Abstract
Medical device-associated infections (MDAI) are a critical problem due to the increasing usage of medical devices in the aging population. The inhibition of biofilm formation through the use of probiotics has received attention from the medical field in the last years. However, this sparse knowledge has not been properly reviewed, so that successful strategies for biofilm management can be developed. This study aims to summarize the relevant literature about the effect of probiotics and their metabolites on biofilm formation in medical devices using a PRISMA-oriented (Preferred Reporting Items for Systematic reviews and Meta-Analyses) systematic search and meta-analysis. This approach revealed that the use of probiotics and their products is a promising strategy to hinder biofilm growth by a broad spectrum of pathogenic microorganisms. The meta-analysis showed a pooled effect estimate for the proportion of biofilm reduction of 70% for biosurfactants, 76% for cell-free supernatants (CFS), 77% for probiotic cells and 88% for exopolysaccharides (EPS). This review also highlights the need to properly analyze and report data, as well as the importance of standardizing the in vitro culture conditions to facilitate the comparison between studies. This is essential to increase the predictive value of the studies and translate their findings into clinical applications.
Highlights
Medical devices have been widely used in the prevention, diagnosis and treatment of some diseases, improving the healthcare and life quality of patients [1,2,3]
Indwelling medical devices, such as mechanical heart valves, artificial veins or catheters, are susceptible to microbial contamination [4,5,6], and their colonization poses a critical problem in the increasing number of healthcare-associated infections (HCAI) [7,8,9]
Indwelling medical devices may differ in design and material, the rate and extent of biofilm formation are mainly affected by the physicochemical properties of the surface, number and type of microorganisms in the liquid to which the device is exposed, as well as by the biofilm formation period and the flow rate and nutrient composition of the liquid through the device [1,2,14]
Summary
Medical devices have been widely used in the prevention, diagnosis and treatment of some diseases, improving the healthcare and life quality of patients [1,2,3]. Indwelling medical devices, such as mechanical heart valves, artificial veins or catheters, are susceptible to microbial contamination [4,5,6], and their colonization poses a critical problem in the increasing number of healthcare-associated infections (HCAI) [7,8,9]. These have been associated with high mortality and morbidity rates, increased length of hospital stay and increased cost of treatment [2,8,10]. Cells in biofilms are 10 to 1000 times more resistant to antimicrobial treatments than their planktonic counterlicenses/by/4.0/)
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