Biofilm‐associated infection is almost exclusively an early-post-injection issue and even then it is a very minimal risk.
• In the first 2-8 weeks the
PMMA microspheres are still being integrated in the body. During this window bacteria introduced at the time of injection—or in the rare case of early cellulitis—can adhere and organize into a biofilm.
• By ~3-6 months a dense collagen capsule surrounds each 30-40 µm microsphere, physically separating it from the bloodstream and greatly reducing the possibility of bacterial adhesion.
As for late biofilm formation, any foreign material can, in theory, be colonized during a bout of bacteremia (e.g., severe pneumonia or sepsis). However, after millions of
PMMA injections over two decades, only isolated case reports exist. Why? The combination of small particle size, smooth surface, and collagen encapsulation makes secondary seeding extraordinarily unlikely.
• Once you pass the three-month mark the probability of a new biofilm forming is infinitesimally small.
• No special lifelong precautions or prophylactic antibiotics are recommended.
Bottom line: biofilm formation is primarily an early-integration concern. After the
PMMA is fully collagen-encased, late infection is theoretically possible but practically negligible.
Hope that helps.
Dr. S
