During the recent transition between acute diseases caused by swarms of
single planktonic bacteria, and chronic infections caused by bacteria
growing in slime-enclosed biofilms, a general clinical consensus has
emerged that pathologies with bacterial etiologies are frequently
culture negative. Because biofilm infections now affect 17 million
Americans per year (killing approximately 450,000), the suggestion that
these common and lethal infections regularly go unnoticed by the only
FDA-approved method for their detection and characterization is a matter
of urgent concern. Biologically, we would expect that planktonic
bacterial cells would colonize any new surface, including the surface of
an agar plate, while the specialized sessile cells of a biofilm
community would have no such proclivity. In the study of biofilm
diseases ranging from otitis media to prostatitis, it was found that
direct microscopy and DNA- and RNA-based molecular methods regularly
document the presence of living bacteria in tissues and samples that are
culture negative. The editors selected orthopedic biofilm infections as
the subject of this book because these infections occur against a
background of microbiological sterility in which modern molecular
methods would be expected to find bacterial DNA, RNA-based microscopic
methods would be expected to locate bacterial cells, and cultures would
be negative. Moreover, in Orthopedics we find an already biofilm-adapted
surgical group in which current strategies are based on the meticulous
removal of compromised tissues, antibiotic options as based on high
biofilm-killing local doses, and there are practical bedside strategies
for dealing with biofilm infections. So here is where the new paradigm
of biofilm infection meets the equally new paradigm of the culture
negativity of biofilms, and this volume presents a conceptual synthesis
that may soon combine the most effective molecular methods for the
detection and identification of bacteria with a surgical discipline that
is ready to help patients.
