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Antibiotic treatment of biofilm infections
Oana Ciofu1, Estrella Rojo-Molinero2, María D Macià2
1Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark.
Abstract:
Bacterial biofilms are associated with a wide range of infections, from those related to exogenous devices, such as catheters or prosthetic joints, to chronic tissue infections such as those occurring in the lungs of cystic fibrosis patients. Biofilms are recalcitrant to antibiotic treatment due to multiple tolerance mechanisms (phenotypic resistance). This causes persistence of biofilm infections in spite of antibiotic exposure which predisposes to antibiotic resistance development (genetic resistance). Understanding the interplay between phenotypic and genetic resistance mechanisms acting on biofilms, as well as appreciating the diversity of environmental conditions of biofilm infections which influence the effect of antibiotics are required in order to optimize the antibiotic treatment of biofilm infections. Here, we review the current knowledge on phenotypic and genetic resistance in biofilms and describe the potential strategies for the antibiotic treatment of biofilm infections. Of note is the optimization of PK/PD parameters in biofilms, high-dose topical treatments, combined and sequential/alternate therapies or the use antibiotic adjuvants.
Insights
Bacterial biofilms cause persistent infections due to phenotypic and genetic resistance, complicating antibiotic treatment. Optimizing therapies by understanding these mechanisms and environmental factors is crucial for effective biofilm infection management.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Bacterial biofilms are implicated in diverse infections, including device-related and chronic conditions like cystic fibrosis lung infections.
- Biofilms exhibit phenotypic resistance, leading to treatment persistence and fostering genetic resistance development.
- Environmental factors significantly impact antibiotic efficacy against biofilms.
Purpose of the Study:
- To review current knowledge on phenotypic and genetic resistance in bacterial biofilms.
- To explore strategies for optimizing antibiotic treatment of biofilm infections.
- To highlight the importance of understanding the interplay between resistance mechanisms and environmental conditions.
Main Methods:
- Literature review of scientific publications on bacterial biofilms, antibiotic resistance, and treatment strategies.
- Analysis of phenotypic and genetic resistance mechanisms within biofilms.
- Synthesis of current understanding of environmental influences on biofilm infections.
Main Results:
- Biofilms possess multiple tolerance mechanisms contributing to recalcitrance to antibiotics (phenotypic resistance).
- Antibiotic exposure in biofilms can lead to the development of genetic resistance.
- Effective treatment requires understanding the interaction between resistance types and environmental variables.
Conclusions:
- Optimizing pharmacokinetic/pharmacodynamic (PK/PD) parameters is essential for biofilm treatment.
- Strategies include high-dose topical treatments, combination therapies, and antibiotic adjuvants.
- A comprehensive understanding of biofilm resistance is key to improving therapeutic outcomes.