2018 International Consensus on Musculoskeletal Infection – Biofilm Workgroup
The number of surgical site infections (SSI) following orthopedic procedures continues to rise, threatening the ultimate success of the procedures, causing avoidable morbidity and a critical socioeconomic burden. Although research in the field continues, there is an immense gap in our knowledge related to many aspects of orthopedic infections. In fact, this issue was highlighted by the Center for Disease Control recently as they updated the SSI prevention Guidelines based on the International Consensus Meeting on Periprosthetic Joint Infection in 2013.
A second International Consensus Meeting, which was expanded to all areas of orthopaedics as an International Consensus Meeting on Musculoskeletal Infection (ICMMI), was held in Philadelphia, Pennsylvania on July 25-27, 2018. Over 800 delegates served in the consensus meeting. These delegates were actively involved in the Delphi process to generated the Consensus Statements (questions and responses/recommendations), which were voted on by 540 delegates in real time at the ICMMI. During the meeting, thirteen biofilm-associated implant-related, bone and joint infection questions were assigned to the Biofilm Workgroup. These questions with their responses and post meeting refined rationales are available below, with an overview summary and discussion will be available in Consensus Articles published in the Journal of Orthopaedic Research.
Saeed K, McLaren AC, Schwarz EM, et al. 2019. 2018 international consensus meeting on musculoskeletal infection: Summary from the biofilm workgroup and consensus on biofilm related musculoskeletal infections. J Orthop Res 37:1007-1017
Click on each question to view the complete document.
Question 1: What is the life cycle of biofilm and the mechanism of its maturation?
Question 2: What surface properties favor biofilm formation?
Question 3: Is the biofilm on orthopaedic implant surface permeable to neutrophils and macrophages in vivo? Are these innate immune cells (meaning any macrophages or neutrophils) capable of engulfing and killing bacteria?
Question 4: Does the timescale of biofilm formation differ between bacterial species? If so, what is the timescale for common causative organisms?
Question 5: Do bacteria form biofilm on the surface of cement spacer in a similar fashion to a metallic implant?
Question 6: Does Mycobacterium tuberculosis form a biofilm on implants?
Question 7: What is the role of the microbial synergy in polymicrobial infections?
Question 8: Is the mapping of biofilm to a particular component or anatomical location an important consideration in management of implant related infections?
Question 9: Is there evidence that interference with bacterial communication by blocking quorum sensing molecules can minimize biofilm formation in vivo?
Question 10: Can a biomaterial surface be modified to dispel bacterial adherence and biofilms? What are the potential concerns in modifying implant surfaces to combat biofilms?
Question 11: What is the relevance of Minimum Inhibitory Concentration (MIC) of infecting organisms in biofilm-mediated chronic infection?
Question 12: What is the Minimum Biofilm Eradication Concentration (MBEC) of anti-infective agents?
Question 13: Do bacteriophages have a role in treating multidrug-resistant periprosthetic joint infection (PJI)?