Device-Related Infections and Bacterial Biofilms

A topical collection in Microorganisms (ISSN 2076-2607). This collection belongs to the section "Medical Microbiology".

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Editor


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Collection Editor
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
Interests: biofilms; prostheses; infection; devices; catheter
Special Issues, Collections and Topics in MDPI journals

Topical Collection Information

Dear Colleagues,

Device-related infections (DRIs) are a significant healthcare problem that can occur when medical devices, such as catheters, implants, and prostheses, become colonized by bacteria. Bacterial biofilms are mostly responsible for the development of DRIs.

Biofilms are complex communities of microorganisms that adhere to surfaces, in addition to tissues, and form a protective extracellular matrix. They are particularly problematic in DRIs because they can resist antibiotics and other antimicrobial agents, as well as the immune system, causing chronic infections that require device removal, which becomes an important problem for patients and healthcare systems.

Several factors contribute to the formation of bacterial biofilms on medical devices, including the surface properties of the device material, host factors such as immune function and nutritional status, and microbial factors such as virulence and antibiotic resistance.

Preventing DRIs requires strategies that target both devices and patients. For example, using materials that resist bacterial adhesion or coating devices with antimicrobial agents can help prevent biofilm formation. Additionally, proper insertion techniques and the appropriate care as well as maintenance of devices can reduce the risk of infection.

The treatment of DRIs often involves removing the infected device; however, this approach may not always be feasible or effective in eradicating biofilms. Alternative treatments include administering local antibiotics directly into the affected area or using antimicrobial agents that can penetrate biofilms.

Research is ongoing to develop new strategies for preventing and treating DRIs caused by bacterial biofilms. These efforts aim to improve patient outcomes while reducing the healthcare costs associated with these infections. In this Topical Collection, we encourage researchers and clinicians to submit research articles, review articles, and short communications that address the various aspects of biofilm formation and persistence in association with DRIs.

Dr. María Guembe
Collection Editor

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Keywords

  • biofilm
  • catheter-related infections
  • device-related infections
  • prosthesis
  • joint infections
  • implants

Published Papers (1 paper)

2025

10 pages, 234 KiB  
Article
Incidence of PJI in Total Knee Arthroplasty Patients Following Expanded Gram-Negative Antibiotic Prophylactic Protocol
by Anzar Sarfraz, Cameron Bussey-Sutton, Emily M. Ronan, Farouk Khury, Joseph A. Bosco, Ran Schwarzkopf and Vinay K. Aggarwal
Microorganisms 2025, 13(5), 1002; https://doi.org/10.3390/microorganisms13051002 - 27 Apr 2025
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Abstract
The efficacy of “Expanded Gram-Negative Antimicrobial Prophylaxis” (EGNAP) in preventing postoperative infections has been previously reported in total hip arthroplasty (THA). However, it remains unclear as to whether these benefits extend to total knee arthroplasty (TKA). This study investigated whether adding EGNAP to [...] Read more.
The efficacy of “Expanded Gram-Negative Antimicrobial Prophylaxis” (EGNAP) in preventing postoperative infections has been previously reported in total hip arthroplasty (THA). However, it remains unclear as to whether these benefits extend to total knee arthroplasty (TKA). This study investigated whether adding EGNAP to our institution’s preoperative antibiotic prophylaxis protocol would affect periprosthetic joint infection (PJI) risk in TKA patients. We retrospectively reviewed 10,666 elective, unilateral, primary TKA cases performed at a single-specialty tertiary academic hospital from 2018 to 2022. Before June 2021, all patients received 2 g of cefazolin for 24 h as part of the prophylactic antibiotic protocol. After June 2021, gentamicin or aztreonam (EGNAP) was added to the protocol for all TKA patients. Patients were grouped based on whether they received EGNAP or not (control group) before surgery. The groups were propensity score-matched in a 2:1 ratio. PJI and nephrotoxicity (using RIFLE criteria) risk was compared. After matching, the final study population consisted of 3007 patients in the non-EGNAP group and 1503 patients in the EGNAP group. There was no significant difference between the EGNAP and no EGNAP groups in the overall incidence of PJI (1.9% vs. 2.0%; p = 0.111) or the incidence of Gram-positive PJIs (0.3% vs. 0.8%; p = 0.103). The incidence of Gram-negative PJIs was 0.5% in the EGNAP group and 0.4% in the no EGNAP group, which was also not different between the groups (p = 0.692). There were no differences in nephrotoxicity between groups (p = 0.521). The addition of EGNAP to the antibiotic prophylactic protocol prior to TKA had no effect on overall or Gram-negative PJI risk in TKA patients. The findings of this study suggest that while EGNAP is safe to use and has minimal nephrotoxic effects, its prophylactic benefits do not extend to the primary TKA population. This may be attributed to the generally low rate of Gram-negative infections in TKA patients, where adding EGNAP does not provide a clear advantage in reducing the risk of such infections, unlike its potential benefits in primary THA population. This study investigates the effects of using prophylactic Gram-negative antibiotics prior to TKA and shows that though it is safe to use, Gram-negative bacterial coverage may have no impact on postoperative infection incidence. Full article
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