Read Aloud the Text Content

This audio was created by Woord's Text to Speech service by content creators from all around the world.

Text Content or SSML code:

Prosthesis infection by biofilm. Currently, millions of people worldwide have been affected by bond or joint degenerative and inflammatory problems. Since 2008 to 2020, the population over 50 years of age with a bond disease has doubled. Then, the use of joint implants has been necessary for them. Several materials used were developed over the decades by the biomedical industry with high biocompatibility. This characteristic gives a better lifestyle to the patient despite their disease. However, prosthetic infection could be unavoidable despite the sterile environment of surgical procedures, and it affects the long lifespan of implants. The infection of an implant results in challenging problems requiring secondary surgical procedures and implant replacement . The toxic response and the subsequent infection could lead to a necrosis of the surrounding tissue ending in amputation or even mortality. Normally, the average cost in a single prosthesis treatment is $6,000 whereas the total cost for a patient with an infected prosthesis is estimated to be $30,000 and more due to the hospitalization time, antibiotic treatments, reimplantation, blood transfusion, examinations, and so on. Common infections. A huge percentage of all implant-associated infections are as a result of staphylococci, and two staphylococcal species, respectively Staphylococcus aureus and Staphylococcus epidermidis, account collectively for 2 out of 3 infection isolates. Aerobic Gram- negative bacilli, including Escherichia coli, Proteus mirabilis and Pseudomonas aeruginosa, are less frequent causes of infection. How is it produced? Its principal cause is the adhesion of microorganisms on the implant surface and the formation of biofilm. It takes place due to a complex interplay of several factors such as bacterial load, microorganism-specific factors, host factors, surgical technique and perioperative environment. In order to understand the microorganisms-implant surface relationship it is important to know the different stages of biofilm formation. First, adhesion to the surface of the implant material takes place. Second, microcolony formation occurs owing to cellular aggregation and EPS production. Those substances create a favorable environment for bacteria which protects them from environmental conditions, antibiotics treatments, and the immune system. Third, microcolony formation due to further remodelling and maturation.Those colonies are presented as towers. And fourth, the biofilm dispersal occurs when bacteria return to a planktonic lifestyle. Why avoid biofilm formation? All orthopaedic materials are vulnerable to colonization by biofilm including cobalt-chromium, titanium, polyethylene, PMMA, and ceramics. Also, it is known that Initial adhesion triggers early biofilm formation, and the point of irreversible binding. The therapeutic point between both is named as “window opportunity”, at this point, bacteria are still susceptible to conventional antibiotics and immune responses. Consequently, avoiding adhesion to prevent bacteria colonization is something to take into account. Surface modification as a potential solution. The implant surface modification minimizes bacterial adhesion, inhibits biofilm formation, and it could provide bactericide action. Therefore, it has been an active area of research.The ideal antimicrobial surface coating shows biocompatible with the host, anti-infective efficiency, durability, mechanical stability to stand forces and does not compromise the implant fixation. There are two types of surface modifications: passive and active.. Passive surface modifications do not release bactericidal agents to the surrounding tissues, instead they prevent or reduce bacterial adhesion through surface chemistry or surface structural modifications. This type of solution has been proved in-vitro, but not in clinical models. Some polymer coatings include hydrophilic poly methacrylic acid, polyethylene oxide or protein-resistant polyethylene glycol. The modification of implant surface structure is carried out at the nanoscale, the key is to decrease bacterial adherence and mechanically lyse microbial cells on the surface of contact. The nanopatterning is created by modifying surface finishing techniques. For instance, creation of nanopores, nanotubes, nanowires, and hydrothermal treatment has demonstrated efficacy in preventing biofilm formation. On the other hand, active surface modifications are coatings that deliver pharmacologically active pre-incorporated bactericidal agents. For instance, antibiotics, antiseptics, metal ions, or organic molecules are delivered with contact killing or drug eluting activity. On the other hand, the pharmacological agents can be degradable or non-degradable. The idea is to interfere with the cell respiration, division, wall formation or bacterial signalling. Some coatings include silver as a common metal; this is mainly due to silver cations which are biochemical active. Other coatings include materials such as hydrogen, chlorine, selenium or titanium alloys. Local carries are another approach to avoid prosthetic joint infections; they are applied at the time of the surgical procedure or can be applied to implant itself. For instance, antibiotic-loaded bone cement has been long established in orthopaedic practice. In the same way, defensive antibacterial coatings are surfaces with pre-loaded antibiotics such as hyaluronic hydrogels, they have shown better infection control. To conclude, prosthetic joint infections are becoming better understood, as a result, the role of bacterial biofilm is crucial to understand the factors that trigger the pathology and their conditions. On the other hand, bacterial colonization over implant surfaces has demonstrated a “window opportunity” as a chance for treatment, before the complete bidding. Finally, a great effort has been present over the problem by the scientific community. Several studies have been carried out awaiting validation on clinical studies. The idea of this technologies is to innovate on actual clinical treatments to provide better outcomes for patients with prosthetic joint infections