Implant-related infections are among the main reasons for joint arthroplasty and osteosynthesis failure. Despite host’s immune system and antibiotic prophylaxis, implant infection may follow bacterial adhesion to biomaterials and biofilm formation, a main reason for bacterial persistence. Over the past 20 years, a wide range of different antibiofilm agents have been investigated both in vitro and in vivo. The results that emerged are promising, though their implementation in orthopedics is still at an early stage. Here we review the main results and propose an original classification of antibiofilm agents, sorted according to their action mechanism. Molecules interfering with biofilm formation (biofilm prevention agents) include anti-adhesion compounds, quorum-sensing inhibitors, nonsteroidal anti-inflammatory drugs, antimicrobial peptides, and active bioglass. N-Acetylcysteine and specific enzymes are able to disrupt already established biofilms (biofilm-disrupting agents). An alternative approach relies on the identification of antimicrobials able to bypass the biofilm barrier (biofilm-bypassing agents) and on the development of antibiofilm vaccine. Local application of antibacterial and antibiofilm agents, like implant coating, is a feasible and promising approach, while systemic antibiofilm treatment is still restricted to animal models. Further research in this promising field appears necessary.
|Title of host publication||Perioperative Medical Management for Total Joint Arthroplasty: How to Control Hemostasis, Pain and Infection|
|Publisher||Springer International Publishing|
|Number of pages||18|
|ISBN (Print)||9783319072036, 9783319072029|
|Publication status||Published - Jan 1 2015|
ASJC Scopus subject areas