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.

CONCLUSION: 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.