Prevention and treatment of orthopedic infections: Present and future

Orthopedic infections are a major cause of morbidity and mortality following orthopedic intervention, which leads to increased healthcare costs associated with their treatment and eradication. Numerous organizational bodies have instituted guidelines to assist with antibiotic management in the perioperative window, but infection rates have remained stagnant. Moving forward, more is needed than perioperative antibiotic prophylaxis to decrease the incidence of infection, including alterations in patient, provider, and system behavior. Patient-specific changes should focus upon mitigating modifiable risk factors, such as obesity, diabetes, smoking, and so on. Provider-specific measures should include appropriately managing open wounds, antibiotic selection, and maintenance of sterile technique. Systemic-specific measures should include limiting participants in the operating room and limiting operating room traffic, banning flash sterilization of operating room products, and so on. However, with the continued stagnation of infection rates, additional advanced technology is needed. Upon the introduction of bacteria, there is a race between bacterial eradication and bacterial seeding of implants; thus, appropriate defense by the implants themselves, via antibiotic impregnation or inhibition of biofilm development, is needed. To date, several preclinical studies have tested different types of “smart” implants to combat bacterial seeding and local infection. While infections in orthopedic surgery have remained largely unchanged in recent years, a team approach between the patient, provider, health system, and implant manufacturers will help to limit orthopedic-based infections and promote an environment of infection prevention.