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Microbial Biofilms in Healthcare: Formation, Prevention and Treatment
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Microbial Biofilms in Healthcare: Formation, Prevention and Treatment

A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Biomaterials".

Deadline for manuscript submissions: closed (31 October 2018) | Viewed by 89441

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Dr. Karen Vickery

E-Mail Website
Guest Editor
Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
Interests: biofilms; infection control; disinfectants; medical implants; cleaning
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Biofilms are ubiquitious and cause many problems in industry. However, no where do biofilms impact on human health and welfare as much as those that are found contaminating the healthcare environment, surgical instruments, equipment and medical implantable devices. Approximately 70% of healthcare associated infections are due to biofilm formation resulting in increased patient morbidity and mortality. Biofilms formed on reusable surgical instruments, such as endoscopes, have been shown to transmit infection from patient to patient while biofilms formed medical implants are recalcitrant to antibiotic treatment, which leaves implant removal as the principal treatment option. Research has focused on preventing biofilm contamination of equipment and implants by physical surface modification of materials or impregnation of biocides into materials whilst treatment options have investigated combination therapy involving dispersal agents and biocides. This Special Issue will detail recent advances in biofilm prevention, removal and treatment strategies practical for use in healthcare.

Prof. Karen Vickery
Guest Editor

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Keywords

  • biofilms
  • healthcare
  • surgical equipment
  • implantable medical devices
  • medical implants
  • cleaning
  • biofilm prevention
  • biofilm removal

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Published Papers (10 papers)

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Editorial

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3 pages, 171 KiB  
Editorial
Special Issue: Microbial Biofilms in Healthcare: Formation, Prevention and Treatment
by Karen Vickery
Materials 2019, 12(12), 2001; https://doi.org/10.3390/ma12122001 - 22 Jun 2019
Cited by 25 | Viewed by 3777
Abstract
Biofilms are a structured community of microorganisms that are attached to a surface. Individual bacteria are embedded in a bacterial-secreted matrix. Biofilms have significantly increased tolerance to removal by cleaning agents and killing by disinfectants and antibiotics. This special issue is devoted to [...] Read more.
Biofilms are a structured community of microorganisms that are attached to a surface. Individual bacteria are embedded in a bacterial-secreted matrix. Biofilms have significantly increased tolerance to removal by cleaning agents and killing by disinfectants and antibiotics. This special issue is devoted to diagnosis and treatment of biofilm-related diseases in man. It highlights the differences between the biofilm and planktonic (single cell) lifestyles and the diseases biofilms cause from periodontitis to breast implant capsular contracture. Biofilm-specific treatment options are detailed in experimental and review manuscripts. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)

