Chapter 16 : Biofilms and Hospital-Acquired Infections

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Many hospital-acquired infections (HAIs) are due to biofilms. Characterizing and identifying biofilm infections are the first steps toward their eradication. This will enable novel strategies to be devised aimed toward the management and control of biofilms. The main nosocomial infections caused by biofilms are bacteremia, urinary tract infections (UTI), and pneumonia. The majority of biofilm-related infections occur in medical and surgical specialties that utilize the greatest number of indwelling devices, e.g., dialysis catheters in renal medicine, ''long lines'' in oncology, prosthetic joints in orthopedic surgery, arterial and venous catheters, and the plethora of lines, urinary catheters, and tracheal tubes found in ICU patients. In particular, central venous catheters (CVCs) are one of the leading causes of nosocomial infection and primary episodes of bacteremia, and urinary catheters are the most frequently colonized devices, albeit usually with less serious sequelae. A mouse model was used to investigate skin graft biofilms. The results showed a decrease in graft associated biofilm that could be isolated from the wound after longer durations of infection. In this study, the researchers attribute this to low nutrients surrounding the biofilm and to host immune response. Biofilm-related infections will inevitably increase with the numbers of indwelling devices used unless more effective strategies can be devised to prevent their colonization by microorganisms. Such strategies could include novel applications of antibiotics and more prophylactic antibiotic use with inherent risks of generating resistant organisms.

Citation: Ebrey R, Shea Hamilton M, Cairns G, Lappin-Scott H. 2004. Biofilms and Hospital-Acquired Infections, p 294-313. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch16
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Image of FIGURE 1

Electron micrograph showing MRSA attached to the surface of urinary catheter (Courtesy of S. M. Jones).

Citation: Ebrey R, Shea Hamilton M, Cairns G, Lappin-Scott H. 2004. Biofilms and Hospital-Acquired Infections, p 294-313. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch16
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Image of FIGURE 2

Electron micrograph showing VRE attached to the surface of urinary catheter (Courtesy of S. M. Jones).

Citation: Ebrey R, Shea Hamilton M, Cairns G, Lappin-Scott H. 2004. Biofilms and Hospital-Acquired Infections, p 294-313. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch16
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Image of FIGURE 3

Examples of multilumen intravascular catheters.

Citation: Ebrey R, Shea Hamilton M, Cairns G, Lappin-Scott H. 2004. Biofilms and Hospital-Acquired Infections, p 294-313. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch16
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Image of FIGURE 4

Micrographs of (a) and (b) biofilm stained using hexidium iodide and visualized under epifluorescence (Phillips, Brading, and Lappin-Scott, unpublished data).

Citation: Ebrey R, Shea Hamilton M, Cairns G, Lappin-Scott H. 2004. Biofilms and Hospital-Acquired Infections, p 294-313. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch16
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Summary of the natural history of classical and biofilm-related infections

Citation: Ebrey R, Shea Hamilton M, Cairns G, Lappin-Scott H. 2004. Biofilms and Hospital-Acquired Infections, p 294-313. In Ghannoum M, O'Toole G (ed), Microbial Biofilms. ASM Press, Washington, DC. doi: 10.1128/9781555817718.ch16

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