This is a very interesting article that points out that bacteria love to form biofilms on the material we love to use in arthroplasty: titanium and that there is competitive colonization of the surface, either by host cells or by bacteria = 'the race for the surface'.
Since this article appeared in a journal that shoulder surgeons may not read regularly, we summarize a bit of the article here.
"Antimicrobial resistance is one of the major healthcare challenges that is currently faced by mankind. By switching into the biofilm state, bacteria can withstand antibiotic chemotherapy, and this is increasingly regarded as the most important nonspecific mechanism of antimicrobial resistance. Biofilms are defined as a community of cells encased within a self-produced matrix that adhere to biological or non-biological surfaces. Because implanted medical devices can be ideal substrates for bacteria to attach, biofilm-mediated infections are one of the leading causes of prosthesis implantation failures.
When implanting a biomaterial, the desired outcome is the correct integration of such material with the host tissue. However, this ideal outcome is often impacted by the presence of bacterial cells at the moment of implantation. According to the concept of “race for the surface”, if host cells are able to colonize the surface of the device first, the chances of bacterial cells to adhere to such surface are lower, therefore lowering the risk of implant infection. A frequent route of infection for implants occurs during surgery, as microorganisms can be introduced on the implant surface, providing them with an advantage to colonize the unprotected surface and create a biofilm.
Taking this in consideration, a reasonable approach would be to design an antimicrobial material or coating, which promotes tissue integration. In that direction, it would be advantageous to precondition the material with host cells. Staphylococcus aureus is found asymptomatically on the skin and its presence there enhances the risk of infection in the surgical site, which is why it is egarded as a frequent causative agent of implant-related infections, especially in orthopaedics."
"Antimicrobial resistance is one of the major healthcare challenges that is currently faced by mankind. By switching into the biofilm state, bacteria can withstand antibiotic chemotherapy, and this is increasingly regarded as the most important nonspecific mechanism of antimicrobial resistance. Biofilms are defined as a community of cells encased within a self-produced matrix that adhere to biological or non-biological surfaces. Because implanted medical devices can be ideal substrates for bacteria to attach, biofilm-mediated infections are one of the leading causes of prosthesis implantation failures.
When implanting a biomaterial, the desired outcome is the correct integration of such material with the host tissue. However, this ideal outcome is often impacted by the presence of bacterial cells at the moment of implantation. According to the concept of “race for the surface”, if host cells are able to colonize the surface of the device first, the chances of bacterial cells to adhere to such surface are lower, therefore lowering the risk of implant infection. A frequent route of infection for implants occurs during surgery, as microorganisms can be introduced on the implant surface, providing them with an advantage to colonize the unprotected surface and create a biofilm.
Taking this in consideration, a reasonable approach would be to design an antimicrobial material or coating, which promotes tissue integration. In that direction, it would be advantageous to precondition the material with host cells. Staphylococcus aureus is found asymptomatically on the skin and its presence there enhances the risk of infection in the surgical site, which is why it is egarded as a frequent causative agent of implant-related infections, especially in orthopaedics."
The authors assessed the potential applicability of three anti-biofilm compounds (based on natural compounds) as part of implanted medical devices by testing them on in a competition model based on the co-culture of SaOS-2 mammalian cells and Staphylococcus aureus (collection and clinical strains) on a titanium surface.
Comment: The search for non-antibiotic approaches to the prevention and treatment of prosthetic infections is of great importance in that it is apparent that antibiotics cannot do the job alone.
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