Biofilm Production in Intensive Care Units: Challenges and Implications

Abstract

The prevalence of infections amongst intensive care unit (ICU) patients is inevitably high, and the ICU is considered the epicenter for the spread of multidrug-resistant bacteria. Multiple studies have focused on the microbial diversity largely inhabiting ICUs that continues to flourish despite treatment with various antibiotics, investigating the factors that influence the spread of these pathogens, with the aim of implementing sufficient monitoring and infection control methods. Despite joint efforts from healthcare providers and policymakers, ICUs remain a hub for healthcare-associated infections. While persistence is a unique strategy used by these pathogens, multiple other factors can lead to persistent infections and antimicrobial tolerance in the ICU. Despite the recognition of the detrimental effects biofilm-producing pathogens have on ICU patients, overcoming biofilm formation in ICUs continues to be a challenge. This review focuses on various facets of ICUs that may contribute to and/or enhance biofilm production. A comprehensive survey of the literature reveals the apparent need for additional molecular studies to assist in understanding the relationship between biofilm regulation and the adaptive behavior of pathogens in the ICU environment. A better understanding of the interplay between biofilm production and antibiotic resistance within the environmental cues exhibited particularly by the ICU may also reveal ways to limit biofilm production and indivertibly control the spread of antibiotic-resistant pathogens in ICUs.

Keywords: ICU; antibiotic resistance; bacterial biofilm production; hospital-acquired infection; indwelling medical devices; molecular genetics.

Figure 1

A schematic diagram representing how ICUs harbor biofilm-producing MDR bacteria while highlighting the complex interplay of biofilm production and antibiotic resistance. Current research has shifted to identifying favorable biofilm treatment combinations, including phage cocktail therapies in combination with effective antibiotics, while developed algorithms are employed to predict anti-biofilm activity of molecules (image created using image database Biorender).