RESUMEN
INTRODUCTION: Postoperative delirium (POD) is a common complication in elderly surgical patients. Patients undergoing hip fractures surgery who are often characterized by advanced age could be particularly prone to suffering POD. We performed a meta-analysis to assess the association between POD and mortality in elderly patients undergoing hip fractures surgery. This meta-analysis included twenty-one cohort studies, and the pooled outcomes demonstrated that approximated one-fourth of patients undergoing hipfracture surgery would develop POD, and delirium increased the mortality in these patients. METHODS: We searched PubMed, Embase, Web of Science, and Scopus for studies that investigated the effect of POD on mortality in elderly patients undergoing hip fracture surgery. Two reviewers independently selected studies, assessed quality, and extracted data. Statistical analyses were performed by STATA 14.0 and RevMan 5.3. Risk ratios (RRs) with 95% confidence intervals (CIs) were derived using random or fixed-effects model. RESULTS: Twenty-one cohort studies enrolling a total of 6288 patients were included, and the pooled prevalence (95% CI) of POD was 28% (23-34%). POD was associated with an increase in perioperative mortality (30-day or in-hospital mortality) [12 studies, 3123 patients, relative risk (RR) (95% CI) 2.79 (1.97-3.93)], 6-month mortality [6 studies, 1673 patients, 2.51 (1.99-3.16)], 1-year mortality [6 studies, 1896 patients, 1.98 (1.62-2.41)], and more than 1-year mortality [8 studies, 1926 patients, 2.06 (1.60-2.64)]. CONCLUSIONS: Our meta-analysis demonstrated that approximated one-fourth of patients undergoing hip fracture surgery would develop POD, and delirium increased the short-term and long-term mortality in these patients.
Asunto(s)
Delirio , Fracturas de Cadera , Complicaciones Posoperatorias , Anciano , Delirio/epidemiología , Delirio/etiología , Fracturas de Cadera/microbiología , Fracturas de Cadera/cirugía , Humanos , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Urinary tract infections (UTIs), which are common among nursing home patients, are associated with adverse outcomes and increased healthcare costs. Antibiotic resistance is an emerging problem, associated with excess morbidity and mortality; it has been suggested that this condition might be more prevalent among subjects with comorbid conditions. The aim of this study was to assess the association, if any, of antibiotic resistance with the burden of comorbidity in elderly with UTIs. This retrospective study enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the "Fondazione San Raffaele Cittadella della Carità", Taranto, Italy, which includes 80 beds under the direction of two geriatricians. The burden of comorbidity was quantified using the Charlson comorbidity score index. Diagnosis of UTI was ascertained by urine culture. Antibiotic resistance was defined according to the European Centre for Disease Prevention and Control expert proposal. Logistic regression was used to assess the adjusted association of the variables of interest with the presence of antibiotic resistance. Antibiotic resistance was detected in 162/299 (54%) patients. In logistic regression, the presence of antibiotic resistance was independently associated with higher Charlson score, after adjusting (odds ratio = 1.06; 95% confidence interval = 1.01-1.10). Antibiotic resistance is highly prevalent among nursing home residents; it is associated with the burden of comorbidity, but not with single diseases. This association and its potential implications should be assessed in dedicated studies.
Asunto(s)
Infecciones Bacterianas/epidemiología , Demencia/epidemiología , Farmacorresistencia Microbiana/genética , Fracturas de Cadera/epidemiología , Hogares para Ancianos , Casas de Salud , Infecciones Urinarias/epidemiología , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Comorbilidad , Demencia/tratamiento farmacológico , Demencia/microbiología , Enterococcus/efectos de los fármacos , Enterococcus/aislamiento & purificación , Enterococcus/patogenicidad , Escherichia coli/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Escherichia coli/patogenicidad , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/microbiología , Fracturas de Cadera/tratamiento farmacológico , Fracturas de Cadera/microbiología , Humanos , Italia/epidemiología , Klebsiella/efectos de los fármacos , Klebsiella/aislamiento & purificación , Klebsiella/patogenicidad , Masculino , Úlcera por Presión/tratamiento farmacológico , Úlcera por Presión/epidemiología , Úlcera por Presión/microbiología , Proteus/efectos de los fármacos , Proteus/aislamiento & purificación , Proteus/patogenicidad , Estudios Retrospectivos , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/microbiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiologíaRESUMEN
BACKGROUND AND PURPOSE: Mechanically failed internal fixation following hip fracture is often treated by salvage arthroplasty. If deep wound infection is present, a 2-stage procedure is often used. We have used a 1-stage procedure in infected cases, and we now report the outcome. PATIENTS AND METHODS: We reviewed 16 cases of deep wound infection after mechanically failed hip fracture fixation, treated between 1994 and 2010. In all patients, a joint prosthesis was implanted in a 1-stage procedure. RESULTS: After an average follow-up period of 12 (2-18) years, no reinfection was detected. In 4 cases, a hip dislocation occurred and 3 of these needed further surgery. INTERPRETATION: A 1-stage procedure for arthroplasty of an infected, mechanically failed hip fracture fixation is feasible and carries a low risk of infection.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Fijación Interna de Fracturas/efectos adversos , Fracturas de Cadera/cirugía , Prótesis de Cadera/efectos adversos , Complicaciones Posoperatorias/epidemiología , Infección de Heridas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Fracturas de Cadera/microbiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Insuficiencia del Tratamiento , Resultado del Tratamiento , Infección de Heridas/microbiologíaRESUMEN
Linezolid is being increasingly used in the treatment of infections with gram-positive organisms especially methicillin resistant Staphylococcal isolates. Though resistance to this antimicrobial is emerging but it is extremely rare. Here we document first case of linezolid resistant Staphylococcus haemolyticus (S.haemolyticus) from India. This organism was isolated from pus oozing from a postsurgical site in 61 year old male hailing from an adjoining state of Haryana.
