Bacterial adherence and the glycocalyx and their role in musculoskeletal infection

Author summary

The two representative case reports included in this article provide direct morphological evidence that pathogenic bacteria present in infections associated with biomaterials and compromised tissues grow in glycocalyx-enclosed microcolonies on these surfaces. The authors propose that the glycocalyx is one of the ways by which these organisms are protected from host defense mechanisms and antibiotics. Furthermore, the results indicate that routine blood culture techniques (aerobic and anaerobic culturing of swabs or tissue with gram staining) and simple aspirations are often not sufficient to identify the true causative organisms since the colonization system and mucosal adhesive film may prevent them from circulating in the blood or effusion in sufficient numbers to be detected. Failure to conduct adequate, more specialized culturing techniques (using SEM, TEM) as presented in this paper will lead to misdiagnosis and thus ineffective treatment of the infection.