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Review
. 2018 Dec;32(4):915-929.
doi: 10.1016/j.idc.2018.06.009. Epub 2018 Sep 18.

Understanding Biofilms and Novel Approaches to the Diagnosis, Prevention, and Treatment of Medical Device-Associated Infections

Yu Mi Wi  1 , Robin Patel  2
Affiliations
Review

Understanding Biofilms and Novel Approaches to the Diagnosis, Prevention, and Treatment of Medical Device-Associated Infections

Yu Mi Wi et al. Infect Dis Clin North Am. 2018 Dec.

Abstract

Treatment of medical device-related infections is challenging and recurrence is common. The main reason for this is that microorganisms adhere to the surfaces of medical devices and enter into a biofilm state in which they display distinct growth rates, structural features, and protection from antimicrobial agents and host immune mechanisms compared with their planktonic counterparts. This article reviews how microorganisms form biofilms and the mechanisms of protection against antimicrobial agents and the host immune system provided by biofilms. Also discussed are innovative strategies for the diagnosis of biofilm-associated infection and novel approaches to treatment and prevention of medical device-associated infections.

Keywords: Biofilm; Extracellular polymeric substance; Extracellular polymeric substance targeting therapy; Medical device-associated infection; Physical–mechanical approach; Surface-coating or eluting substrate; Tolerance.

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Figures

Figure 1
Figure 1. Scanning electron microscopy of Staphylococcus epidermidis biofilm
S. epidermidis was grown in the laboratory on a Teflon surface.
Figure 2
Figure 2. Steps in biofilm formation on an orthopedic prosthesis
Biofilm formation has distinct stages: Initial Attachment, in which microorganism attaches to an orthopedic implant through interactions between the microorganism and host molecules on the foreign body surface as well as the foreign body surface itself; Biofilm Growth, in which the microorganism begins to proliferate, and individual cells adhere to one another, and become surrounded by a self-produced extracellular polymeric substance; Biofilm Maturation, whereby the biofilm develops a structured multicellular community protecting its members against from external threats, including host defense mechanisms and antimicrobial treatments; and finally Cell Detachment, whereby planktonic cells may be released from the surface of large biofilms, causing distant metastatic infections and further regional biofilm establishment.
See this image and copyright information in PMC

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