Biofilm Infections (eBook)

About the Editors: Thomas Bjarnsholt, Ph.D., Technical University of Denmark, Lyngby, Denmark Peter Oestrup Jensen, Dept. of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark Claus Moser, Ph.D., Dept. of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark Niels Hoeby, Dept. of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark

Preface 5
Contents 8
Contributors 10
1 Introduction to Biofilms 14
1.1 Introduction 14
1.2 The Development of the Biofilm Era 14
1.3 What Is a Biofilm 15
1.4 How Biofilms Are Formed 17
1.5 Who Forms Biofilm and Where Are They Found 20
1.6 What Is the Implication of Biofilms 20
References 20
2 Chronic Wound Colonization, Infection, and Biofilms 23
2.1 Introduction 23
2.2 Types of Chronic Wounds 24
2.2.1 Venous Leg Ulcers 24
2.2.2 Pressure Ulcers 25
2.2.3 Diabetic Ulcers 26
2.2.4 Neuropathic Ulcers 26
2.2.5 Traumatic Ulcers 26
2.2.6 Arterial Ulcers 26
2.3 Wound Treatment 26
2.3.1 Local Wound Treatment 27
2.3.2 Debridement 28
2.4 Bacteria and Wounds 29
2.5 Immune Response to Biofilms 31
2.6 Biofilm Formation in Acute Wounds: In Vivo Models 31
2.7 Evidence of Biofilms in Human Wounds 32
2.8 Clinical Implications of Chronic Wound Biofilm 32
2.9 Future Aspects 33
References 34
3 The Relation of Biofilms to Chronic Otitis MediaINTbreak and Other Ear-Related Chronic Infections
3.1 Introduction 37
3.2 Otitis Media 38
3.2.1 Experimental Studies 38
3.2.2 Clinical Studies 39
3.3 Tonsils and Adenoids 41
3.3.1 Experimental Studies 41
3.3.2 Clinical Studies 42
3.4 Medical Devices in Otorhinolaryngology 42
3.5 Other Biofilm Findings in Otolaryngologic Diseases 43
3.6 Future Implications 44
References 44
4 Human Oral Bacterial Biofilms: Composition, Dynamics,INTbreak and Pathogenesis
4.1 Introduction 47
4.2 Composition of Oral Biofilms 48
4.3 Spatiotemporal Development of Oral Biofilms 50
4.4 Signaling Between Bacteria Within Biofilms 55
4.5 Dental Caries 57
4.5.1 Current Concepts of Caries 57
4.5.2 Caries Lesion Dynamics 59
4.5.3 From Specific Infection to Ecological Imbalance 61
4.6 Periodontal Diseases 63
4.6.1 Mechanisms of Bacterial Pathogenesis 65
4.6.2 Clinical Parameters of Periodontal Diseases 65
4.6.3 Epidemiology of Periodontal Diseases 66
4.6.4 Periodontal Therapy 66
4.6.5 Refractory Periodontitis 68
4.7 A Role for Oral Biofilms in Systemic Infection? 69
4.8 Immunobiology of Biofilm/Tissue Interaction 70
4.9 Conclusion 73
References 73
5 Implant-Associated Infection 81
5.1 Introduction 81
5.1.1 Epidemiology of Implant-Associated Infection 81
5.1.2 Overview of Selected Permanent Implants Used in Medicine 81
5.1.2.1 Intravascular Devices 82
5.1.2.2 Intracorporeal Extravascular Devices 82
5.1.2.3 Intracorporeal Devices with Direct Extra-corporeal Connection 83
5.1.2.4 Extracorporeal Devices 84
5.2 Pathogenesis 84
5.2.1 Route of Infection 84
5.2.2 Mechanisms of Persistence 84
5.2.2.1 Microbiology of Implant-Associated Infections 84
5.2.2.2 Intracellular Persistence 85
5.2.2.3 Microbial Biofilms on Implants 85
5.2.3 Host Defense Around Implants 86
5.3 Selected Implant-Associated Infections 87
5.3.1 Prosthetic Joint Associated 87
5.3.2 Mammary Implants 90
5.3.3 Cardiac Pacemakers and Cardioverter-Defibrillators (ICD) 90
5.3.4 Vascular Prostheses 91
5.3.5 Dental Implants 93
5.3.6 Peritoneal Dialysis Catheters 93
5.4 Prevention 94
5.4.1 Perioperative Antimicrobial Prophylaxis 94
5.4.2 Prophylaxis of Late Hematogenous Infections in Patients with Orthopedic Devices 95
5.5 General Principles of Antimicrobial Therapy 95
5.6 Outlook 97
References 97
