Biofilm: basic principles, pathophysiology, and implications for clinicians.
BACKGROUND
Biofilm is ubiquitous throughout nature including bacteria, fungi, protozoa-associated bacteriophages, and viruses. Whereas it is adaptive for certain organisms in a variety of environments, biofilm is important in understanding and treating clinically relevant infections, especially those involving temporarily or durably implanted devices.


METHODS
Review of pertinent English-language literature.


RESULTS
Important advances have been made in understanding biofilm structure and function that elucidate key events in biofilm-based infectious processes. Wounds, oral cavity, urinary tract, gastrointestinal tract, and device-associated biofilm-based infections dominate clinically relevant infections. Criteria have been articulated to detect and diagnose biofilm-associated infection but there are hurdles to overcome to treat effectively such infection. Native biofilm resistance mechanisms as well as incompletely effective human immune system responses impede successful infection resolution. Biofilm-appropriate education appears under-represented in standardized surgical education curriculum.


CONCLUSIONS
Several potential methods of enabling primary prevention as well as treatment of biofilm-associated infection are on the near horizon. There is an opportunity to enhance surgical education regarding biofilm prevention, diagnosis, and therapy.
1 Department of Surgery, Yale School of Medicine , New Haven, Connecticut.
Michael R
MR
Hall
Edward
E
McGillicuddy
Lewis J
LJ
Kaplan
D018441:Biofilms; D055499:Catheter-Related Infections; D003428:Cross Infection; D004783:Environmental Microbiology; D006801:Humans