## 2 Implant-Associated Infections
Examples of such protective approaches of SCVs are (i) possessing a stringent response characterized by an inhibition of DNA replication and post-transcriptional regulation via decreased ribosomal assembly, inhibiting bacterial cell growth. (ii) Virulent expression of toxins, including phenol soluble modulus (PSM, causing both the evasion of _S. aureus_ to host neutrophils and indolence within host osteoblasts), alpha- and delta-hemolysins, and the _agr_ locus. (iii) Upregulation of genes detoxifying the host oxidative stress response. (iv) Downregulation of genes involved in the cell wall regulon _vnaRS_, orchestrating antibiotic resistance and switching SCVs from acute to chronic infections [5]. A more dramatic PJI was reported in a patient with an implanted right hip prosthesis, where his left hip was previously replaced with 60 gentamicin-impregnated cement beads. His right hip prosthesis was loosened and, consequently, replaced. The dramatic scene was the isolation of gentamicin-resistant Staphylococcus strain from the hip prosthesis. Then, the authors questioned the usefulness of using gentamicin-impregnated cement beads. Did the used beads help the patient or stimulate the development of the gentamicin-resistant _Staphylococcus_ strain [122]? The suspicions about the efficacy of administrating gentamicin-releasing cement were summarized as such cement adversely contributes to the development of gentamicin resistance because of the insufficient sub-lethal released concentrations [122, 123]. Another problem that has recently been addressed regarding local gentamicin therapy following knee implant was the 'hidden' gentamicin allergy, causing pain and swelling of the knee, and allergic contact dermatitis [124]. The human breast contains endogenous flora originated from the nipple ducts, similar to that of the healthy skin [3]. Staphylococcus skin flora are commensally resided and commonly cultured from surgical sites following breast reconstruction (BR) [20]. The patient's skin is the predominant source of infection at the time of surgery. Surgical site infections (SSIs) could worsen this infection scenario, provoking breast implants' loss (as displayed in Figure 1) and costing healthcare systems [125]. Multidrug-resistant bacteria, causing nosocomial infections, are the most common implant-associated infections [1]. Postoperative infections have existed as a challenging complication following BR. Surgical procedure (i.e., surgical environment, contaminated saline, contaminated implant during surgery) and the underlying clinical condition of the patient are the main contributing factors for breast implant-associated infections [3]. Regarding orthopedic implants, bacterial antibiotic resistance made routine surgical procedures, such as hip and knee replacements, a looming challenge because of a foreseeable risk of contracting a life-threatening untreatable bacterial infection [4, 103]. However, the infection rates in orthopedic implants (an incidence rate of 1.5% [126]) remain lower than in breast implants, which have an incidence rate ranging widely between 1% and up to 35% [127], resulting in breast explcompelling to adopt a series of precautions at BR to reduce such a high infection rate. The assessment of 121 breast implant procedures from seven breast units operated by 22 surgeons revealed inconsistent prophylactic precautions. What stood consistent was the MRSA screening and prophylactic perioperative administration of antibiotics. The authors concluded that a breast implant checklist for infection prevention could be a better practice [128]. [PERSON] et al. [125] have set a \"Theatre Implant Checklist\" to prevent SSIs in BR, including four main points. (i) Pre-operation, has MRSA screening been performed and treated if positive? (ii) Upon surgery induction, there is a series of checkpoints as has the patient received prophylactic antibiotics? Has a conductive warming blanket been placed? Have no entry signs been put on doors, and laminar flows been operated?