Biofilms, Infection, and Antimicrobial Therapy

520 Pages·2006·6.59 MB·English

DK2989_half 7/6/05 9:13 AM Page 1
Biofilms,
Infection,
and
Antimicrobial
Therapy

DK2989_title 7/6/05 9:12 AM Page 1
Biofilms,
Infection,
and
Antimicrobial
Therapy
edited by
John L. Pace
Mark E. Rupp
Roger G. Finch
Boca Raton London New York Singapore
A CRC title, part of the Taylor & Francis imprint, a member of the
Taylor & Francis Group, the academic division of T&F Informa plc.
DK2989_Discl.fm Page 1 Thursday, June 30, 2005 8:19 AM
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Library of Congress Cataloging-in-Publication Data
Biofilms, infection, and antimicrobial therapy / edited by John L. Pace, Mark Rupp, and Roger G.
Finch.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-8247-2643-X (alk. paper)
1. Biofilms. 2. Pathogenic microorganisms. 3. Anti-infective agents. I. Pace, John L. II. Rupp, Mark.
III. Finch, R. G. (Roger G.)
[DNLM: 1. Biofilms. 2. Anti-Bacterial Agents. 3. Infection. 4. Prosthesis-Related Infections. QW
50 B6147 2005]
QR100.8.B55B565 2005
616.9'041--dc22 2005044047
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Dedication
To
Yvonne, Sarah, and Katherine,
who suffered by my absence during
the many hours that I spent at
the laboratory bench — JLP

Preface
One of the greatest medical achievements of the 20th century undoubtedly was
the rapid and effective introduction of antiinfective chemotherapy subsequent to
Fleming’s discovery of penicillin. Clearly untold numbers of lives have been saved
by the application of natural product, semisynthetic, and synthetic antimicrobial
compounds to the treatment of infectious disease. Academic, industrial, and govern-
ment scientists, physicians and associated healthcare workers, and administrators all
contributed to these efforts that have served humankind so well.
This success in some way belies the effectiveness of the agents that were dis-
covered and developed into powerful therapies because we have often overlooked the
complexity of the pathogenic microorganisms and their interactions with human and
animal hosts. The clearest example of this was our very slow grasp of the signifi-
cance of microbial biofilms. Von Leeuwenhoek alluded to biofilms in his writings
(circa 1650), and later reports by Zobell (1942) and others clearly described multi-
cellular prokaryotic communities from natural environments. Another 30 years
passed before Costerton and colleagues began to emphasize the very significant role
of adherent microbial communities in human infectious disease. In the 20 years sub-
sequent to that declaration, many advances have been made, and yet much of the
antimicrobial research continues to focus on methods utilizing planktonic bacteria.
This phenomenon is due in part to the often good correlations of minimal inhibitory
concentration (MIC) breakpoints for antibiotics with clinical outcomes, and takes
into account exposure at the site of infection as well as activity against the target.
However, the successful use of the MIC value may also have been due to the nature
of infections and patient’s status. As the infectious disease landscape continues to
evolve such that biofilm-related infections become more predominant, the correlation
between in vitrosusceptibility results and clinical outcomes may likely decline. The
erosion of the basis for effective antimicrobial therapy has arisen from the nature of
the patient population due to underlying debilitation and impaired immune status, but
also from the increasing emphasis on the use of indwelling medical devices (IMD).
This trend at least is well known and has been recognized by governmental agencies
including the Food and Drug Administration and the Centers for Disease Control and
Prevention, and behooves the scientific and medical community to reflect on future
approaches to addressing this problem.
In this book we have attempted to develop a general understanding of the problems
for a broad audience. Thomas and colleagues have contributed an excellent overview
of economic burden associated with treating biofilm-related infections. Schinabeck
and Ghannoum have described the central role of IMD in the infections, and Gorman
and Jones have provided us with detailed descriptions of how implant surface char-
acteristics contribute to the adherence of pathogens and initiation of infections.
In addition to the major principles, discussion of cutting edge aspects have been pro-
vided by Lewis and colleagues in the area of antibacterial tolerance and persisters,
which is central to the problem of treating biofilm-related infections. Animal models
have been described by Handke and Rupp essential for identification of new effec-
tive therapeutic regimens. Discussion of the effectiveness of various antimicrobial
agents for therapy of associated infections and extensive clinical protocols have been
included as well. Finch and Gander have described how an understanding of anti-
microbial pharmacodynamics can lead to improved efficacy, and the chapter by
Dodge et al. on beta-lactam therapy is insightful. The detailed protocols provided by
Lewis and Raad, Stryjewski and Corey, and Antonios et al. should aid physicians in
the treatment of these refractory and often difficult-to-treat infections. It is our hope
that this book will provoke thought and lead to more research resulting in improved
therapies for infections where biofilms play a substantial role.
Table of Contents
SECTION I Biofilms: Background, Significance,
and Roles of Catheters and Indwelling
Devices
Chapter 1
Microbial Biofilms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Xiuping Jiang and John L. Pace
Chapter 2
Economic Impact of Biofilms on Treatment Costs . . . . . . . . . . . . . . . . . . . . . . .21
John G. Thomas, Isaiah Litton, and Harald Rinde
Chapter 3
Biofilm-Related Indwelling Medical Device Infections . . . . . . . . . . . . . . . . . . . .39
Matthew K. Schinabeck and Mahmoud A. Ghannoum
Chapter 4
Medical Device Composition and Biological Secretion Influences
on Biofilm Formation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Sean P. Gorman and David S. Jones
SECTION II Biofilm-Forming Pathogens
Chapter 5
Role of Biofilms in Infections Caused by Escherichia coli . . . . . . . . . . . . . . . . .73
Grégory Jubelin, Corinne Dorel, and Philippe Lejeune
Chapter 6
Staphylococcus aureusBiofilms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
Julie M. Higashi and Paul M. Sullam