Adherent bacterial colonization in the pathogenesis of osteomyelitis

Author summary

Osteomyelitic bone can be plagued by extensive bacterial growth in adherent biofilms, which can be observed by direct scanning electron microscropy, and may even obscure the entire infected bone surface. Through synchronized production of exopolysaccharide polymers, microcolony formation and surface adhesion is mediated, and a fibrous matrix is formed which is readily visible by transmission electron microscopy. Multiple bacterial morphotypes may be present simultaneously in these biofilms. The result is an infection that may be very resistant to either antibiotic therapy or host clearance in the damaged tissue or bone, leading to persistent infection unless the compromised material is removed.