Medical Device-Associated Infections Caused by Biofilm-Forming Microbial Pathogens and Controlling Strategies

Abstract

Hospital-acquired infections, also known as nosocomial infections, include bloodstream infections, surgical site infections, skin and soft tissue infections, respiratory tract infections, and urinary tract infections. According to reports, Gram-positive and Gram-negative pathogenic bacteria account for up to 70% of nosocomial infections in intensive care unit (ICU) patients. Biofilm production is a main virulence mechanism and a distinguishing feature of bacterial pathogens. Most bacterial pathogens develop biofilms at the solid-liquid and air-liquid interfaces. An essential requirement for biofilm production is the presence of a conditioning film. A conditioning film provides the first surface on which bacteria can adhere and fosters the growth of biofilms by creating a favorable environment. The conditioning film improves microbial adherence by delivering chemical signals or generating microenvironments. Microorganisms use this coating as a nutrient source. The film gathers both inorganic and organic substances from its surroundings, or these substances are generated by microbes in the film. These nutrients boost the initial growth of the adhering bacteria and facilitate biofilm formation by acting as a food source. Coatings with combined antibacterial efficacy and antifouling properties provide further benefits by preventing dead cells and debris from adhering to the surfaces. In the present review, we address numerous pathogenic microbes that form biofilms on the surfaces of biomedical devices. In addition, we explore several efficient smart antiadhesive coatings on the surfaces of biomedical device-relevant materials that manage nosocomial infections caused by biofilm-forming microbial pathogens.

Keywords: antibacterial; antifouling; biofilms; healthcare-associated infections; nosocomial infections; surface coatings.

Figure 1

Stages of biofilm formation and mechanism showing antibiotic resistance by pathogenic bacterial strain. Reprinted from the [19], Copyright © 2023 by the authors and Licensee MDPI, Basel, Switzerland.

Figure 3

Stages of biofilm formation on the surface of the medical devices. Reprinted from the [73], Copyright © 2021 by the authors and Licensee MDPI, Basel, Switzerland.

Figure 4

Representation of biofilm formation control and its removal by various methods. Reprinted from the [95], Copyright © 2023 by the authors and Licensee, Elsevier Ltd. (Amsterdam, The Netherlands).

Figure 2

Mechanisms of resistance to antibiotics and their effects. Reprinted from the [27], Copyright © 2021 by the authors and Licensee, Frontiers in Microbiology (Lausanne. Switzerland).