title: Microbiome, biofilms, and pneumonia in the ICU.
abstract: OBJECTIVE
  Lower respiratory tract infections remain one of the leading causes of death in the world. Recently, the introduction of molecular methods based on DNA sequencing and microarrays for the identification of nonculturable microorganisms and subspecies variations has challenged the previous 'one bug - one disease' paradigm, providing us with a broader view on human microbial communities and their role in the development of infectious diseases. The purpose of this review is to describe recent understanding of the role of microbiome and bacterial biofilm in the development of lung infections, and, at the same time, to present new areas of research opportunities.
  
  
  RESULTS
  The review describes recent literature in cystic fibrosis patients, chronic obstructive pulmonary disease patients, and literature in mechanically ventilated patients that helped to elucidate the role of microbiome and biofilm formation in the development of pneumonia.
  
  
  CONCLUSIONS
  The characterization of the human microbiome and biofilms has changed our understanding of lower respiratory tract infections. More comprehensive, sensitive, and fast methods for bacterial, fungal, and viral detection are warranted to establish the colonization of the lower respiratory tract in healthy individuals and sick patients. Future research might explore the global bacterial, fungal, and viral pulmonary ecosystems and their interdependence to target novel preventive approaches and therapeutic strategies in chronic and acute lung infections.
authors: aDipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Università degli Studi di Milano bDipartimento di Anestesia e Rianimazione, Ospedale Niguarda Ca' Granda, Milan, Italy cDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Massimiliano
authors: M
authors: Pirrone
authors: Riccardo
authors: R
authors: Pinciroli
authors: Lorenzo
authors: L
authors: Berra
mesh_terms: D018441:Biofilms / Q000254:growth & development*; D003550:Cystic Fibrosis / Q000150:complications; D006801:Humans; D007362:Intensive Care Units; D064307:Microbiota; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012121:Respiration, Artificial / Q000009:adverse effects