title: The efficacy of topical antibiofilm agents in a sheep model of rhinosinusitis.
abstract: BACKGROUND
  Biofilms have been shown to be resistant to conventional antibiotic treatment. This study uses a sheep biofilm model developed by our department to investigate several novel topical anti-biofilm treatments.
  
  
  METHODS
  Staphylococcal biofilms were grown in 54 sheep frontal sinuses over 8 days: Each sinus was randomized to (1) no intervention, (2) single mupirocin flush, (3) regular 12-hourly mupirocin flushes for 5 days, (4) Citric Acid Zwitterionic Surfactant (CAZS) via hydrodebrider, (5) gallium nitrate, (6) CAZS with gallium nitrate, (7) CAZS with mupirocin, and (8) saline regular flushes. Sheep were sacrificed and the sinus mucosa harvested 1 or 8 days after treatment to assess treatment and any biofilm regrowth. Confocal scanning laser microscopy was used to confirm the presence or absence of biofilms, and the extent of biofilm reduction was quantitated using fluorescent in situ hybridization and colony forming unit counts.
  
  
  RESULTS
  In the control sheep biofilm coverage averaged 31.7%. Saline and mupirocin b.d. washes for 5 days had 23% and 0.84% coverage, respectively, when harvested on day 8. A single mupirocin and gallium wash had 7.7% and 16.2% on day 1 and 5.88% and 16.0% on day 8. CAZS with hydrodebrider had 6.66% on day 1 but 21.95% on day 8 whereas CAZS with hydodebrider and gallium had 13.3% on day 8.
  
  
  CONCLUSIONS
  This study shows that regular treatment with mupirocin produced the most marked reduction in biofilm surface area coverage (0.84% and 1.25%) with sustained effects over the 8-day follow-up period.
authors.affiliation: Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
authors.forename: Tong
authors.initials: T
authors.lastname: Le
authors.forename: Alkis
authors.initials: A
authors.lastname: Psaltis
authors.forename: Lor Wai
authors.initials: LW
authors.lastname: Tan
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
mesh_terms: D000818:Animals; D018441:Biofilms / Q000187:drug effects*; D019343:Citric Acid / Q000008:administration & dosage* / Q000494:pharmacology; D003114:Colony-Forming Units Assay; D005708:Gallium / Q000008:administration & dosage*; D016712:Mupirocin / Q000008:administration & dosage*; D020135:Peptide Nucleic Acids / Q000032:analysis; D012220:Rhinitis / Q000382:microbiology*; D012756:Sheep; D012852:Sinusitis / Q000382:microbiology*; D013501:Surface-Active Agents / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D020135:Peptide Nucleic Acids; D013501:Surface-Active Agents; D019343:Citric Acid; D005708:Gallium; D016712:Mupirocin; C027235:gallium nitrate