Asunto(s)
Acetamidas/farmacología , Antibacterianos/farmacología , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Fracturas de Cadera/microbiología , Oxazolidinonas/farmacología , Infecciones Estafilocócicas/microbiología , Staphylococcus haemolyticus/efectos de los fármacos , Infección de la Herida Quirúrgica/microbiología , Clindamicina/farmacología , Fracturas de Cadera/complicaciones , Fracturas de Cadera/cirugía , Humanos , India , Linezolid , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Rifampin/farmacología , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus haemolyticus/aislamiento & purificación , Infección de la Herida Quirúrgica/tratamiento farmacológico , Resultado del TratamientoRESUMEN
INTRODUCTION: This study analysed the predictors of mortality in patients who are diagnosed with deep infection following hip fracture surgery. METHODS: Data were prospectively collected for 3 years from all patients undergoing hip fracture surgery and who had developed a subsequent deep infection. Infection was defined as positive microbiology culture from deep tissue or fluid samples. Demographic data, treatment, complications and subsequent surgeries were analysed. Potential predisposing factors including chronic medical co-morbidities, American Society of Anesthesiologists (ASA) grade, alcohol excess and smoking were assessed. The main outcome measures were 30-day and 1-year mortality. RESULTS: There were 2718 consecutive operations performed for a fracture of the proximal femur over a 3-year period. Forty-three (1.6%) patients had a deep postoperative infection diagnosed on fluid and/or tissue sampling. The mean age was 73 years (25-94) and 65% were female. Of the 43 patients who developed deep infection, the primary procedure in 25 (58%) patients was reduction and internal fixation, with 18 (42%) undergoing hemi-arthroplasty. The most common causative organism was Staphylococcus epidermidis (n=13, 30%), with methicillin-resistant Staphylococcus aureus (MRSA) accounting for 23% (n=10). The 30-day mortality was significantly higher than that of patients with no deep infection (19% vs. 6.5%; p=0.004). On univariate analysis, increasing age, dementia and diabetes were predictive of both 30-day and 1-year mortality (all p<0.05). S. aureus (sensitive or resistant) was approaching significance at 1 year (p=0.065). On multivariate analysis, dementia and diabetes were independent predictors of 30-day mortality, with dementia and S. aureus predictive at 1 year. CONCLUSIONS: The 30-day mortality rate in patients diagnosed with deep infection following hip fracture surgery is higher than those without infection. Dementia, diabetes and S. aureus infection are independent predictors of mortality following deep infection.
Asunto(s)
Fijación Interna de Fracturas/mortalidad , Fracturas de Cadera/mortalidad , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/mortalidad , Staphylococcus aureus/patogenicidad , Infección de la Herida Quirúrgica/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Demencia/mortalidad , Diabetes Mellitus/mortalidad , Femenino , Fracturas de Cadera/microbiología , Fracturas de Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/cirugía , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/cirugía , Reino Unido/epidemiologíaRESUMEN
Periprosthetic fracture and infection are both challenges following hip arthroplasty. We report the case of an 87 year old female who underwent open reduction and internal fixation of a periprosthetic femoral fracture. Her post-operative course was complicated by infection with Clostridium perfringens. Early aggressive antibiotic treatment and surgical debridement were successful, and allowed retention of the original components.
