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Abstract
Biofilms are well-organized, complex microbial communities that are often highly resistant to antimicrobial agents and host defenses. Biofilms are often formed on the surfaces of surgical implants and indwelling catheters. Being extremely resistant to removal, biofilms, once formed, cause numerous complications and often result in persistent infections that require long-term hospitalization for treatment. Until now, preventive measures employing prophylactic antimicrobials that prohibit or restrict biofilm formation have been the only feasible, effective options available, with the constant concomitant threat of antimicrobial resistance. However, the development of chemical agents that specifically act upon the virulence of biofilms, rather than destroying the microorganisms or suppressing their growth, is a promising new approach. Such agents are highly desirable in that they might allow clinicians to prevent the development of antimicrobial resistance. Effective suppression of biofilm formation would dramatically change the way to treat infectious disease. In this literature review, the types of infections associated with biofilms and relevant therapeutic options that have been approved, in use, or under development to treat biofilm infections are discussed, along with novel approaches to biofilm control that may be applicable to the development of future anti-biofilm agents.
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Table 1.
Experimental approaches for the treatment or prophylaxis of biofilm-associated infections (3)
| Approach | Mode of action |
|---|---|
| Pilicides | Inhibits bacterial pilus biogenesis and surface attachment |
| RNA III inhibiting peptide (RIP) | Disrupts quorum-sensing pathways in staphylococci |
| Acyl-homoserine lactone mimetics | Disrupts quorum-sensing pathways |
| Furanones | Disrupts quorum-sensing pathways |
| Omigard (omiganan cationic peptide) | Topical gel for prophylaxis settings including CRBSIsa |
| Aganocides | Hypochlorous acid based compounds |
| Ceragenins | Depolarizes membrane potential; device coatings |
| Lysostaphin | Prevents or disrupts staphylococcal biofilms |
| Device coatings | Controlled release of antimicrobials from device surfaces |
| Hydrogel coatings | Controlled release of silver compounds |
| Surface acoustic waves | Disrupts device adhesion and colonization |
| Pulsed ultrasound | Enhances local release of antibiotic from cements |
| Electric direct current | Prevents or disrupts biofilm colonization |
| Intelligent implants | MEMSb-based release of antimicrobial(s) from reservoir |
| Gallium compounds | Antimicrobial potentiator via disruption of iron metabolism |
Table 2.
Biofilm-related activity of approved and investigational antimicrobial agents (3)
| Antimicrobial | Description | Biofilm-related activity |
|---|---|---|
| Dalbavancin | Lipoglycopeptide | CRBSIa treatment |
| Daptomycin | Lipopeptide | Biofilm reduction as lock solution in CVCb model |
| Right-sided endocarditis | ||
| Poor in vitro activity on adherent staphylococci | ||
| Linezolid | Oxazolidinone | Effective in combination with rifampin |
| Quinupristin-dalfopristin | Streptogramins | Bone and joint infections |
| Biofilm reduction as lock solution in CVC model | ||
| Telavancin | Lipoglycopeptide | Biofilm reduction in sorbarod model |
| Tigecycline | Glycylcycline | Biofilm reduction in silicone disk model |
| Effective in combination with rifampin | ||
| CBR-2092 | Rifamycin-quinolone hybrid | Optimized for biofilm activity |
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