The Fight Against the Slime: Can We Ever Win?

Microorganisms universally attach to surface and produce extracellular matrix of polysaccharidic nature termed slime. This phenomenon is now regularly referred to as biofilm formation. Biofilm-associated infections pose a serious problem for public health because bacteria growing in a biofilm are more recalcitrant to the action of antibiotics and host defenses than cells growing in a planktonic state. In orthopedic surgery, such proprieties of biofilm made prosthesis-associated infection a devastating complication. In such a “war,” the prevention with adequate pharmacological prophylaxis, pathogen-specific treatment, and the combination antimicrobial regimens are of paramount importance. The better knowledge in PJI pathogenesis and biofilm formation, reached in these last years, is a new weapon in the armamentarium of physicians.