Abstract
Many bacteria secrete a highly hydrated framework of extracellular polymer matrix on suitable substrates and embed within the matrix to form a biofilm. Bacterial biofilms are observed on many medical devices, endocarditis, periodontitis and lung infections in cystic fibrosis patients. Bacteria in biofilm are protected from antibiotics and >1,000 times of the minimum inhibitory concentration may be required to treat biofilm infections. Here, we demonstrated that shock waves could be used to remove Salmonella, Pseudomonas and Staphylococcus biofilms in urinary catheters. The studies were extended to a Pseudomonas chronic pneumonia lung infection and Staphylococcus skin suture infection model in mice. The biofilm infections in mice, treated with shock waves became susceptible to antibiotics, unlike untreated biofilms. Mice exposed to shock waves responded to ciprofloxacin treatment, while ciprofloxacin alone was ineffective in treating the infection. These results demonstrate for the first time that, shock waves, combined with antibiotic treatment can be used to treat biofilm infection on medical devices as well as in situ infections.
Highlights
Many pathogenic bacteria can form biofilms in or on tissues; these in situ biofilms cause inflammation and tissue damage[22]
Biofilms were grown in the presence of urine on urinary catheters as determined by scanning electron microscopy (SEM) (Fig. 1a–d) and the increase in biomass attached to the catheter surface was seen by crystal violet staining for biofilms[25] (Fig. 1e)
To disintegrate the kidney stones, the shock wave should generate at least 80bar since the yielding stress of kidney stones is 80bar at maximum[33]
Summary
Many pathogenic bacteria can form biofilms in or on tissues; these in situ biofilms cause inflammation and tissue damage[22]. These biofilms may form on surface of tonsils[23] and on respiratory tract surfaces e.g. the paranasal sinuses[24] etc. A diaphragmless shock tube has been used for in vivo treatment of Pseudomonas lung infection and Staphylococcus skin suture infection in mice. This is first time that, an in vivo study of shock wave treatment of biofilms has been presented. The studies show that, in combination with antibiotic therapy, shock waves have the potential to treat lung and skin infections caused by bacteria
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