Beyond the germ: Rethinking implant-related infections as a host-microbiota-biomaterial ecosystem

Area of Science:

• Infectious Diseases
• Biomaterials Science
• Microbiome Research
• Immunology

Background:

• Implant-related infections are a major cause of implant failure, morbidity, and mortality.
• Traditional views focus on microbial contamination and biofilm formation.
• Emerging evidence highlights the complex interplay of host biology, microbiota, biomaterials, and environment.

Purpose of the Study:

• To re-evaluate the pathogenesis of implant-associated infections.
• To explore the complex interactions at the host-microbe-material interface.
• To propose a new paradigm for infection prevention and treatment.

Main Methods:

• Review of current literature on implant infections.
• Integration of concepts from immunology, microbiome science, and biomaterials research.
• Emphasis on systems biology approaches including multi-omics profiling and predictive modeling.

Main Results:

• Infection susceptibility arises from a dynamic interplay between host, microbiota, and biomaterials.
• Biofilms may have a dual role, acting as both pathogenic reservoirs and detoxification systems.
• Host immune tone, metabolic status, and biomaterial properties significantly influence infection risk.

Conclusions:

• A shift from microbial eradication to ecosystem management is needed for implant infection control.
• Systems biology approaches offer promising strategies for prevention and treatment.
• Novel strategies include engineered probiotics, dietary modulation, and advanced implant designs.