Clinical Impact of Multidrug-Resistant Acinetobacter baumannii in Orthopedic Infections and Emerging Anti-Biofilm Strategies—A Scoping Review

Acinetobacter baumannii (AB) is recognized as a major opportunistic nosocomial pathogen. Its success largely depends on the ability to adhere to and colonize both biotic and abiotic surfaces, survive under adverse environmental conditions, and acquire antimicrobial resistance determinants. In orthopedic settings, its ability to form biofilms is a key virulence factor that contributes to the development of implant-associated infections. Although Gram-positive bacteria remain the leading etiologic agents of orthopedic implant infections, the increasing emergence of multidrug-resistant isolates of this Gram-negative bacterium in periprosthetic tissues and other implant-associated niches has become a major clinical concern. The intrinsic antibiotic tolerance of biofilm-embedded bacterial cells and the multidrug resistance of AB render these infections difficult to eradicate. We conducted a scoping review to summarize the current evidence on the role of AB in orthopedic implant-related infections, with emphasis on its epidemiology, clinical management, biofilm formation on abiotic surfaces, and emerging anti-biofilm and other preventive strategies. A deeper understanding of these aspects is essential to better delineate the pathogenic potential of AB and to support the development of more effective approaches for the prevention and management of orthopedic implant-associated infections.