The 2-year long Delphi process for the 2025 International Consensus Meeting (ICM 2025) for Musculoskeletal Infection (MSKI) commenced on May 31, 2023, and culminated with the in-person voting May 8-10 in Istanbul, Turkey. The documents for all of the General Session, Hip and Knee, Spine, Shoulder, and Biofilm Sections are available on the ICM 2025 website at https://www.icmortho.org. The Biofilm Section was Chaired by Dr. Edward M. Schwarz, Editor-in-Chief, Journal of Orthopaedic Research, and most of the Biofilm Liaisons and voting Delegates are members of the Orthopaedic Research Society. Below is a list of the Biofilm Questions with links to their documents containing the Question, Response, Rationale with systematic literature review, Conclusion, and Voting Results.

B1 CANCELLED
B2 Has the in-vitro antimicrobial efficacy of antiseptic irrigation solutions translated to a reduction in SSI/PJI in clinical practice?
B3 Is there an immune proteome in PJI?
B4 What is (are) the best preclinical model(s) of orthopedic infection for the evaluation of diagnostic technologies?
B5 What is (are) the best preclinical model(s) of orthopedic infection for the evaluation therapeutic efficacy?
B6 Are bilateral animal models of bone infection ethical?
B7 Are there any specific agents that have been shown to be efficacy against biofilm in pre-clinical models?
B8 What critical pathogens should be routinely evaluated in preclinical models to study important questions in orthopedic infection research?
B9 Can bacteria survive in the intracellular space of osteoblasts?
B10 Do intracellular bacteria play a role in propagating musculoskeletal infections?
B11 How should antimicrobial properties of an orthopedic titanium implant be evaluated in animal and clinical studies?
B12 What are the minimum data set for studying orthopedic infections?
B13 Are monoclonal antibodies capable of eradicating biofilms in orthopedic infections?
B14 Is there a role for the use of proteolytic enzymes to treat orthopedic infections?
B15 Are we certain that biofilms are the main challenge of treating implant associated infections?
B16 Are ultrasonic debridement devices useful for removal of biofilm in orthopedic infections?
B17 Does biofilm form in the synovial fluid?
B18 Does the concept of viable but not culturable (VBNC) apply to orthopedic infections?
B19 Does delivery of local antibiotics have any influence in removal of biofilm in orthopedic infections?
B20 Does biofilm have different affinities for different surfaces?
B21 What key regulatory mechanisms control the release of extracellular DNA (eDNA) through autolysis, a process that significantly contributes to the structural integrity of the biofilm within Staphylococcus aureus cells?
B22 Are there any novel alloys that are resistant to formation of biofilm during orthopedic infections?
B23 Are there any methods to detect biofilms in vivo?
B24 Are biofilms carcinogenic or associated with bone tumors?
B25 What are the best strategies to prevent biofilm formation and maturation?
B26 Can electric fields be used to detach and destroy biofilm?
B27 Are there any antibiotics with anti-biofilm properties?
B28 Is Dithiothreitol useful for disrupting biofilm in synovial fluid?
B29 In case of polymicrobial infection, do all pathogens participate synergistically in biofilm formation or is there any antagonistic influence by some organisms?
B30 Are there any technological advances in creating smart antibiotic carriers in the fight against biofilms?
B31 CANCELLED
B32 Are there any physical non-cytotoxic methods (e.g. ultraviolet, microwave, etc.) that can be utilized to disrupt and destroy biofilm in orthopedic infections?