Dhillon Mandeep Singh, Hooda Aman, Moriarty Thomas Fintan, Sharma Siddhartha
Foot & Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopedics, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Department of Emergency Medicine (Orthopedics), Ambedkar Institute of Medical Sciences, Mohali, Punjab India.
Indian J Orthop. 2022 Dec 20;57(1):44-51. doi: 10.1007/s43465-022-00782-6. eCollection 2023 Jan.
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.
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.
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.
Orthopedic surgeons should be aware of the key concepts pertaining to biofilms, and the impact that these can have on clinical practice.
肌肉骨骼感染是骨科和创伤患者发病的主要原因，与治疗时间延长相关，而且遗憾的是，功能预后较差。使问题更加复杂的是，抗菌药物耐药性（AMR）对肌肉骨骼感染的治疗影响日益增大，一些高耐药病原体的有效抗生素种类越来越少。大多数骨科手术都涉及植入物，现在人们认识到这些植入物上细菌生物膜的形成是导致骨科手术抗生素治疗失败的主要因素。
本综述概述了与肌肉骨骼感染相关的生物膜的类型、结构、形成和发病机制。此外，还描述了生物膜管理的关键概念以及更好地治疗与生物膜相关的肌肉骨骼感染患者的未来前景。
细菌生物膜是包裹在胞外多糖基质（EPS）中的动态、有生命的细菌聚集体。生物膜实际上是几乎所有细菌种类（包括革兰氏阳性菌、革兰氏阴性菌以及真菌）的一种自然生存模式。无论微生物种类如何，生物膜生长模型都通过几种明确的机制赋予耐药性。在大多数情况下，生物膜管理通常需要采取激进措施以确保根除，包括手术和药物干预。
骨科医生应了解与生物膜相关的关键概念以及这些概念对临床实践可能产生的影响。
