Biofilm formation and the biological response

Biofilm is one of the major burden in the treatment of periprosthetic joint infections, as this biological structure allows bacteria to be less susceptible to antibiotics, thwarting pharmacological therapies. Biofilm production is a multistep process beginning with the adhesion of microbial cells to a surface where they initiate to produce specific proteins that will be included in the extracellular matrix. Bacteria embedded in biofilm are able to evade the host's immune system, negatively influencing the migratory behavior of phagocytes that become enable to exert their biological function. The use of biofilm matrix-degrading enzymes, low-frequency ultrasound, bacteriophages, quorum sensing inhibitors, and silver nanoparticles represent promising antibiofilm approaches that may eradicate the clinical and economic impact of biofilm. Biofilm formation poses also problem in isolation and identification of bacteria in clinical samples in orthopedic field. New methodologies, as chemical-debonding bacteria, are recently developed in order to disrupt the extracellular matrix and facilitate the diagnosis of biofilm-associated infections.