How biofilm changes our understanding of cleaning and disinfection

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Abstract

Biofilms are ubiquitous in healthcare settings. By nature, biofilms are less susceptible to antimicrobials and are associated with healthcare-associated infections (HAI). Resistance of biofilm to antimicrobials is multifactorial with the presence of a matrix composed of extracellular polymeric substances and eDNA, being a major contributing factor. The usual multispecies composition of environmental biofilms can also impact on antimicrobial efficacy. In healthcare settings, two main types of biofilms are present: hydrated biofilms, for example, in drains and parts of some medical devices and equipment, and environmental dry biofilms (DSB) on surfaces and possibly in medical devices. Biofilms act as a reservoir for pathogens including multi-drug resistant organisms and their elimination requires different approaches. The control of hydrated (drain) biofilms should be informed by a reduction or elimination of microbial bioburden together with measuring biofilm regrowth time. The control of DSB should be measured by a combination of a reduction or elimination in microbial bioburden on surfaces together with a decrease in bacterial transfer post-intervention. Failure to control biofilms increases the risk for HAI, but biofilms are not solely responsible for disinfection failure or shortcoming. The limited number of standardised biofilm efficacy tests is a hindrance for end users and manufacturers, whilst in Europe there are no approved standard protocols. Education of stakeholders about biofilms and ad hoc efficacy tests, often academic in nature, is thus paramount, to achieve a better control of biofilms in healthcare settings.

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Biofilms--matrix-enclosed microbial accretions that adhere to biological or non-biological surfaces--represent a significant and incompletely understood mode of growth for bacteria. Biofilm formation appears early in the fossil record (approximately 3.25 billion years ago) and is common throughout a diverse range of organisms in both the Archaea and Bacteria lineages, including the 'living fossils' in the most deeply dividing branches of the phylogenetic tree. It is evident that biofilm formation is an ancient and integral component of the prokaryotic life cycle, and is a key factor for survival in diverse environments. Recent advances show that biofilms are structurally complex, dynamic systems with attributes of both primordial multicellular organisms and multifaceted ecosystems. Biofilm formation represents a protected mode of growth that allows cells to survive in hostile environments and also disperse to colonize new niches. The implications of these survival and propagative mechanisms in the context of both the natural environment and infectious diseases are discussed in this review.

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Rodney M. Donlan (2002)

Microorganisms attach to surfaces and develop biofilms. Biofilm-associated cells can be differentiated from their suspended counterparts by generation of an extracellular polymeric substance (EPS) matrix, reduced growth rates, and the up- and down- regulation of specific genes. Attachment is a complex process regulated by diverse characteristics of the growth medium, substratum, and cell surface. An established biofilm structure comprises microbial cells and EPS, has a defined architecture, and provides an optimal environment for the exchange of genetic material between cells. Cells may also communicate via quorum sensing, which may in turn affect biofilm processes such as detachment. Biofilms have great importance for public health because of their role in certain infectious diseases and importance in a variety of device-related infections. A greater understanding of biofilm processes should lead to novel, effective control strategies for biofilm control and a resulting improvement in patient management.

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A biofilm is a structured consortium of bacteria embedded in a self-produced polymer matrix consisting of polysaccharide, protein and DNA. Bacterial biofilms cause chronic infections because they show increased tolerance to antibiotics and disinfectant chemicals as well as resisting phagocytosis and other components of the body's defence system. The persistence of, for example, staphylococcal infections related to foreign bodies is due to biofilm formation. Likewise, chronic Pseudomonas aeruginosa lung infection in cystic fibrosis patients is caused by biofilm-growing mucoid strains. Characteristically, gradients of nutrients and oxygen exist from the top to the bottom of biofilms and these gradients are associated with decreased bacterial metabolic activity and increased doubling times of the bacterial cells; it is these more or less dormant cells that are responsible for some of the tolerance to antibiotics. Biofilm growth is associated with an increased level of mutations as well as with quorum-sensing-regulated mechanisms. Conventional resistance mechanisms such as chromosomal beta-lactamase, upregulated efflux pumps and mutations in antibiotic target molecules in bacteria also contribute to the survival of biofilms. Biofilms can be prevented by early aggressive antibiotic prophylaxis or therapy and they can be treated by chronic suppressive therapy. A promising strategy may be the use of enzymes that can dissolve the biofilm matrix (e.g. DNase and alginate lyase) as well as quorum-sensing inhibitors that increase biofilm susceptibility to antibiotics. (c) 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

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Author and article information

Contributors

Jean-Yves Maillard: maillardj@cardiff.ac.uk

Bio :

Jean-Yves Maillard

is a Professor of Pharmaceutical Microbiology at the School of Pharmacy & Pharmaceutical Sciences, Cardiff University, Wales. His field of expertise concerns antimicrobials, particularly biocides; their activity, mechanisms of action, and emerging antimicrobial resistance and cross-resistance. He has a particular interest in sporicides, complex biofilms, dry surface biofilms, biocidal product design and efficacy including antimicrobial wipes. His expertise also concerns the design of efficacy test protocols that mimic real life applications. Over the years, he has been the recipient of multiple awards including innovation and engagement ones. He has published over 180 peer-reviewed articles, 20 book chapters and 3 books and over 150 refereed conference communications. He is a member of the editorial board for the Journal of Antimicrobial Chemotherapy. He has contributed to several working groups for the development of novel protocols, including Clostridium difficile efficacy standard test, pre-wetted wipe standard test and antimicrobial surface test. He is the Chair of the British Standard Institute (BSI) CH/216/0-/01 group on antimicrobial hard surface, a member of the TC330 committee on antimicrobial hard surface, Chair of the TC330 working sub-group on bacterial resistance to antimicrobial surfaces, a steering group member of the CEN working group on bacterial biocide resistance testing and of the BSI working group on biofilm testing. He is a steering group member of the Safer Disinfectant Network which he helped to establish in 2018. He is also a member of the international scientific expert group of Clean Hospitals ( www.CleanHospitals.com).

Isabella Centeleghe:

Bio :

Isabella Centeleghe

is a Postdoctoral Research at the School of Pharmacy & Pharmaceutical Sciences, Cardiff University, Wales. She completed her PhD in 2022 looking at the resistance of dry surface biofilm to disinfection. Her postdoctoral project is focused on the dissemination of antimicrobial resistance in drain biofilms from One Health settings. Not only does she perform lab work but some of her research has involved both interviews and surveys of healthcare professionals to understand their knowledge of cleaning and disinfection. She is a champion for the Microbiology Society and is a STEM ambassador, helping the next generation learn about science.

Journal

Journal ID (nlm-ta): Antimicrob Resist Infect Control

Journal ID (iso-abbrev): Antimicrob Resist Infect Control

Title: Antimicrobial Resistance and Infection Control

Publisher: BioMed Central (London )

ISSN (Electronic): 2047-2994

Publication date (Electronic): 7 September 2023

Publication date PMC-release: 7 September 2023

Publication date Collection: 2023

Volume: 12

Electronic Location Identifier: 95

Affiliations

GRID grid.5600.3, ISNI 0000 0001 0807 5670, School of Pharmacy and Pharmaceutical Sciences, , Cardiff University, ; Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB Wales, UK

Article

Publisher ID: 1290

DOI: 10.1186/s13756-023-01290-4

PMC ID: 10483709

PubMed ID: 37679831

SO-VID: bd0a4727-defc-4a68-854c-46dc6e0ad863

License:

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