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Chapter 15 : Biofilms and Implant Infections

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Abstract:

Biofilms are a primitive type of developmental biology in which spatial organization of the cells within the matrix optimizes the utilization of the nutritional resources available; they incorporate an immobilized enzyme system in which the millieu and the enzyme activities are constantly changing and evolving to the appropriate steady state. The biomaterial properties affecting initial adhesion range from chemical properties to hydrophobicity to surface roughness. Since these biomedical devices are usually surrounded by body fluids, such as urine, blood, saliva, and synovial fluid, their surfaces often acquire a glycoproteinaceous conditioning film following implantation. For short-term urinary catheterization, up to 50% of the patients develop an associated urinary tract infection (UTI), but almost all patients undergoing long-term catheterization ultimately became infected with associated device colonization organisms. Several groups have demonstrated that the biofilm lifestyle leads to dramatically increased levels of resistance to the most commonly used antifungal agents, fluconazole and amphotericin B. Different mechanisms may be responsible for the intrinsic resistance of biofilms. These include: (i) effects of the biofilm matrix on penetration of drugs, (ii) decreased growth rate and nutrient limitation, (iii) expression of resistance genes, particularly those encoding efflux pumps, and (iv) presence of “persister” cells. It has been reported that biofilms are up to 4,000 times more resistant to fluconazole compared with planktonic, free-floating cells.

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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FIGURE 1

Microbial life forms. Courtesy of John G. Thomas, West Virginia University. LAG, lag phase;LOG, logarithmic growth phase.

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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Image of FIGURE 2
FIGURE 2

Biofilm development. Eight factors that are involved in biofilm architecture. Shading indicates most important factors.

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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Image of FIGURE 3
FIGURE 3

FIGURE 3 Routes of access for microorganisms. Figure courtesy of Peter Kite

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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Image of FIGURE 4
FIGURE 4

FIGURE 4 Pathophysiology of VAP and significance of luminal growth. ET, endotracheal tube. NG, nasogastric tube. Courtesy of John G. Thomas, West Virginia University.

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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Image of FIGURE 5
FIGURE 5

Luminal biofilm examples. Clinical comparison of planktonic versus sessile life forms. BSI, bloodstream isolate; GNR, gram-negative rod; MBEC, minimal biofilm elimination concentration. Courtesy of John G. Thomas, West Virginia University.

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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FIGURE 6

Biofilm (sessile) antiinfective characteristics. Courtesy of John Thomas, West Virginia University.

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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Tables

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TABLE 1

Characteristics of biofilms

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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TABLE 2

Clinical consequences

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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TABLE 3

Diversity of IMDs

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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TABLE 4

TABLE 4 Chemical products used in medical devices

TABLE 4 Chemical products used in medical devices

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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TABLE 5

Factors that are involved in biofilm stability in monospecies versus mixed species

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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TABLE 6

Device-related infections in the United States

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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TABLE 7

Organisms commonly forming biofilms arranged by IMD

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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TABLE 8

Infectious disease DRGs

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15
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TABLE 9

Combinations used in biofilm treatment

Citation: Thomas J, Ramage G, Lopez-Ribot J. 2004. Biofilms and Implant Infections, p 269-293. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch15

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