Research

Jump to: Editorial, Review

10 pages, 1428 KiB  
Article
Candida auris Dry Surface Biofilm (DSB) for Disinfectant Efficacy Testing
by Katarzyna Ledwoch and Jean-Yves Maillard
Materials 2019, 12(1), 18; https://doi.org/10.3390/ma12010018 - 21 Dec 2018
Cited by 54 | Viewed by 6946
Abstract
Candida auris is an emerging pathogen that needs to be controlled effectively due to its association with a high mortality rate. The presence of biofilms on dry surfaces has been shown to be widespread in healthcare settings. We produced a C. auris dry [...] Read more.
Candida auris is an emerging pathogen that needs to be controlled effectively due to its association with a high mortality rate. The presence of biofilms on dry surfaces has been shown to be widespread in healthcare settings. We produced a C. auris dry surface biofilm (DSB) on stainless steel surfaces following sequential hydration and desiccation cycles for 12 days. The ASTM2967-15 was used to measure the reduction in viability of 12 commercially wipe-based disinfectants and sodium hypochlorite (1000 ppm) against C. auris DSB. We also evaluated C. auris transferability and biofilm regrowth post-treatment. A peracetic acid (3500 ppm) product and two chlorine-based products (1000 ppm available chlorine) were successful in reducing C. auris viability and delaying DSB regrowth. However, 50% of the products tested failed to decrease C. auris viability, 58% failed to prevent its transferability, and 75% did not delay biofilm regrowth. Using three different parameters to measure product efficacy provided a practical evaluation of product effectiveness against C. auris DSB. Although log10 reduction in viability is traditionally measured, transferability is an important factor to consider from an infection control and prevention point of view as it allows for determination of whether the surface is safe to touch by patients and hospital staff post-treatment. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)
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15 pages, 1869 KiB  
Article
In Vitro Efficacy of Antibiotics Released from Calcium Sulfate Bone Void Filler Beads
by Phillip A. Laycock, John J. Cooper, Robert P. Howlin, Craig Delury, Sean Aiken and Paul Stoodley
Materials 2018, 11(11), 2265; https://doi.org/10.3390/ma11112265 - 13 Nov 2018
Cited by 33 | Viewed by 6938
Abstract
15 different antibiotics were individually mixed with commercially available calcium sulfate bone void filler beads. The antibiotics were: amikacin, ceftriaxone, cefuroxime, ciprofloxacin, clindamycin, colistamethate sodium, daptomycin, gentamicin, imipenem/cilastatin, meropenem, nafcillin, rifampicin, teicoplanin, tobramycin and vancomycin. The efficacy of specific released antibiotics was validated [...] Read more.
15 different antibiotics were individually mixed with commercially available calcium sulfate bone void filler beads. The antibiotics were: amikacin, ceftriaxone, cefuroxime, ciprofloxacin, clindamycin, colistamethate sodium, daptomycin, gentamicin, imipenem/cilastatin, meropenem, nafcillin, rifampicin, teicoplanin, tobramycin and vancomycin. The efficacy of specific released antibiotics was validated by zone of inhibition (ZOI) testing using a modified Kirby–Bauer disk diffusion method against common periprosthetic joint infection pathogens. With a subset of experiments (daptomycin, rifampin, vancomycin alone and rifampin and vancomycin in combination), we investigated how release varied over 15 days using a repeated ZOI assay. We also tested the ability of these beads to kill biofilms formed by Staphylococcus epidermidis 35984, a prolific biofilm former. The results suggested that certain antibiotics could be combined and released from calcium sulfate with retained antibacterial efficacy. The daptomycin and rifampin plus vancomycin beads showed antimicrobial efficacy for the full 15 days of testing and vancomycin in combination with rifampin prevented resistant mutants. In the biofilm killing assay, all of the antibiotic combinations showed a significant reduction in biofilm bacteria after 24 h. The exposure time was an important factor in the amount of killing, and varied among the antibiotics. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)
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11 pages, 12988 KiB  
Article
The Effect of Negative Pressure Wound Therapy with and without Instillation on Mature Biofilms In Vitro
by Shamaila Tahir, Matthew Malone, Honghua Hu, Anand Deva and Karen Vickery
Materials 2018, 11(5), 811; https://doi.org/10.3390/ma11050811 - 16 May 2018
Cited by 29 | Viewed by 6212
Abstract
Background: To investigate the effect of negative pressure wound therapy (NPWT) with and without instillation (NPWTi) on in vitro mature biofilm. Methods: Mature biofilms of Pseudomonas aeruginosa and Staphylococcus aureus were grown under shear (130 rpm) on polycarbonate coupons in a CDC biofilm [...] Read more.
Background: To investigate the effect of negative pressure wound therapy (NPWT) with and without instillation (NPWTi) on in vitro mature biofilm. Methods: Mature biofilms of Pseudomonas aeruginosa and Staphylococcus aureus were grown under shear (130 rpm) on polycarbonate coupons in a CDC biofilm reactor for 3 days. Coupons containing biofilms were placed in a sterile petri dish and sealed using NPWT or NPWTi. Coupons were exposed to treatment for 24 h with NPWT alone or with instillation of: Povidone iodine solution (PVP-I) (10% w/v equivalent to 1% w/v available iodine, BETADINE®, Mundipharma, Singapore), surfactant based antimicrobial solution with polyhexamethylene biguanide (SBPHMB) (Prontosan®, B Braun Medical, Melsungen, Germany), Gentamicin 1 µg/mL (GM) (G1264 Sigma-Aldrich Pty Ltd., Castle Hill, Australia) Rifampicin 24 µg/mL (RF) (R3501 Sigma-Aldrich Pty Ltd., Castle Hill, Australia) and NaCl 0.9% (Baxter, Deerfield, IL, USA). Bacterial cell viability and biofilm architecture pre-and post-treatment were assessed using colony forming units (cfu), Live/Dead viability staining, confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Results: Significant reductions were obtained in S. aureus biofilm thickness (65%) and mass (47%) when treated with NPWTi as compared to NPWT only. NPWTi with instillation of SBPHMB, PVP-I and RF achieved between 2 and 8 log10 reductions against S. aureus biofilm (p < 0.05–0.001). Conversely, PVP-I and SBMO achieved a 3.5 log10 reduction against P. aeruginosa (p < 0.05). Conclusions: NPWT alters biofilm architecture by reducing biofilm thickness and mass, but this does not affect bacterial cell viability. NPWT with instillation of certain antimicrobials solutions may provide a further synergistic effect in reducing the number of viable biofilm microorganisms. Our in vitro model may be used for screening the effectiveness of antimicrobials used under instillation prior to animal or human studies. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)
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Review

