Cell surface characteristics of microbiological isolates from human percutaneous titanium implants in the head and neck

Percutaneous implants are commonly associated with several problems, and different failure modes have been described. Infections constitute one serious complication which may lead to the removal of the implant. In contrast to infections around polymer implants, infections around skin-penetrating titanium implants anchored in the temporal bone are often cured by local treatment. Coagulase-negative staphylococci are the most common etiological agents in infections related to polymers whereas Staphylococcus aureus is considered as the main pathogen in infections around metallic implants. Microbial adhesion is a prerequisite for an infection. In the present study, the cell surface of microbes isolated from the skin around skin-penetrating titanium implants, with and without signs of infection, was characterized with respect to expression of cell surface hydrophobicity and to binding of immobilized fibronectin, vitronectin and collagen type 1 which could mediate adhesion. Expression of protein binding was similar in strains isolated from the two groups. No strain expressed a hydrophobic cell surface as determined by two-phase separation, and we conclude that the microenvironment around a titanium implant promotes expression of a hydrophilic rather than a hydrophobic cell surface which in turn makes many infections around a titanium implant curable by local treatment.