Pathogenesis of Biomaterial-Associated Infection

Biomaterial infections associated with indwelling surgical devices are responsible for ~50% of all nosocomial infections. The development of orthopedic biomaterial-associated infections comes at great physical and emotional cost to patients, resulting in substantial economic costs to healthcare providers. Understanding of its pathogenesis has progressed greatly since the biofilm hypothesis was first proposed. However, the biofilm hypothesis only partially elucidates the pathogenesis of these infections. A greater appreciation of the mechanisms underpinning immune evasion by common pathogens has highlighted a previous underestimation of the role this behavior has in the development of these troublesome infections. Recognition of the importance of the immune system interaction in the pathogenesis of biomaterial-associated infections will not only update our paradigm of this condition but also help to identify and develop potential therapeutic targets. This review aims to provide an overview of the pathogenesis of biomaterial-associated infections. It focuses primarily on the development of bacterial biofilms and the immune-evasive behavior of the most common orthopedic pathogens.