Osteomyelitis = Gate to hell

Involvement of biofilm is one of the reasons why bone and soft tissue infections in the orthopedic field become intractable. A biofilm is a aggregation of bacteria surrounded by an extracellular matrix, which makes it difficult for antimicrobial agents to incorporate and shows high resistance to most of antimicrobial agents.

Biofilms tend to form on the surfaces of artificial joints and osteosynthetic implants in the orthopedic field. Antibacterial resistance increases with biofilm maturation, and a minimal biofilm eradication concentration (MBEC) is required to suppress mature biofilms, which is 100 to 1000 of the minimal inhibitory concentration (MIC) for general planktonic bacteria. Therefore, it is believed that once a biofilm is formed, the infection cannot be controlled without removing the implant.