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The Journal of Bone and Joint Surgery, Vol 67, Issue 2 264-273, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Bacterial adherence to biomaterials and tissue. The significance of its role in clinical sepsis
AG Gristina and JW Costerton
The direct examination of tissue and biomaterials from prosthesis-related
infections of twenty-five patients showed that the causative bacteria grew
in glycocalyx-enclosed biofilms that were adherent to surfaces of
biomaterials and tissues in 76 per cent. This high rate of recovery of
adherent biofilm-mediated growth suggests that the process occurs commonly
in the presence of a foreign body or biomaterial-related infection. Because
of the adherent mode of growth of the infecting organisms, accurate
microbiological sampling was difficult. The analysis of joint fluids or of
swabs of excised tissue and of prosthetic surfaces often yielded only one
species from what was a polymicrobial population based on electron
microscopic studies. We adapted direct quantitative sampling methods from
environmental microbiology in order to recover a large number of species
from these infections, but comparison of the organisms isolated by these
techniques with the morphological types that were seen by electron
microscopy indicated that in some instances all bacterial components of the
biofilms were still not being recovered.
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