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15 pages, 1017 KiB  
Review
Action of Antimicrobial Peptides against Bacterial Biofilms
by Muhammad Yasir, Mark Duncan Perry Willcox and Debarun Dutta
Materials 2018, 11(12), 2468; https://doi.org/10.3390/ma11122468 - 5 Dec 2018
Cited by 216 | Viewed by 11229
Abstract
Microbes are known to colonize surfaces and form biofilms. These biofilms are communities of microbes encased in a self-produced matrix that often contains polysaccharides, DNA and proteins. Antimicrobial peptides (AMPs) have been used to control the formation and to eradicate mature biofilms. Naturally [...] Read more.
Microbes are known to colonize surfaces and form biofilms. These biofilms are communities of microbes encased in a self-produced matrix that often contains polysaccharides, DNA and proteins. Antimicrobial peptides (AMPs) have been used to control the formation and to eradicate mature biofilms. Naturally occurring or synthetic antimicrobial peptides have been shown to prevent microbial colonization of surfaces, to kill bacteria in biofilms and to disrupt the biofilm structure. This review systemically analyzed published data since 1970 to summarize the possible anti-biofilm mechanisms of AMPs. One hundred and sixty-two published reports were initially selected for this review following searches using the criteria ‘antimicrobial peptide’ OR ‘peptide’ AND ‘mechanism of action’ AND ‘biofilm’ OR ‘antibiofilm’ in the databases PubMed; Scopus; Web of Science; MEDLINE; and Cochrane Library. Studies that investigated anti-biofilm activities without describing the possible mechanisms were removed from the analysis. A total of 17 original reports were included which have articulated the mechanism of antimicrobial action of AMPs against biofilms. The major anti-biofilm mechanisms of antimicrobial peptides are: (1) disruption or degradation of the membrane potential of biofilm embedded cells; (2) interruption of bacterial cell signaling systems; (3) degradation of the polysaccharide and biofilm matrix; (4) inhibition of the alarmone system to avoid the bacterial stringent response; (5) downregulation of genes responsible for biofilm formation and transportation of binding proteins. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)
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11 pages, 929 KiB  
Review
The A, B and C’s of Silicone Breast Implants: Anaplastic Large Cell Lymphoma, Biofilm and Capsular Contracture
by Maria Mempin, Honghua Hu, Durdana Chowdhury, Anand Deva and Karen Vickery
Materials 2018, 11(12), 2393; https://doi.org/10.3390/ma11122393 - 28 Nov 2018
Cited by 58 | Viewed by 8196
Abstract
Breast implantation either for cosmetic or reconstructive e purposes is one of the most common procedures performed in plastic surgery. Biofilm infection is hypothesised to be involved in the development of both capsular contracture and anaplastic large cell lymphoma (ALCL). Capsular contracture is [...] Read more.
Breast implantation either for cosmetic or reconstructive e purposes is one of the most common procedures performed in plastic surgery. Biofilm infection is hypothesised to be involved in the development of both capsular contracture and anaplastic large cell lymphoma (ALCL). Capsular contracture is one of the principal reasons for breast revision surgery and is characterised by the tightening and hardening of the capsule surrounding the implant, and ALCL is an indolent lymphoma found only in women with textured implants. We describe the types of breast implants available with regard to their surface characteristics of surface area and roughness and how this might contribute to capsular contracture and/or biofilm formation. The pathogenesis of capsular contracture is thought to be due to biofilm formation on the implant, which results in on-going inflammation. We describe the current research into breast implant associated ALCL and how implant properties may affect its pathogenesis, with ALCL only occurring in women with textured implants. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)
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17 pages, 2346 KiB  
Review
Oral Microbes, Biofilms and Their Role in Periodontal and Peri-Implant Diseases
by Jérôme Frédéric Lasserre, Michel Christian Brecx and Selena Toma
Materials 2018, 11(10), 1802; https://doi.org/10.3390/ma11101802 - 22 Sep 2018
Cited by 116 | Viewed by 13439
Abstract
Despite many discoveries over the past 20 years regarding the etio-pathogenesis of periodontal and peri-implant diseases, as well as significant advances in our understanding of microbial biofilms, the incidence of these pathologies still continues to rise. This review presents a general overview of [...] Read more.
Despite many discoveries over the past 20 years regarding the etio-pathogenesis of periodontal and peri-implant diseases, as well as significant advances in our understanding of microbial biofilms, the incidence of these pathologies still continues to rise. This review presents a general overview of the main protagonists and phenomena involved in oral health and disease. A special emphasis on the role of certain keystone pathogens in periodontitis and peri-implantitis is underlined. Their capacity to bring a dysregulation of the homeostasis with their host and the microbial biofilm lifestyle are also discussed. Finally, the current treatment principles of periodontitis and peri-implantitis are presented and their limits exposed. This leads to realize that new strategies must be developed and studied to overcome the shortcomings of existing approaches. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)
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27 pages, 1520 KiB  
Review
Targeting the Bacterial Protective Armour; Challenges and Novel Strategies in the Treatment of Microbial Biofilm
by Nor Fadhilah Kamaruzzaman, Li Peng Tan, Khairun Anisa Mat Yazid, Shamsaldeen Ibrahim Saeed, Ruhil Hayati Hamdan, Siew Shean Choong, Weng Kin Wong, Alexandru Chivu and Amanda Jane Gibson
Materials 2018, 11(9), 1705; https://doi.org/10.3390/ma11091705 - 13 Sep 2018
Cited by 39 | Viewed by 6769
Abstract
Infectious disease caused by pathogenic bacteria continues to be the primary challenge to humanity. Antimicrobial resistance and microbial biofilm formation in part, lead to treatment failures. The formation of biofilms by nosocomial pathogens such as Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa [...] Read more.
Infectious disease caused by pathogenic bacteria continues to be the primary challenge to humanity. Antimicrobial resistance and microbial biofilm formation in part, lead to treatment failures. The formation of biofilms by nosocomial pathogens such as Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa), and Klebsiella pneumoniae (K. pneumoniae) on medical devices and on the surfaces of infected sites bring additional hurdles to existing therapies. In this review, we discuss the challenges encountered by conventional treatment strategies in the clinic. We also provide updates on current on-going research related to the development of novel anti-biofilm technologies. We intend for this review to provide understanding to readers on the current problem in health-care settings and propose new ideas for new intervention strategies to reduce the burden related to microbial infections. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)
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Graphical abstract

