Antibiotic treatment of biofilm infections

Ciofu, Oana; Rojo-Molinero, Estrella; Macià, María D.; Oliver, Antonio

doi:10.1111/apm.12673

Cited by 335 publications

(288 citation statements)

References 166 publications

(174 reference statements)

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“…Biofilms are microbial communities wrapped in a polysaccharidic matrix produced by the bacteria, which are adhered to an inert or biotic surface. Biofilms are far less susceptible to antibiotics than planktonic cells, and therefore, they have been associated with a wide range of infections in a clinical setting, from those related to exogenous devices (i.e., catheters or prosthetic joints) to chronic tissue infections, such as those occurring in the lungs of CF patients [26,27].…”

Section: Discussionmentioning

confidence: 99%

Clonal Diversity, Biofilm Formation, and Antimicrobial Resistance among Stenotrophomonas maltophilia Strains from Cystic Fibrosis and Non-Cystic Fibrosis Patients

et al. 2020

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The intrinsic antibiotic resistance of Stenotrophomonas maltophilia, along with its ability to form biofilm both on abiotic surfaces and host tissues, dramatically affects the efficacy of the antibiotic therapy. In this work, 85 S. maltophilia strains isolated in several hospital of central Italy and from several clinical settings were evaluated for their genetic relatedness (by pulsed-field gel electrophoresis, PFGE), biofilm formation (by microtiter plate assay), and planktonic antibiotic resistance (by Kirby–Bauer disk diffusion technique). The S. maltophilia population showed a high genetic heterogeneity: 64 different PFGE types were identified, equally distributed in cystic fibrosis (CF) and non-CF strains, and some consisted of multiple strains. Most of the strains (88.2%) were able to form biofilm, although non-CF strains were significantly more efficient than CF strains. CF strains produced lower biofilm amounts than non-CF strains, both those from respiratory tracts and blood. Non-CF PFGE types 3 and 27 consisted of strong-producers only. Cotrimoxazole and levofloxacin were the most effective antibiotics, being active respectively against 81.2% and 72.9% of strains. CF strains were significantly more resistant to piperacillin/tazobactam compared to non-CF strains (90% versus 53.3%), regardless of sample type. Among respiratory strains, cotrimoxazole was more active against non-CF than CF strains (susceptibility rates: 86.7% versus 75%). The multidrug resistant phenotype was significantly more prevalent in CF than non-CF strains (90% versus 66.7%). Overall, the multidrug-resistance level was negatively associated with efficiency in biofilm formation. Our results showed, for the first time, that in S. maltophilia both classical planktonic drug resistance and the ability of biofilm formation might favor its dissemination in the hospital setting. Biofilm formation might in fact act as a survival mechanism for susceptible bacteria, suggesting that clinical isolates should be routinely assayed for biofilm formation in diagnostic laboratories.

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Section: Discussionmentioning

confidence: 99%

Clonal Diversity, Biofilm Formation, and Antimicrobial Resistance among Stenotrophomonas maltophilia Strains from Cystic Fibrosis and Non-Cystic Fibrosis Patients

et al. 2020

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“…Surgical debridement is an important part of treatment. Many times the debridement is intralesional, making it difficult for the surgeon to be certain removal of biofilm is complete and biofilm fragments remaining in the surgical site have the potential to propagate the infection …”

mentioning

confidence: 99%

2018 international consensus meeting on musculoskeletal infection: Summary from the biofilm workgroup and consensus on biofilm related musculoskeletal infections

