Biofilms in Surgical Site Infections: Recent Advances and Novel Prevention and Eradication Strategies

Abstract

Surgical site infections (SSIs) are common postoperative occurrences due to contamination of the surgical wound or implanted medical devices with community or hospital-acquired microorganisms, as well as other endogenous opportunistic microbes. Despite numerous rules and guidelines applied to prevent these infections, SSI rates are considerably high, constituting a threat to the healthcare system in terms of morbidity, prolonged hospitalization, and death. Approximately 80% of human SSIs, including chronic wound infections, are related to biofilm-forming bacteria. Biofilm-associated SSIs are extremely difficult to treat with conventional antibiotics due to several tolerance mechanisms provided by the multidrug-resistant bacteria, usually arranged as polymicrobial communities. In this review, novel strategies to control, i.e., prevent and eradicate, biofilms in SSIs are presented and discussed, focusing mainly on two attractive approaches: the use of nanotechnology-based composites and natural plant-based products. An overview of new therapeutic agents and strategic approaches to control epidemic multidrug-resistant pathogenic microorganisms, particularly when biofilms are present, is provided alongside other combinatorial approaches as attempts to obtain synergistic effects with conventional antibiotics and restore their efficacy to treat biofilm-mediated SSIs. Some detection and real-time monitoring systems to improve biofilm control strategies and diagnosis of human infections are also discussed.

Assessment of the biofilm-forming ability on solid surfaces of periprosthetic infection-associated pathogens

“…Therefore, research on biofilm formation and prevention has especially garnered attention in fields related to aquatics and industrial water systems. Here, we characterized the biofilm-forming capabilities of life-threatening pathogens on surfaces commonly used in clinical environments, which can endanger patients 4 , 34 . This study is to relatively compare the intrinsic biofilm-forming capabilities of a broad range of clinically relevant pathogens.…”

“…Various stimuli induce bacteria to form biofilms on a surface 2 and behave differently from the planktonic growth mode 3 . Dangerous bacterial infections such as surgical site infections are attributed to these bacteria, which are protected from common antibiotics 4 , 5 . Bacteria especially form biofilms on medical devices like implants, causing catheter-associated urinary tract infections, peri-implant mucositis, and peri-implantitis 6 – 8 .…”

The Enhancement of Antimicrobial Photodynamic Therapy of Escherichia Coli by a Functionalized Combination of Photosensitizers: In Vitro Examination of Single Cells by Quantitative Phase Imaging

“…Approximately 80% of surgical site infections (SSIs) are caused by biofilm-forming bacteria. E. coli belongs to the group of microorganisms related to this common postoperative occurrence [ 6 ]. In particular, Gram-negative bacteria are considered more pathogenic, since Gram-positive bacteria are more susceptible to antibiotics because they do not contain an outer membrane.…”

“…In the context of the worldwide rise of bacterial antibiotics, photodynamic therapy may be a beneficial alternative to the conventional treatment method [ 9 ]. Moreover, photodynamic therapy is considered to be a novel strategy to control biofilm-associated SSIs [ 6 ]. Over 50% of the bacteria on the NIAID list of critical pathogens have been treated with this strategy at least one time [ 10 ].…”

Wide Spectrum Potent Antimicrobial Efficacy of Wound Dressings Impregnated with Cuprous Oxide Microparticles

“…It has been calculated that one out of 24 surgical interventions will be complicated due to a microbial infection [4]. Wound infections cause a significant burden to patients and to the health care systems [5,6]. Protecting wounds from pathogens is an important clinical practice in the management of wounds, and an important role of wound dressings is to prevent and treat wound infections [3].…”