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Efficacy of Cold Atmospheric Plasma Against Methicillin-Resistant Staphylococcus aureus Biofilms: A Systematic Review
Reyhaneh Shoorgashti1, Faezeh Dehghan Ghanatkaman2, Sana Baghizadeh2
1Researcher, Department of Oral Medicine, TeMS. C., Islamic Azad University, Tehran, Iran, azad.ac.ir.
Background:
Methicillin-resistant Staphylococcus aureus poses a serious threat to global health due to its resistance to conventional antibiotics and its ability to form resilient biofilms. Cold atmospheric plasma has emerged as a promising alternative for microbial biofilm inactivation.
Objective:
To systematically evaluate the in vitro efficacy of cold atmospheric plasma in disrupting or eradicating methicillin-resistant Staphylococcus aureus biofilms and to identify factors influencing treatment outcomes METHODS: A comprehensive search was conducted in five databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar) for in vitro studies published up to July 2025. Eligible studies assessed cold atmospheric plasma effects on methicillin-resistant Staphylococcus aureus biofilms. Data were extracted on study characteristics, cold atmospheric plasma device parameters, exposure conditions, and microbial outcomes. Risk of bias was assessed using a modified version of the ToxRTool.
Results:
Seventeen in vitro studies were included. Most studies originated from European countries (n = 10), with a peak in publications observed in 2021. Dielectric barrier discharge and plasma jets were the most common devices. Air-based plasmas were the most commonly used in 12 studies, followed by helium. All studies reported cold atmospheric plasma-mediated reductions in methicillin-resistant Staphylococcus aureus biofilm load, with log10 colony-forming unit reductions ranging from 1 to > 6, depending on exposure time, surface material, and device configuration. Several studies demonstrated near-complete biofilm eradication within minutes. Synergistic effects were observed when cold atmospheric plasma was combined with antibiotics.
Conclusions:
These findings suggest that cold atmospheric plasma may have potential as an adjunctive strategy for biofilm-related infection control, although further standardized and clinically relevant studies are needed.
Insights
Cold atmospheric plasma effectively reduces methicillin-resistant Staphylococcus aureus biofilms in vitro. This technology shows promise as an adjunctive treatment for biofilm infections, potentially overcoming antibiotic resistance.
Area of Science:
- Microbiology
- Biophysics
- Materials Science
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) presents a significant global health challenge due to antibiotic resistance and robust biofilm formation.
- Cold atmospheric plasma (CAP) is an emerging technology with potential for inactivating microbial biofilms.
Purpose of the Study:
- To systematically evaluate the in vitro efficacy of CAP in disrupting or eradicating MRSA biofilms.
- To identify factors influencing CAP treatment outcomes for MRSA biofilms.
Main Methods:
- A comprehensive literature search was performed across five major databases for in vitro studies up to July 2025.
- Studies assessing CAP effects on MRSA biofilms were included, with data extracted on device parameters, exposure conditions, and microbial outcomes.
- Risk of bias was assessed using a modified ToxRTool.
Main Results:
- Seventeen in vitro studies were included, predominantly using dielectric barrier discharge and plasma jet devices with air-based plasmas.
- All studies reported significant reductions in MRSA biofilm load (log10 CFU reductions from 1 to >6), influenced by exposure time, surface material, and device.
- Near-complete biofilm eradication was achieved within minutes in several studies, with observed synergistic effects when CAP was combined with antibiotics.
Conclusions:
- Cold atmospheric plasma demonstrates potential as an adjunctive strategy for controlling biofilm-related infections.
- Further standardized and clinically relevant research is necessary to fully establish CAP's role in infection control.
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