Biofilms as a risk factor for infectious complications in surgery: a review of modern methods of prevention and eradication

This review focuses on the analysis of bacterial biofilms (BFs) as one of the most significant risk factors for the development and chronicity of infectious complications in surgery. BFs are structured communities of microorganisms (MOs) encased in a protective exp polysaccharide matrix (EPS), which exhibit high resistance to standard antibiotic therapy (ABT) and host immune factors through a combination of mechanisms, including limited diffusion of antibacterial agents, the presence of metabolically inactive persister cells, and active horizontal gene transfer of resistance determinants. The presented work systematizes data on the clinical significance of BFs in implant-associated infections (IAIs), chronic wounds, peritonitis, and mediastinitis. Modern diagnostic methods are examined in detail, highlighting the limitations of traditional microbiological culturing techniques and the significant potential of imaging approaches (specifically confocal microscopy), molecular genetic methods, and the value of detecting specific BF biomarkers. The section on prevention places particular emphasis on methods for modifying implant surfaces and the application of antimicrobial coatings during surgical procedures. Eradication strategies are analyzed from the perspective of a combined approach, encompassing radical surgical debridement of the infectious focus, physical methods (negative pressure wound therapy with instillation, ultrasonic cavitation), and contemporary principles of pharmacotherapy involving both local and systemic antibiotic delivery. Promising innovative directions are highlighted separately, including the use of quorum-sensing (QS) inhibitors, bacteriophages producing depolymerases, enzymatic matrix degradation, electrochemical methods, and nanotechnological systems for targeted delivery of antibacterial agents. The authors emphasize the necessity of developing multimodal strategies that integrate surgical, physical, and pharmacological methods for the effective control of biofilm-associated infections, which is expected to subsequently reduce the incidence of postoperative complications.