Asunto(s)
Infecciones por Clostridium/patología , Desbridamiento , Fracturas de Cadera/microbiología , Fracturas Periprotésicas/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Administración Oral , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones por Clostridium/complicaciones , Infecciones por Clostridium/terapia , Clostridium perfringens/aislamiento & purificación , Femenino , Fracturas de Cadera/patología , Fracturas de Cadera/cirugía , Articulación de la Cadera/microbiología , Articulación de la Cadera/patología , Articulación de la Cadera/cirugía , Humanos , Inyecciones Intravenosas , Metronidazol/uso terapéutico , Ácido Penicilánico/análogos & derivados , Ácido Penicilánico/uso terapéutico , Fracturas Periprotésicas/patología , Fracturas Periprotésicas/cirugía , Infecciones Relacionadas con Prótesis/patología , Infecciones Relacionadas con Prótesis/terapia , Tazobactam , Resultado del TratamientoRESUMEN
PURPOSE: The aim of this study was to assess the incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonisation in patients admitted into a level 1 German trauma centre with proximal femur fractures, to correlate this incidence with defined risk factors for MRSA colonisation and to determine its influence on morbidity and mortality. METHODS: Between August and November 2006, 65 patients were included in the study. Cotton-tipped swab samples were taken from the nose, throat, groin and any skin defects in the emergency room. The following factors were recorded: age, gender, any concomitant diseases, the fracture type and treatment device, skin lesions, hospitalisation within the last year, any urinary or vascular catheters, a nasogastric or gastrostomy tube, an ileal stoma, the use of a respirator and antibiotic therapy within the last year. During follow-up, data concerning any surgical site infections; any chest, urinary or vascular catheter infections; the success of decontamination and death within 1 year after surgery were collected. RESULTS: The risk factors for MRSA colonisation were positive in 40 patients. The incidence of MRSA colonisation was 17%, which is higher than in most comparable studies but consistent with some very recent publications. The nosocomial infection rates, surgical site infection rates and mortality within the 1-year follow-up period were significantly higher in the MRSA-colonised patients. CONCLUSION: The high incidence of MRSA in this study supports the need for systematic detection of MRSA-colonised patients. In our hospital, any patient with positive risk factors for MRSA colonisation is swabbed in the emergency room and treated as MRSA positive until proven otherwise.
Asunto(s)
Fracturas de Cadera/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Anciano de 80 o más Años , Infección Hospitalaria/transmisión , Femenino , Fracturas del Cuello Femoral/microbiología , Fracturas del Cuello Femoral/cirugía , Fracturas de Cadera/cirugía , Hospitalización , Humanos , Masculino , Factores de Riesgo , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/transmisión , Centros TraumatológicosRESUMEN
INTRODUCTION: Surgical site infections (SSIs) are the most common nosocomial infections after surgery.However, clinical guidance on how to handle any suspicious clusters of SSI in orthopaedic surgery is missing. We report on problem analysis and solution finding following the observation of an increased rate of SSI in trauma implant surgery. SETTING: Trauma unit of a university hospital. METHODS: Over a 2-year observation period, all patients (n = 370) following surgical stabilisation of proximal femur fractures in a trauma unit of a university hospital were consecutively followed using a standardised case report form. First, a retrospective cohort of 217 patients was collected for whom an increased SSI rate was detected. Based on risk analysis, new standard perioperative procedures were developed and implemented. The impact was evaluated in a prospective cohort of 153 comparable patients. Uni- and multivariable analysis of factors associated with the risk for SSI was undertaken. RESULTS: The intervention bundle resulted in a significant reduction of an initially increased SSI incidence of 6.9 (down) to 2.0% (p = 0.029). Multivariable analysis revealed four risk factors significantly associated with a higher risk of SSI caused by different bacteria: duration of surgery (p = 0.002), hemiarthroplasty(p = 0.002), haematoma (p = 0.004) and the presence of two operating room staff members (p < 0.001 and 0.035). CONCLUSIONS: A standardised prospective SSI protocol and detection system offering the simultaneous use of data should guarantee every institution immediate alarm registration to avoid comparable problem situations. Detailed interdisciplinary analysis followed by the implementation of coherent interventions, based on a best-evidence structured bundle approach, may adequately resolve similar critical incidence episodes.