6 The Role of Bacterial Biofilms in Infections of Catheters and Shunts 103
6.1 Catheters and Biofilm 103
6.1.1 What Are Catheters and Why Are They Used? 103
6.1.2 Catheter Infection 104
6.1.3 Clinical Evidence for Infections Associated with Catheters 106
6.1.4 Involvement of Biofilms in Catheter Infections 108
6.1.5 Biofilm and Microbial Diversity in Catheters 109
6.1.6 New Potentials in Diagnosis 110
6.1.7 Prevention and Treatment 114
6.2 Conclusion 116
References 117
7 Osteomyelitis 122
7.1 Introduction 122
7.1.1 Anatomy and Function of Bone 122
7.2 Types and Pathogenesis of Osteomyelitis 125
7.2.1 Hematogenous Osteomyelitis 125
7.2.2 Contiguous Focus Osteomyelitis 127
7.3 Etiology of Bacterial Osteomyelitis 127
7.3.1 Staphylococcus spp. 129
7.3.1.1 Virulence 129
7.3.1.2 Adherence 130
7.3.1.3 Staphylococcal Biofilm 132
7.4 Properties of the Host Immune Response in the Development of Osteomyelitis 137
7.5 Diagnosis, Treatment and Prevention of Osteomyelitis 139
7.5.1 Diagnosis 139
7.5.2 Antimicrobial Chemotherapy 140
7.5.3 Novel Treatments 140
7.5.4 Prevention 141
7.6 Conclusion 143
References 143
8 The Importance of Biofilms in Chronic Rhinosinusitis 149
8.1 Introduction 149
8.1.1 Background 149
8.1.2 Biofilms Defined 150
8.1.3 Biofilms and Disease 151
8.1.4 Head and Neck Biofilm-Related Diseases 152
8.1.5 Factors Contributing to Biofilm Antibiotic Resistance 153
8.1.5.1 Antibiotic Resistance 153
8.2 Biofilms and Chronic Rhinosinusitis: What Is the Evidence? 155
8.3 Etiology of CRS 157
8.4 Evidence that Chronic Rhinosinusitis Is a Polymicrobial Disease 158
8.5 Biofilms and CRS Making the Case for a Paradigm Shift 159
8.6 Other Factors Contributing to Development of Biofilm on Rhinosinus Mucosa 162
8.7 Pathophysiology of the Biofilm Communities 163
8.8 Current Paradigms in the Medical and Surgical Management of CRS 163
8.9 Treatments 164
8.10 Scientific Challenge/Importance of CRS Challenge to an Existing Paradigm 166
8.11 Conclusions 166
References 167
9 Helicobacter pylori and Biofilm Formation 171
9.1 Introduction 171
9.2 Biofilm Formation by H. pylori 172
9.2.1 Environmental 172
9.2.2 Dental Plaque 172
9.2.3 Gastric Mucosa 173
9.3 Discussion 174
References 175
10 Pseudomonas aeruginosa Biofilms in the Lungs of Cystic Fibrosis Patients 177
10.1 Cystic Fibrosis 177
10.2 Survival of P. aeruginosa by Adaptation to the Inflammatory Defense System The Fundamental Biofilm Strategy 178
10.3 The Conductive and the Respiratory Zones of the Lungs 179
10.3.1 Survival of P. aeruginosa by Adaptation to the Respiratory Zone of the Lungs 181
10.3.2 Survival of P. aeruginosa by Adaptation to the Conductive Zone of the Lungs 184
10.4 Survival of P. aeruginosa Biofilms by Adaptation to the Antibiotic Therapy 185
10.5 Evolutionary Implications of the Adaptability of P. aeeruginosa 187
10.6 Clinical Consequences of P. aeruginosa Biofilms in CF Lungs 187
10.7 Prophylaxis and Treatment of P. aeruginosa Biofilms in CF Lungs 188
References 189
11 Innate Immune Response to Infectious Biofilms 195
11.1 Introduction 195
11.2 Definition 196
11.3 Recognition of Biofilms 196
11.3.1 Secreted PRRs 196
11.3.2 Complement Receptors 197
11.3.3 Membrane Bound Receptors 198
11.3.4 Toll-Like Receptors (TLRs) 198
11.4 The Innate Response to Biofilms 201
11.5 Conclusion -- Significance of the Innate Immune Response for Biofilm Formation 204
References 205
12 Adaptive Immune Responses and Biofilm Infections 211
12.1 Introduction 211
12.2 Components of the Adaptive Immune Response 212
12.3 Activation of the Adaptive Immune Response the Dendritic Cells 213