20 pages, 618 KiB  
Review
Control of Biofilm Formation in Healthcare: Recent Advances Exploiting Quorum-Sensing Interference Strategies and Multidrug Efflux Pump Inhibitors
by Bindu Subhadra, Dong Ho Kim, Kyungho Woo, Surya Surendran and Chul Hee Choi
Materials 2018, 11(9), 1676; https://doi.org/10.3390/ma11091676 - 10 Sep 2018
Cited by 75 | Viewed by 8814
Abstract
Biofilm formation in healthcare is an issue of considerable concern, as it results in increased morbidity and mortality, imposing a significant financial burden on the healthcare system. Biofilms are highly resistant to conventional antimicrobial therapies and lead to persistent infections. Hence, there is [...] Read more.
Biofilm formation in healthcare is an issue of considerable concern, as it results in increased morbidity and mortality, imposing a significant financial burden on the healthcare system. Biofilms are highly resistant to conventional antimicrobial therapies and lead to persistent infections. Hence, there is a high demand for novel strategies other than conventional antibiotic therapies to control biofilm-based infections. There are two approaches which have been employed so far to control biofilm formation in healthcare settings: one is the development of biofilm inhibitors based on the understanding of the molecular mechanism of biofilm formation, and the other is to modify the biomaterials which are used in medical devices to prevent biofilm formation. This review will focus on the recent advances in anti-biofilm approaches by interrupting the quorum-sensing cellular communication system and the multidrug efflux pumps which play an important role in biofilm formation. Research efforts directed towards these promising strategies could eventually lead to the development of better anti-biofilm therapies than the conventional treatments. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)
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18 pages, 1937 KiB  
Review
Phenotypic Variation during Biofilm Formation: Implications for Anti-Biofilm Therapeutic Design
by Marie Beitelshees, Andrew Hill, Charles H. Jones and Blaine A. Pfeifer
Materials 2018, 11(7), 1086; https://doi.org/10.3390/ma11071086 - 26 Jun 2018
Cited by 53 | Viewed by 15662
Abstract
Various bacterial species cycle between growth phases and biofilm formation, of which the latter facilitates persistence in inhospitable environments. These phases can be generally characterized by one or more cellular phenotype(s), each with distinct virulence factor functionality. In addition, a variety of phenotypes [...] Read more.
Various bacterial species cycle between growth phases and biofilm formation, of which the latter facilitates persistence in inhospitable environments. These phases can be generally characterized by one or more cellular phenotype(s), each with distinct virulence factor functionality. In addition, a variety of phenotypes can often be observed within the phases themselves, which can be dependent on host conditions or the presence of nutrient and oxygen gradients within the biofilm itself (i.e., microenvironments). Currently, most anti-biofilm strategies have targeted a single phenotype; this approach has driven effective, yet incomplete, protection due to the lack of consideration of gene expression dynamics throughout the bacteria’s pathogenesis. As such, this article provides an overview of the distinct phenotypes found within each biofilm development phase and demonstrates the unique anti-biofilm solutions each phase offers. However, we conclude that a combinatorial approach must be taken to provide complete protection against biofilm forming bacterial and their resulting diseases. Full article
(This article belongs to the Special Issue Microbial Biofilms in Healthcare: Formation, Prevention and Treatment)
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