;57(1):44-51.
doi: 10.1007/s43465-022-00782-6. eCollection 2023 Jan.

Biofilms-What Should the Orthopedic Surgeon know?

Mandeep Singh Dhillon  1 , Aman Hooda  2 , Thomas Fintan Moriarty  3 , Siddhartha Sharma  1
Affiliations
Review

Biofilms-What Should the Orthopedic Surgeon know?

Mandeep Singh Dhillon et al. Indian J Orthop. .

Abstract

Background: Musculoskeletal infections are a major source of morbidity for orthopedic and trauma patients, are associated with prolonged treatment times, and, unfortunately, suffer from poor functional outcomes. Further complicating the issue, antimicrobial resistance (AMR) is increasingly impacting the treatment of musculoskeletal infections with a diminishing repertoire of effective antibiotic agents for some highly resistant pathogens. Most orthopedic surgical procedures involve implants, and the formation of bacterial biofilms on these implants is now recognized as a major factor contributing to the failure of antibiotic therapy in orthopedic surgery.

Methods: This review presents an overview of the types, structure, formation, and pathogenesis of biofilms as they pertain to musculoskeletal infections. Furthermore, it describes the key concepts in the management of biofilms and future perspectives for the better treatment of patients with biofilm-related musculoskeletal infections.

Results: A bacterial biofilm is a dynamic, living conglomerate of bacteria encased in an extracapsular polysaccharide matrix (EPS). Biofilms are a natural mode of survival for virtually all bacterial species, including both Grampositive and Gram-negative bacteria, as well as fungi. The biofilm model of growth confers resistance by several well-defined mechanisms regardless of the species of the microorganism. In most cases, biofilm management often necessitates radical measures to ensure eradication including both surgical and medical interventions.

Conclusions: Orthopedic surgeons should be aware of the key concepts pertaining to biofilms, and the impact that these can have on clinical practice.

Keywords: Antimicrobial resistance; Bacteria; Biofilm; Extracellular polymeric substance; Fracture-related infection; Musculoskeletal infection; Peri-prosthetic joint infection.

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Conflict of interest statement

Conflicts of interestOn behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Mechanisms of antimicrobial resistance. (1) limitation of drug uptake (2) modification of drug target (3) drug inactivation and (4) active drug effluent
Fig. 2
Fig. 2
Scanning electron microscope (SEM) images of a Staphylococcus aureus biofilm. Note is made of oval bacterial colonies encased within a thick meshwork of extracellular polymeric substance
Fig. 3
Fig. 3
Schematic diagram illustrating different components of a biofilm
Fig. 4
Fig. 4
Stages in the formation of a biofilm- (1) Attachment phase, (2) Growth or micro-colonization, (3) Maturation phase and (4) Dispersal phase- Spread of infection to the new site
See this image and copyright information in PMC

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