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Evidence for microbial biofilms in cholesteatomas
Richard A Chole1, Brian T Faddis
1Department of Otolaryngology, Washington University School of Medicine, St Louis, MO 63110, USA. choler@msnotes.wustl.edu
Archives of Otolaryngology--Head & Neck Surgery
|October 9, 2002
Summary
Microbial biofilms, which are resistant to antibiotics, were found in human and experimental cholesteatomas. This discovery may explain the persistent infections associated with cholesteatomas.
Area of Science:
- Microbiology
- Otolaryngology
- Pathology
Background:
- Sessile bacteria in biofilms exhibit high resistance to antimicrobial agents.
- Biofilm-forming organisms are frequently cultured from experimentally induced cholesteatomas.
- The keratin matrix of cholesteatomas provides an ideal environment for biofilm formation.
Purpose of the Study:
- To investigate the presence of microbial biofilms within the keratin matrix of infected cholesteatomas.
Main Methods:
- Histomorphologic evaluation of 24 human and 22 experimental cholesteatomas using light and transmission electron microscopy.
- Human tissues were obtained during surgical cholesteatoma eradication.
- Experimental cholesteatomas in gerbils were induced or occurred spontaneously and harvested after several months.
Main Results:
- Bacteria were observed within keratin accumulations in 21/22 gerbil and 16/24 human cholesteatomas.
- These bacterial accumulations exhibited ultrastructural characteristics of amorphous polysaccharide biofilm matrix.
- Both Gram-positive and Gram-negative bacteria were identified.
Conclusions:
- Strong anatomic evidence supports the presence of bacterial biofilms in both experimental and human cholesteatomas.
- The existence of biofilms may account for the persistent and recurrent infections characteristic of cholesteatomas.
- Surgical eradication remains the primary effective treatment for infected cholesteatomas.