A multimodal approach can be used to identify bacteria on the implant surface, fluid around the device, the implant capsule, and surrounding host tissue. Bacteria can be imaged on breast implants. Light microscopy and laser scanning microscopy can be used along with immunofluorescence to identify the relative abundance and the spatial orientation of bacteria on the implant. Infrared imaging uses a combination of immunofluorescence as well as the ability to image large surface areas of the implant to identify bacteria. Scanning electron microscopy provides exquisite detail regarding the bacteria but can be limited by sampling bias. Culture techniques are probably the most common way to identify bacteria associated with a breast implant. There are standard culture techniques which can readily identify planktonic bacteria which can be cultured in select media. A more sensitive technique is to use sonicated cultures. With sonication, bacterial biofilms can be dislodged from an abiotic surface to then facilitate standard culture techniques. This is recommended to detect bacterial infections on implants. Recent advances in microbiology and genomics have enabled us to identify bacteria using their DNA sequences and this can be done using Sanger sequencing or to identify rare bacteria and biofilm bacteria using 16S RNA sequencing or to assess the functional genes within a sample can use shotgun metagenomic sequencing. While 16S sequencing typically looks at the composition of bacteria in a particular specimen, proteomics, transcriptomics, and metabolomics begins to look at the function or physiology of the bacteria in a specimen and potentially how they interact with the host. Proteomics studies the structure, interaction, composition, and function of proteins in bacterial and host cells and major techniques that are used with this approach include x-ray crystallography, nuclear magnetic resonance, and matrix-assisted laser desorption ionization, time-of-flight mass spectrometry. Transcriptomics serves to identify and quantify the mRNA transcripts in a cell and it enables interpretation of the functional elements of the genome. By contrast, metabolomics is the analysis of the small molecule products of host and bacterial metabolism. Unique chemical signatures left behind by these cellular processes provide discrete information about the physiologic state and the interaction between bacteria, host, and potentially device.

multimodal approach

bacterial identification

microscopy techniques

genomic advancements

proteomics and metabolomics