The pathogenesis of biomaterial- related infection is peculiar. Some factors, such as the presence of a stable and sheltering surface of the device, the local damage of the tissues when the devices are implanted, the impairment of neutrophil granulocyte function, and finally, the systemic general condition of the patient have to be carefully considered, because the presence of a systemic condition can increase the risk of developing infections. The inflammatory reaction of the tissues subsequent to surgical trauma is a major pathogenic factor in biomaterial infection development. Molecule exposure or secretion constitutes an optimal environment for bacteria adhesion and biofilm growth. Many strategies have been developed to prevent or reduce bacteria contamination in biomaterials. These include morphological modifications, such as appropriate polishing, reduction in concavity on the surfaces, or modification of physical properties such as surface- free energy. These can be done with different technologies, including ion implantation, plasma treatment, and so on. Chemical modification of the surface could be obtained with the same techniques. Antimicrobial effects due to antifouling molecule grafting or adhesion inhibitors are also proposed.
