Culture Negative Orthopedic Biofilm Infections

During the recent transition between acute diseases caused by swarms of single planktonic bacteria, and chronic infections caused by bacteria growing in slime-enclosed biofilms, a general clinical consensus has emerged that pathologies with bacterial etiologies are frequently culture negative. Because biofilm infections now affect 17 million Americans per year (killing approximately 450,000), the suggestion that these common and lethal infections regularly go unnoticed by the only FDA-approved method for their detection and characterization is a matter of urgent concern. Biologically, we would expect that planktonic bacterial cells would colonize any new surface, including the surface of an agar plate, while the specialized sessile cells of a biofilm community would have no such proclivity. In the study of biofilm diseases ranging from otitis media to prostatitis, it was found that direct microscopy and DNA- and RNA-based molecular methods regularly document the presence of living bacteria in tissues and samples that are culture negative. The editors selected orthopedic biofilm infections as the subject of this book because these infections occur against a background of microbiological sterility in which modern molecular methods would be expected to find bacterial DNA, RNA-based microscopic methods would be expected to locate bacterial cells, and cultures would be negative. Moreover, in Orthopedics we find an already biofilm-adapted surgical group in which current strategies are based on the meticulous removal of compromised tissues, antibiotic options as based on high biofilm-killing local doses, and there are practical bedside strategies for dealing with biofilm infections. So here is where the new paradigm of biofilm infection meets the equally new paradigm of the culture negativity of biofilms, and this volume presents a conceptual synthesis that may soon combine the most effective molecular methods for the detection and identification of bacteria with a surgical discipline that is ready to help patients.

This book discusses Prosthetic Joint Infection (PJI), which remains one of the most common problems necessitating revision arthroplasty. It pursues a multidisciplinary approach, bringing together opinions from the leading experts in the field. The book identifies the potential causes of these infections, provides sound diagnostic criteria guidelines, and explains how these prosthetic infections are managed from orthopedic surgery, clinical and diagnostic perspectives. PJI can lead to multiple revision surgeries and significant patient morbidity. Periprosthetic infection rates remain around 1–2% after primary total hip and knee arthroplasty and account for approximately 7–12% of all revision cases. Orthopedic hardware infections are much-feared and costly complications that can occur when these devices are implemented both in traumatic cases as well as in joint replacement surgery. Because these infections can lead to higher morbidity, it is important to understand their pathophysiology and the principles behind their diagnosis and initial treatment. The pathogenesis of these kinds of infections is intimately connected to the biofilm-producing trait characteristic of many microorganisms, which can have a critical effect on the likely success of treatments. The book offers a unique guide for all scientists working in arthroplasty who are seeking an update on the field, and for newcomers alike.

This book will cover both the evidence for biofilms in many chronic bacterial infections as well as the problems facing these infections such as diagnostics and treatment regimes. A still increasing interest and emphasis on the sessile bacterial lifestyle biofilms has been seen since it was realized that that less than 0.1% of the total microbial biomass lives in the planktonic mode of growth. The term was coined in 1978 by Costerton et al. who defined the term biofilm for the first time.In 1993 the American Society for Microbiology (ASM) recognised that the biofilmmode of growth was relevant to microbiology. Lately many articles have been published on the clinical implications of bacterial biofilms. Both original articles and reviews concerning the biofilm problem are available.

This book outlines the most updated clinical guidelines that are vital for the prevention infections and care of patients with joint infections following a replacement surgery, one of the highest volume medical interventions globally. Sections address the diagnosis, management approaches and prevention of prosthetic joint infections. Written by experts in the field, this text provides a brief overview of the literature and current recommendations in each of the specified areas. Given the rapidly evolving state-of-play in this clinical area, this compendium grows increasingly important to clinicians in their management decisions. Prosthetic Joint Infections is a valuable resource for infectious disease specialists, epidemiologists, surgeons, and orthopedic specialists who may work with patients with prosthetic joint infections.

This comprehensive, clinically oriented reference details the state-of-the-art approach to infections of bones and joints. Utility for all practitioners is ensured by the wide range of contributors who include infectious disease specialists, rheumatologists, orthopedic surgeons, and radiologists. This is the definitive resource for the clinician who treats orthopedic infections.

Infections of the bones (osteomyelitis) and joints (septic arthritis) are serious health problems which require antibiotics and often surgery. Awareness among health professionals of the causes and treatment options for various types of bone and joint infections is essential for effective resolution. Bone and Joint Infections takes a multidisciplinary approach in covering the diagnostic and therapeutic treatment of osteomyelitis and septic arthritis, including different types of implant-associated infections. Correct and rapid diagnosis of bone and joint infection is crucial, and requires the input of a variety of specialists. Bone and Joint Infection takes a similarly collaborative and comprehensive approach, including chapters authored by clinicians, laboratory specialists, and surgeons. Covering the basic microbiology and clinical aspects of bone and joint infection, this book will be a valuable resource both for researchers in the lab and for physicians and surgeons seeking a comprehensive reference on osteomyelitis and septic arthritis.

Throughout the biological world, bacteria thrive predominantly in surface-attached, matrix-enclosed, multicellular communities or biofilms, as opposed to isolated planktonic cells. This choice of lifestyle is not trivial, as it involves major shifts in the use of genetic information and cellular energy, and has profound consequences for bacterial physiology and survival. Growth within a biofilm can thwart immune function and antibiotic therapy and thereby complicate the treatment of infectious diseases, especially chronic and foreign device-associated infections. Modern studies of many important biofilms have advanced well beyond the descriptive stage, and have begun to provide molecular details of the structural, biochemical, and genetic processes that drive biofilm formation and its dispersion. There is much diversity in the details of biofilm development among various species, but there are also commonalities. In most species, environmental and nutritional conditions greatly influence biofilm development. Similar kinds of adhesive molecules often promote biofilm formation in diverse species. Signaling and regulatory processes that drive biofilm development are often conserved, especially among related bacteria. Knowledge of such processes holds great promise for efforts to control biofilm growth and combat biofilm-associated infections. This volume focuses on the biology of biofilms that affect human disease, although it is by no means comprehensive. It opens with chapters that provide the reader with current perspectives on biofilm development, physiology, environmental, and regulatory effects, the role of quorum sensing, and resistance/phenotypic persistence to antimicrobial agents during biofilm growth.