The biocidal activity of peracetic acid (PAA) and benzalkonium chloride (BAC) on Pseudomonas aeruginosa biofilms was investigated by using a recently developed confocal laser scanning microscopy (CLSM) method that enables the direct and real-time visualization of cell inactivation within the structure. This technique is based on monitoring the loss of fluorescence that corresponds to the leakage of a fluorophore out of cells due to membrane permeabilization by the biocides. Although this approach has previously been used with success with various Gram-positive species, it is not directly applicable to the visualization of Gram-negative strains such as P. aeruginosa, particularly because of limitations regarding fluorescence staining. After adapting the staining procedure to P. aeruginosa, the action of PAA and BAC on the biofilm formed by strain ATCC 15442 was investigated. The results revealed specific inactivation patterns as a function of the mode of action of the biocides. While PAA treatment triggered a uniform loss of fluorescence in the structure, the action of BAC was first localized at the periphery of cell clusters and then gradually spread throughout the biofilm. Visualization of the action of BAC in biofilms formed by three clinical isolates then confirmed the presence of a delay in penetration, showing that diffusion-reaction limitations could provide a major explanation for the resistance of P. aeruginosa biofilms to this biocide. Biochemical analysis suggested a key role for extracellular matrix characteristics in these processes.The control of microbial surface contamination is a major concern in terms of public health. Pseudomonas aeruginosa is a Gram-negative bacterium that is well known to be involved in a large number of human infections (14, 30). Numerous outbreaks have been linked directly to its presence on medical equipment (11,15,16,25). The persistence of this bacterium in the environment can be attributed to its ability to form biofilms that increase its resistance to disinfection treatments. Numerous studies have indeed reported the high resistance of P. aeruginosa biofilms (compared to their planktonic counterparts) to numerous biocides, including chlorine, quaternary ammonium compounds, and aldehydes (5,10,13,26). Although the precise mechanisms underlying this resistance remain unclear, it appears to be a multifactorial process that is primarily related to the physiological and structural characteristics of the biofilm. It is now generally accepted that biofilms constitute heterogeneous structures that group subpopulations with distinct physiological states and resistance phenotypes (28).Data on biocide reactivity within these heterogeneous structures could provide a clearer understanding of the mechanisms involved in biofilm resistance and ultimately facilitate the development of new and more efficient treatments. Recently, a noninvasive technique based on confocal laser scanning microscopy (CLSM) was developed and used to investigate spatial and temporal patterns of antimicrobial...