Asunto(s)
Artroplastia de Reemplazo de Cadera/mortalidad , Infección Hospitalaria/microbiología , Fracturas de Cadera/microbiología , Infección de la Herida Quirúrgica/microbiología , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Infección Hospitalaria/mortalidad , Femenino , Fracturas de Cadera/complicaciones , Fracturas de Cadera/mortalidad , Fracturas de Cadera/cirugía , Humanos , Incidencia , Masculino , Estudios Prospectivos , Infección de la Herida Quirúrgica/mortalidad , Resultado del TratamientoRESUMEN
In a prospective study we assessed 440 patients, sequentially admitted to the trauma unit with hip fracture. Of the 403 who had a swab on admission, 5.2% (21/403) were found to be colonised with MRSA. Fifty two percent of MRSA colonised patients were admitted from their own home, 29% from residential homes and 19% from nursing homes. MRSA colonisation was found in 3.6% of patients admitted from their own home, 10.9% of residential home patients, and 17.4% of nursing home patients. A high proportion (80.9%) of colonised patients had been admitted to a hospital within the previous one year, and the high prevalence of previous hospitalisation among people from institutional care may explain the higher rates of MRSA carriage among these individuals. When a patient gives a history of hospitalisation within the previous year, it is clearly sensible to consider the use of an agent such as teicoplanin for perioperative prophylaxis.
Asunto(s)
Fracturas de Cadera/cirugía , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Femenino , Fracturas de Cadera/microbiología , Humanos , Masculino , Admisión del Paciente , Infección de la Herida Quirúrgica/microbiología , Teicoplanina/uso terapéuticoAsunto(s)
Profilaxis Antibiótica/efectos adversos , Clostridioides difficile/aislamiento & purificación , Infección Hospitalaria/epidemiología , Enterocolitis Seudomembranosa/epidemiología , Fracturas de Cadera/microbiología , Antibacterianos/uso terapéutico , Comorbilidad , Infección Hospitalaria/inducido químicamente , Infección Hospitalaria/microbiología , Enterocolitis Seudomembranosa/inducido químicamente , Enterocolitis Seudomembranosa/microbiología , Heces/microbiología , Femenino , Fracturas de Cadera/complicaciones , Fracturas de Cadera/tratamiento farmacológico , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Reino Unido/epidemiologíaRESUMEN
We report the case of an infected nonunion of the proximal femoral in an elderly patient. There was extensive involvement of the entire proximal femur precluding salvage. An impromptu use of a cephalomedullary nail coated with antibiotic-laden bone cement is described, followed by reimplantation with a revision-type proximal femoral prosthesis. The patient had resection of the proximal femur, placement of a temporary functional spacer, and reimplantation after a course of antibiotics, with good success. The method we describe is a reasonable alternative when standard off-the-shelf systems or other methods of temporary spacer creation are not available.
Asunto(s)
Antibacterianos/uso terapéutico , Fracturas de Cadera/cirugía , Procedimientos Ortopédicos/instrumentación , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Tobramicina/uso terapéutico , Vancomicina/uso terapéutico , Anciano , Antibacterianos/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/etiología , Cementos para Huesos , Sistemas de Liberación de Medicamentos , Femenino , Fracturas de Cadera/microbiología , Humanos , Dispositivos de Fijación Ortopédica/microbiología , Procedimientos Ortopédicos/métodos , Tobramicina/administración & dosificación , Vancomicina/administración & dosificaciónRESUMEN
OBJECTIVES: To assess whether allogeneic blood transfusion in the perioperative period is associated with changes in mortality or complication rates in patients undergoing surgical treatment for hip fracture (proximal femoral fracture). DESIGN: Retrospective case-control series, all patients followed up for 1 year or until death. SETTING: District General Hospital in Peterborough, UK. PATIENTS PARTICIPANTS: Three thousand six hundred twenty-five consecutive patients admitted and operated for hip fracture (proximal femoral fracture) during July 1989 to January 2002 (151 months); 1068 (29.9%) received a perioperative allogeneic blood transfusion. MAIN OUTCOME MEASURES: Thirty- 120-, and 365-day mortality, deep and superficial wound infection rates. RESULTS: Overall mortality for all patients at 1 year post fracture was 28.2% (1007 patients). Transfusion was associated with a statistically significant increase in mortality from 120 days onward after hip fracture. However, when this was adjusted with a statistical regression model for baseline characteristics and confounding variables, this difference became statistically insignificant (P = 0.17). Infection rates in the transfusion group were 2.0% for superficial infection and 0.9% for deep infection compared with 1.9% and 0.6%, respectively, in the nontransfusion group. These figures were not statistically significantly different. Other complications of deep venous thrombosis, chest infection, and congestive cardiac failure showed no statistically significant increase in those patients who received transfusion. CONCLUSIONS: Our data suggest that transfusion is not associated with a change in mortality or infection rates in the hip-fracture patient.