12.4 Activation of the Adaptive Immune Response Diagnostic Tool 214
12.5 Antibody Responses and Biofilm Infections 215
12.6 Marker for Appropriate Treatment 217
12.7 Types of Adaptive Immune Response 217
12.8 Adaptive Immune Response and CF 219
12.9 Conclusion 222
References 222
13 Antibiotic Tolerance and Resistance in Biofilms 225
13.1 Introduction 225
13.2 Antibiotic Tolerance in Biofilms 225
13.2.1 Restricted Penetration of Antimicrobials 226
13.2.2 Differential Physiological Activity 226
13.2.3 Persisters and Phenotypic Variants 228
13.2.4 Specific Tolerance Mechanisms Connected to the Biofilm Mode of Growth 229
13.2.5 Specific Tolerance Mechanisms Not Connected to the Biofilm Mode of Growth 230
13.3 Antibiotic Resistance in Biofilms 232
13.4 Prevention of Tolerance and Resistance in Biofilms in Clinical Settings 234
13.5 Conclusions 235
References 235
14 Novel and Future Treatment Strategies 240
14.1 Introduction 240
14.2 Prevention of Biofilm Formation 242
14.2.1 Antibodies 242
14.2.2 Pilicides 242
14.3 Removal/Killing of Biofilm 243
14.3.1 Silver 243
14.3.2 Enzymes 244
14.3.2.1 Dispersin B 244
14.3.2.2 DNase 244
14.3.3 Bacteriophages 245
14.3.4 Electrical Currents 245
14.3.5 Dispersal Signals 245
14.4 Weakening of Biofilm 246
14.4.1 Quorum-Sensing Inhibitors 246
14.4.2 Inhibition of Type III Secretion 249
14.4.3 C-Di-GMP 249
14.5 Surface Coatings 250
14.6 Future Perspectives 252
References 252
15 Different Methods for Culturing Biofilms In Vitro 259
15.1 Introduction 259
15.2 Static Microtiter Plate Assays 259
15.2.1 Basic Microtiter Dish Biofilm Assay Protocol 260
15.3 Flow Cells 261
15.3.1 Basic Flow Cell Protocol 263
15.3.2 Sample Protocol 263
15.4 Tube Biofilms 264
15.4.1 Basic Protocol for Growing Tube Biofilms 264
15.5 Colony Biofilms 265
15.5.1 Colony Biofilm Preparation Protocol 266
15.6 Biofilm Growth on Peg Lids 267
15.6.1 Basic Protocol 269
15.7 Rotating Disk and Concentric Cylinder Reactors 269
15.7.1 The Basic Protocol for the RDR (The Protocol for the CCR Is Well Described in Willcock et al. 2000 ) 271
15.8 Summary 272
References 272
16 In Vivo Models of Biofilm Infection 275
16.1 Introduction Diversity of In Vivo Biofilm Models 275
16.2 In Vivo Biofilm Models 280
16.2.1 Periodontal Biofilm Models 280
16.2.2 Foreign-Body Models of Biofilm Infection 281
16.2.2.1 Urinary Tract Infection Models 281
16.2.2.2 Other Foreign Body Models 282
16.2.2.3 Osteomyelitis Models 282
16.2.3 In Vivo Models of Biofilms Adhered to Host Mucosa or Soft-Tissue 283
16.2.3.1 Lung Infection Models 283
16.2.3.2 Endocarditis Models 284
16.2.3.3 Keratitis Models 284
16.2.3.4 In Vivo Models of Otitis Media and Sinusitis 285
16.2.3.5 Wound Models 285
16.3 In Vivo Biofilm Detection Methods 286
16.3.1 Microscopic Methods for Imaging Biofilms Formed In Vivo 288
16.3.1.1 Light Microscopy of Stained Specimens 288
16.3.1.2 High Resolution of Biofilm/Host Interactions with Electron Microscopy 290
16.3.1.3 Using Fluorescent Signals to Image Bacteria and Hydrated EPS with Epifluorescence and Confocal Laser Scanning Microscopy 290
16.3.1.4 Additional Fluorescence-Based Detection Methods 291
16.3.2 Non-microscopic Methods of Detection 292
16.3.2.1 Enumeration of Bacteria by Determining Colony Forming Units 292
16.3.2.2 Whole-Animal Imaging 293
16.3.2.3 Detection of Biofilms by Biofilm-Specific Antibodies 293
16.4 Concluding Remarks 293
References 294
17 Summary and Perspectives 299
17.1 Summary 299
17.1.1 Diagnostic Problems 300
17.1.2 Treatment Problems 301
17.1.3 Prevention 301
17.1.4 Experimental 302
Index 303