Gowrishankar Muthukrishnan, Débora C. Coraça‐Huber, Gerald J. Atkins, Ahmad Abbaszadeh, Armita A. Abedi, Ezzuddin Abuhussein, Joshua S. Bingham, Kyle H. Cichos, Tom Coenye, L. Drago, John Hamilton, Noreen J. Hickok, Ferdinando Iannotti, Jessica Amber Jennings, Louise Kruse Jensen, Bingyun Li, Mojieb Manzary, T. Fintan Moriarty, Katya McDonald, K. Nishitani, Nicholas Norton, Ebru Oral, Javad M. Parvizi, Dina Raafat, Kordo B. A. Saeed, Imre Sallai, Schwarz Em, Claudia Siverino, Amita Sekar, J.C. Tate, Margarita Trobos, Andie R. Tubbs
Musculoskeletal infection (MSKI) remains a major problem after trauma and elective orthopedic surgery. Chronic MSKI is related to the formation of biofilm, which impairs diagnosis and effective treatments. Therefore, to understand and communicate global standards and best practices, the 2025 International Consensus Meeting (ICM) on MSKI created a Biofilm Section to address crucial aspects of biofilm biology pertaining to its mechanisms of drug resistance and immune evasion, and potential approaches to overcome them. This featured a 2-year process, with final voting and discussion on May 8-10, 2025, in Istanbul, Turkey. This Consensus Article is the effort of the Biofilm Basic Mechanisms Workgroup, which interpreted the results on ICM questions related to (1) the infectious microenvironment; (2) appropriate inocula in preclinical research; (3) biofilm behavior in infected tissues; and (4) synergy within biofilms and with other comorbidities. Collectively, we find that this field has the necessary research tools to discover the pathophysiology of orthopedic implant-associated biofilm development and maturation, perform clinically relevant studies in animal models, and elucidate mechanisms that allow opportunistic infections in compromised tissues and patients with other health issues.