The Role of Material Technologies Targeting P. Aeruginosa and S. Aureus Quorum Sensing in Biofilm Formation

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Periprosthetic joint infections are a major complication after total joint arthroplasty. Pseudomonas aeruginosa and Staphylococcus aureus are of great clinical concern, due to high antibiotic resistance, which is even increased when they form a biofilm on the implant surface. In this qualitative systematic review based on the PRISMA statement, biofilm formation of S. aureus and P. aeruginosa was studied, with a particular emphasis on the role of quorum sensing (QS). Treatment of infection by these bacteria by regulation or inhibition of the QS system via material technology was also reviewed. Pubmed, Google Scholar and Embase were searched. Articles were selected on their titles and use of the English language. All abstracts of the remaining articles were judged on the quality of the article, and fit with the scope of the review. This led to a selection of 62 articles, which consisted of 29 research articles and 33 reviews. In P. aeruginosa different QS systems are present in a hierarchal structure. These QS systems play an important role for formation of virulence factors and polymeric substances used in biofilm formation. In S. aureus, QS regulates biofilm dispersal, but not biofilm formation. Different treatments, either preventative by inhibiting biofilm formation or curative by biofilm dispersal are described in the literature. Combinations of QS inhibitors (QSI) and either antibiotics or metallic (nano)particles showed most promise in biofilm inhibition. QSI’s and other biofilm inhibitors are only under preclinical investigation. Furthermore, QS has different functions in different bacteria, and treatment using QSI’s are not suitable for every infection. While this makes QSI therapy unfit as an alternative to antibiotics, QSI’s in combination with antibiotics can be a potent strategy to prevent biofilm formation.