Microorganisms in a sessile phase exhibit a distinct phenotype with respect to gene transcription, growth rate and ability to resist antimicrobial or
Table 1. Medical devices associated with biofilm infections
Central venous catheters Pacemakers
Arterial catheters Spinal implants
Pulmonary artery catheters Penile implants
Umbilical catheters Breast implants
Peritoneal dialysis catheters Orthopedic prostheses
Urinary catheters Cochlear implants
Nasogastric tubes Neurosurgical stimulators
Gastrostomy tubes Middle ear implants
Enteral feeding tubes Dental implants
Endotracheal tubes Voice prostheses
Tracheostomy tubes Implanted monitors
Ureteral stents Mechanical heart valves Fracture fixation devices Joint prostheses
Vascular grafts and assist devices Intrauterine devices Intraocular and contact lenses Coronary stents Intracranial pressure devices Suture material disinfection treatments from planktonic (freely suspended) organisms and therefore pose a public health problem.
Biofilm, as a matter of fact, is involved in acute and chronic infectious diseases and has been described in human and experimental pathology such as native valve endocarditis, otitis media, bacterial chronic rhinosinusitis, COPD, chronic urinary infections, bacterial prostatitis, osteomyelitis, dental caries, biliary tract infections, Legionnaire's disease and amyloidosis.
Modern medicine is largely based on medical devices support and their surfaces, even if from many different materials, represent a possible site of microorganism adhesion with biofilm formation. Table 1 reports medical devices documented to be biofilm contaminated with consequent clinical sequelae. When a medical device is microbiologically contaminated, biofilm formation depends on several variables, bacteria and non-bacteria dependent. Main variables are: type and number of microorganism, type and physicochem-ical characteristics of surface, flow rate, components (nutrients, antimicrobials) and temperature of liquid through the device. The rapid growing of scientific knowledge on the matter is documented by an increasing number of published reviews dealing with biofilm and related problems [4-11].
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