Saeed

McLaren²,

Schwarz³

et al. 2019

Journal Orthopaedic Research

133

123

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Biofilm-associated implant-related bone and joint infections are clinically important due to the extensive morbidity, cost of care and socioeconomic burden that they cause. Research in the field of biofilms has expanded in the past two decades, however, there is still an immense knowledge gap related to many clinical challenges of these biofilm-associated infections. This subject was assigned to the Biofilm Workgroup during the second International Consensus Meeting on Musculoskeletal Infection held in Philadelphia USA (ICM 2018) (https://icmphilly.com). The main objective of the Biofilm Workgroup was to prepare a consensus document based on a review of the literature, prepared responses, discussion, and vote on thirteen biofilm related questions. The Workgroup commenced discussing and refining responses prepared before the meeting on day one using Delphi methodology, followed by a tally of responses using an anonymized voting system on the second day of ICM 2018. The Working group derived consensus on information about biofilms deemed relevant to clinical practice, pertaining to: (1) surface modifications to prevent/inhibit biofilm formation; (2) therapies to prevent and treat biofilm infections; (3) polymicrobial biofilms; (4) diagnostics to detect active and dormant biofilm in patients; (5) methods to establish minimal biofilm eradication concentration for biofilm bacteria; and (6) novel anti-infectives that are effective against biofilm bacteria. It was also noted that biomedical research funding agencies and the pharmaceutical industry should recognize these areas as priorities. ß

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“…Not only has the presence of wound biofilm been shown to impair healing, but it has been known for decades that microbes in the biofilm phenotype are highly tolerant of the action of systemic antibiotics compared with planktonic microbes . In many cases, antibiotic concentrations adequate to achieve antimicrobial efficacy would risk toxicity to the host . The tolerance of biofilms towards antimicrobials has received a considerable amount of research attention.…”

Section: Systemic Antibiotics: Current Practice and The Evidencementioning

confidence: 99%

“…On the other hand, AMR results from a fundamental change in the microbe itself, leading to the loss of antibiotic effectiveness against a previously susceptible microbe. The exposure of microorganisms to antibiotics promotes the potential for a selective pressure to develop AMR . This change in susceptibility can evolve via protective mutation and through the acquisition of genes encoding resistance transferred from other resistant organisms, potentially existing within the same biofilm .…”

Section: Antimicrobial Resistance Verses Tolerancementioning

confidence: 99%

Diabetic foot infection: A critical complication

Hurlow

Humphreys

Bowling

et al. 2018

International Wound Journal

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The number of people in the world with diabetes has nearly quadrupled in the past 40 years. Current data show that 25% of these diabetics will develop a foot ulcer in their lifetime and that the cost of care for a diabetic foot ulcer (DFU) is over twice that of any other chronic ulcer aetiology. Microbial biofilm has been linked to both wound chronicity and infection. Close to 1 in 2 diabetics with a DFU are predicted to go on to develop a diabetic foot infection (DFI). The majority of these DFIs have been found to evolve even before the diabetic individual has received an initial referral for expert DFU management. Of these infected DFUs, less than half have been shown to heal over the next year; many of these individuals will require costly hospitalisation, and current data show that far too many DFIs will require extremity amputation to achieve infection resolution. The development of an infection in a DFU is critical at least in part because paradigms of infection prevention and management are evolving. The effectiveness of our current practice standards is being challenged by a growing body of research related to the prevalence and recalcitrance of the microbes in biofilm to topical and systemic antimicrobials. This article will review the magnitude of current challenges related to DFI prevention and management along with what is currently considered to be standard of care. These ideas will be compared and contrasted with what is known about the biofilm phenotype; then, considerations to support progress towards the development of more cost-effective protocols of care are highlighted.

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Antibiotic treatment of biofilm infections

Cited by 335 publications

References 166 publications

Clonal Diversity, Biofilm Formation, and Antimicrobial Resistance among Stenotrophomonas maltophilia Strains from Cystic Fibrosis and Non-Cystic Fibrosis Patients

Clonal Diversity, Biofilm Formation, and Antimicrobial Resistance among Stenotrophomonas maltophilia Strains from Cystic Fibrosis and Non-Cystic Fibrosis Patients

2018 international consensus meeting on musculoskeletal infection: Summary from the biofilm workgroup and consensus on biofilm related musculoskeletal infections

Diabetic foot infection: A critical complication

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