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biofilm cells grow only very poorly, when they are recovered from surfaces and dispersed on agar plates, so we
know that many culture negative presentations are actually low grade biofilm infections. We know that acute
exacerbations may respond to antibiotic therapy, but that
true biofilm cells are not killed, so we know that colonized
devices and affected tissues must be removed before device-related infections can be resolved. We know that both
ultrasonic energy and DC electric fields can reduce the
resistance of biofilm cells to that of planktonic cells, so we
can invoke their use in the treatment of chronic infections.
We know that cells in biofilms express a profoundly different phenotype from that expressed by planktonic cells, so
we are now targeting biofilm-specific genes with new
agents that will kill these matrix-enclosed organisms. We
have discovered that the process of biofilm formation is
controlled by simple chemical signals, and that analogues
of these compounds can be used to inhibit biofilm formation, and even to induce the detachment of preformed
biofilms from surfaces. The application of these concepts
to the problem of device-related infections shows great
promise, and we propose clinical testing of several antibiofilm strategies.
References
Cook G, Costerton JW, Darouiche RO: Direct confocal microscopy
studies of the bacterial colonization in vitro of a silver-coated heart
valve sewing cuff. Int J Antimicrobial Agents 13:169, 2000
Costerton JW, Stewart PS, Greenberg EP: Bacterial biofilms: A common cause of persistent infections. Science 284:1318, 1999
Costerton JW, Stewart PS: Battling Biofilms. Scientific American
285:75, 2001