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Treatment of Orthopedic Infections: Addressing the Biofilm Issue

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Culture Negative Orthopedic Biofilm Infections

Part of the book series: Springer Series on Biofilms ((BIOFILMS,volume 7))

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Abstract

Chronic infections of bone and joints always have been considered especially difficult to treat, requiring multiple operations with long hospital stays, prolonged antibiotic medication in high dosage, and extended periods of impairment. Still cure often cannot be obtained leading to amputation in many cases. The reasons for infection resistance against conventional antimicrobial therapies have been elucidated only in the last three decades, based on the pioneering work of William Costerton, showing that pathogens may change from the familiar planktonic forms into phenotypically different sessile forms after adhesion to unvascularized surfaces, forming the organized biocoenosis of a biofilm. Biofilm-embedded bacteria are present in all orthopedic infections and require much higher concentrations (up to 1,000 times) of antibiotics for elimination than their planktonic forms. For creating higher local antibiotic concentrations, carriers have been developed, but the frequently used devices made of poly(methyl methacrylate) cannot provide sufficient concentrations in the surrounding tissues and spaces and act as a substrate of biofilm colonization themselves. Antibiofilm substances have been investigated but are not yet available for clinical practice. Presently the only possibility of a biofilm-centered treatment is found in sophisticated techniques of debridement combined with increased antibiotic concentrations at the site of infection. Highly purified bone has been found to be an appropriate tool for storing and delivering the required amount of antibiotics in order to eliminate biofilm remnants after meticulous debridement. Additionally it offers the advantage of reconstructing osseous defects that always are present after surgically treated bone infection. Using antibiotic-impregnated bone graft treatment of infection, reconstruction and internal stabilization may be performed within a single operation. Long hospital stays and treatments associated with prolonged periods of pain and/or reduced mobility may be avoided.

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Authors and Affiliations

  1. Osteitis Centre, Privatklinik Döbling, Vienna, Austria

    Heinz Winkler

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  1. Heinz Winkler
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Correspondence to Heinz Winkler .

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Editors and Affiliations

  1. Center for Genomic Sciences, Allegheny-Singer Research Inst., East North Ave. 320, Pittsburgh, 15212-4772, Pennsylvania, USA

    Garth D. Ehrlich

  2. , Department of Orthopedic Surgery, Allegheny General Hospital, East North Avenue, Pittsburgh, 15212, USA

    Patrick J. DeMeo

  3. Center for Genomic Sciences, Biofilm Research, Allegheny-Singer Research Institute, East North Avenue 320, Pittsburgh, 15212, Pennsylvania, USA

    J. William Costerton

  4. Privatklinik Döbling GmbH, Heiligenstädter Str. 57-63, Wien, 1190, Austria

    Heinz Winkler

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Winkler, H. (2012). Treatment of Orthopedic Infections: Addressing the Biofilm Issue. In: Ehrlich, G., DeMeo, P., Costerton, J., Winkler, H. (eds) Culture Negative Orthopedic Biofilm Infections. Springer Series on Biofilms, vol 7. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29554-6_9

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