Prosthetic Joint Infection

Javier Cobo; Jose Luis Del Pozo


Expert Rev Anti Infect Ther. 2011;9(9):787-802. 

In This Article


The pathogenesis of implant-associated infection involves interactions between the microorganism, the implant and the host.[17] PJIs are typically caused by microorganisms growing in biofilms, and these biofilms are the essential factor in the persistence of infection (Figure 1 & Box 1, Box 2, Box 3). A small number of skin bacteria (i.e., staphylococci) can colonize an implant during surgery and persist despite of the presence of granulocytes and/or antimicrobial agents.[18] Bacterial biofilms exhibit dramatically reduced (i.e., 500–5000 times) susceptibility to killing by antimicrobial agents as compared with free-floating (planktonic) cells of the same microorganism.[19] A variety of potential mechanisms implicated in biofilm resistance to antimicrobial agents have been proposed including: restricted penetration through the biofilm matrix, antimicrobial destroying enzymes, quorum-sensing signaling systems, existence of altered growth rate (i.e., persister cells) inside the biofilm, stress response to hostile environmental conditions, and overexpression of genes.[20] It has also been described that efficacy of treatment is indirectly correlated to the age of the biofilm.[21]