Pathogenesis and treatment concepts of orthopaedic biofilm infections

• Published in: FEMS immunology and medical microbiology Vol. 65; no. 2; pp. 158 - 168
• Main Authors: Zimmerli, Werner, Moser, Claus
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2012; Oxford University Press
• Subjects: Algorithms; Animal models; Animals; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Bacteria - pathogenicity; Bacterial Infections - drug therapy; Bacterial Infections - microbiology; Bacterial Infections - pathology; Bacterial Infections - surgery; Bacterial Physiological Phenomena; biofilm; Biofilms; Biofilms - growth & development; Coatings; Disease Models, Animal; Humans; Infection; Infections; Joint diseases; Joint Prosthesis - microbiology; Joints (anatomy); Microorganisms; Observational studies; Orthopedics; Pathogenesis; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - pathology; Prosthesis-Related Infections - surgery; prosthetic joint infection; quorum sensing; Randomized Controlled Trials as Topic; Rifampin; Rifampin - therapeutic use; treatment; Treatment Outcome; Vaccination; treatment; quorum sensing; rifampin; biofilm; prosthetic joint infection
• ISSN: 0928-8244; 1574-695X; 2049-632X
• DOI: 10.1111/j.1574-695X.2012.00938.x

Abstract Implant-associated infection is caused by surface-adhering bacteria persisting as biofilm. Periprosthetic joint infection is difficult to diagnose and treat. The high susceptibility of implanted devices to infection is because of a locally acquired host defense defect, and persistence is mainly because of the rapid formation of a biofilm resistant to host defense and antimicrobial agents. Successful treatment of periprosthetic joint infection requires the optimal surgical procedure combined with long-term antimicrobial therapy directed against surface-adhering microorganisms. Surgical treatment according to an algorithm has been validated in several observational studies. The role of rifampin against device-associated staphylococcal infection has been evaluated in an animal model, in observational studies and in a controlled trial. Given the limited efficacy of traditional antibiotics in implant-associated infections, novel strategies such as coating of the device, vaccination against biofilms, and quorum-sensing inhibitors are promising future options for prevention and treatment.