Asunto(s)
Fijación de Fractura/efectos adversos , Fracturas de Cadera/microbiología , Fracturas de Cadera/mortalidad , Atención Perioperativa/efectos adversos , Complicaciones Posoperatorias/etiología , Reacción a la Transfusión , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Fracturas de Cadera/cirugía , Humanos , Estimación de Kaplan-Meier , Masculino , Oportunidad Relativa , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/mortalidad , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
Hip fracture affects more than 55,000 people in the UK each year and this number is increasing. Because of their advanced age and other risk factors, hip fracture patients are at risk of developing infection and a variety of other non-infective complications. Surveillance of superficial wound and deep joint infection is important because of the large number of patients involved and represents a good example of targeted surveillance. Furthermore this may be conducted as part of a quality control programme monitoring other interventions such as prophylaxis for vascular thrombosis. However, to carry this out successfully, a simple but efficient system for recording, collecting and analysing data is required and adequate post-discharge surveillance must be carried out.
Asunto(s)
Fracturas de Cadera/complicaciones , Fracturas de Cadera/microbiología , Garantía de la Calidad de Atención de Salud , Infección de Heridas/prevención & control , Artroplastia de Reemplazo de Cadera/mortalidad , Prótesis de Cadera/microbiología , Humanos , Control de Infecciones/métodos , Reino UnidoRESUMEN
Oral norfloxacin prevented Gram-negative bacilluria in female patients with hip fractures, who needed medium-term transurethral catheterization. This was shown in a placebo-controlled double-blind study of 34 patients. Seventeen of these received a suspension containing 200 mg norfloxacin and 500 mg amphotericin B, twice daily. In the placebo group, six cases of Gram-negative bacilluria had occurred by day 7, as compared with no cases during a median time of catheterization of 23 days in the group on medication. Bacteriuria, either by Gram-positive cocci or by Gram-negative bacilli, was observed in 50% of patients on placebo by day 7; in the treatment group this was the case by day 17 (P less than 0.001). Subsequent bacteriuria with Gram-positive cocci was eliminated by nitrofurantoin (50 mg qid) within four days. Norfloxacin is very suitable for the prevention of Gram-negative bacilluria, because it decontaminates Gram-negative bacilli from the bowel, reaches high concentrations in urine and rarely produces resistant variants.
Asunto(s)
Bacteriuria/prevención & control , Sistema Digestivo/microbiología , Norfloxacino/uso terapéutico , Cateterismo Urinario/efectos adversos , Anciano , Anciano de 80 o más Años , Anfotericina B/uso terapéutico , Candida albicans , Heces/microbiología , Femenino , Bacterias Gramnegativas , Fracturas de Cadera/complicaciones , Fracturas de Cadera/microbiología , Humanos , Norfloxacino/orinaRESUMEN
Minimal inhibitory and bactericidal concentrations (MIC and MBC) of methicillin, dicloxacillin, cephalothin and cefuroxime were determined against 26 strains of staphylococci, using a broth dilution method with surgical wound fluid (WF) and Mueller-Hinton broth (MH) as test media. The staphylococci were all clinical isolates; 17 strains were coagulase-positive and 9 were coagulase-negative. The MIC-values of dicloxacillin and cephalothin estimated in MH were lower than those estimated in WF. For methicillin and cefuroxime the MIC-values in the two media were similar. With regard to MIC-values, the two penicillins were identical in WF, as were the two cephalosporins, but the cephalosporins were found to be more active than the penicillins, with an average of one dilution step. As regards the MBC to MIC ratios, no differences were found neither between the two media nor between the four antibiotics.
Asunto(s)
Antibacterianos/farmacología , Infecciones Estafilocócicas/microbiología , Staphylococcus/efectos de los fármacos , Infección de la Herida Quirúrgica/microbiología , Cefuroxima/farmacología , Cefalotina/farmacología , Medios de Cultivo , Dicloxacilina/farmacología , Fracturas de Cadera/complicaciones , Fracturas de Cadera/microbiología , Fracturas de Cadera/cirugía , Humanos , Meticilina/farmacología , Staphylococcus aureus/efectos de los fármacosRESUMEN
Bacteria produce a virulence-related polysaccharide exocellular slime (the glycocalyx), which preferentially adheres to the surfaces of biomaterials and compromised tissues. This biofilm resists antibiotic penetration and provides a degree of protection from antibodies and macrophages. Similar adhesive cell-to-substrate phenomena have been noted in natural environments and in bacterial-animal cell disease states. The adherent glycocalyx is one of the fundamental reasons for increased susceptibility to infection in the presence of biomaterials and compromised tissues and a significant factor in the persistence of such infection until the removal of the prosthetic device.