The role of microbial biofilms in prosthetic joint infections

Figures & data

Scanning electron micrograph of biofilms on PMMA cement.

Table 1. Putative biofilm-active antibiotics

Antibiotic	Class	MOA	Spectrum of activity	Important side effects ^b
Rifampicin ^at1/2: 4 h	Rifamycin	BactericidalInhibition of bacterial RNA synthesis	Gram-positive and -negative bacteria	Nausea, gastrointestinal disturbances, hepatotoxicity, thrombocytopenia, rash, red discoloration of urine, flu-like symptoms
Daptomycint1/2: 9 h	Lipopetide	BactericidalInsertion of hydrophobic tail into cell membrane, resulting in membrane depolarization and cell death	Gram-positive bacteria including MRSA, VRSA, VRE, and PRSP. Log- and stationary-phase of bacteria	Nausea, vomiting, diarrhea, hypertension and hypotension, myopathy, neuropathy, urethritis, anemia, hypokalemia, arthralgia
Linezolidt1/2: 6 h	Oxazolidinones	BacteriostaticBinds to the bacterial 23S ribosomal RNA of the 50S subunit, thus preventing the formation of a functional 70S complex. Production by MSSA and MRSA	Gram-positive bacteria including MRSA, MSSA, CoNS, and enterococci including VRE.Good tissue distribution and bioavailability	Nausea, vomiting, diarrhea, thrombocytopenia, myelosuppression, reversible optic neuritis, irreversible peripheral neuropathy, serotonin syndrome
Tigecyclinet1/2: 42 h	Glycylcylines (synthetic derivative of tetracyclines)	BacteriostaticBinds 30S bacterial ribosomal subunit and prevents binding of tRNA to the mRNA ribosome complex	Active against Gram-positive bacteria (including VRE and MRSA), Gram-negative bacilli, and anaerobes	Nausea, vomiting, diarrhea, sore mouth and throat, dysphagia, vitamin B complex deficiency, dental abnormalities, hepatotoxicity
Minocyclinet1/2: 15 h	Tetracyclines	Same as tigecycline	Similar to tigecycline and also active against Neisseria meningitidis	Similar to tigecycline and in addition, vestibular disturbances with dizziness, tinnitus, and impaired balance—especially in women
Vancomycint1/2: 8 h	Glycopeptides	BactericidalInhibits bacterial cell wall formationInterferes with peptidoglycan synthesis	Gram-positive bacteria. MRSA	Tinnitus, deafness (reversible on cessation of drug), nephrotoxicity, maculopapular rash (with rapid i.v. infusion)

^a Should ideally be used as combination therapy to avoid rapid emergence of resistance.

MOA: mechanism of action; MRSA: methicillin-resistent Staphylococcus aureus; MSSA: methicillin-sensitive Staphylococcus aureus;

VRE: vancomycin-resistent enterococcus; PRSP: penicillin-resistant Streptococcus pneumoniae; CoNS: coagulase-negative staphylococci; t_1/2: serum half-life of drug.

^bThese side effects are generally attributed to systemic administration.