Presence Of Bacterial Biofilms Research Articles

Understanding biofilm: what a community nurse should know.

The job of a community nurse involves effort to support wound healing. It is now well accepted in wound science that the presence of bacterial biofilm is an important risk factor for wound chronicity. Therefore, this problem is important for the community nurse to assess and address in order to avoid cost waste and to promote optimal patient quality of life. However, there exist many questions about exactly how biofilm impairs healing, how its presence can be clinically diagnosed in a wound, and how this barrier to healing can be most cost effectively treated. The goal of this article is to provide the front-line, community wound care nurse with the practical understanding needed to cost effectively address these challenges in the clinical setting.

Heterokont Predator Develorapax marinus gen. et sp. nov. - A Model of the Ochrophyte Ancestor.

Heterotrophic lineages of Heterokonta (or stramenopiles), in contrast to a single monophyletic group of autotrophs, Ochrophyta, form several clades that independently branch off the heterokont stem lineage. The nearest neighbors of Ochrophyta in the phylogenetic tree appear to be almost exclusively bacterivorous, whereas the hypothesis of plastid acquisition by the ancestors of the ochrophyte lineage suggests an ability to engulf eukaryotic alga. In line with this hypothesis, the heterotrophic predator at the base of the ochrophyte lineage may be regarded as a model for the ochrophyte ancestor. Here, we present a new genus and species of marine free-living heterotrophic heterokont Develorapax marinus, which falls into an isolated heterokont cluster, along with the marine flagellate Developayella elegans, and is able to engulf eukaryotic cells. Together with environmental sequences D. marinus and D. elegans form a class-level clade Developea nom. nov. represented by species adapted to different environmental conditions and with a wide geographical distribution. The position of Developea among Heterokonta in large-scale phylogenetic tree is discussed. We propose that members of the Developea clade represent a model for transition from bacterivory to a predatory feeding mode by selection for larger prey. Presumably, such transition in the grazing strategy is possible in the presence of bacterial biofilms or aggregates expected in eutrophic environment, and has likely occurred in the ochrophyte ancestor.

Biofilm's Role in Chronic Cholesteatomatous Otitis Media: A Pilot Study.

Cholesteatoma is a destructive lesion involving the temporal bone, which may induce severe complications due to its expansion and erosion of adjacent structures. Bacterial biofilm plays a crucial role in the pathogenesis of many otolaryngologic inflammatory/infectious chronic diseases. In this pilot study, we investigated, by means of cultural examination and with scanning electron microscope, the presence of bacterial biofilm in a series of samples from the epitympanic and mastoid region in patients affected by cholesteatoma and from the promontory region in patients with healthy mucosa who were undergoing to stapes surgery. The preliminary data support the association between biofilm and cholesteatoma (81.3% of the cases) and allow us to hypothesize that keratinized matrix of cholesteatoma may represent the ideal substrate for biofilm colonization and survival; this finding is consistent with the clinical course of aural cholesteatoma, characterized by recurrent exacerbations and recalcitrant course.

Adenoid Vegetations - Reservoir of Bacteria for Chronic Otitis Media with Effusion and Chronic Rhinosinusitis.

Otitis media and rhinosinusitis are commonly encountered illnesses in pediatric population. Literature reports have documented the association between the occurrence of these two conditions and even their almost identical microbiological findings. Until recently, the key factor in the association of these two conditions was considered to be the hypertrophic adenoid tissue, but within the past few years there have been evidences in the literature about the presence of bacterial biofilms on the adenoids suggesting biofilms to be also responsible for both conditions, chronic otitis media with effusion and chronic rhinosinusitis. The aim of this study was to make a microbiological analysis of the adenoid tissue specimens taken from patients with chronic otitis media with effusion and chronic or recurrent rhinosinusitis and to determine their potential for biofilms formation. After the surgical intervention, adenoidectomy, microbiological evaluation and analysis of the adenoid tissue specimens taken from 20 patients were made. Having in mind the disease history, chronic otitis media with effusion was diagnosed in all 20 patients and chronic rhinosinusitis in 9 patients. The results obtained from the microbiological analyses showed many potentially pathogenic bacteria in the adenoids that were almost identical with the most common organisms incorporated in the etiopathogenesis of both conditions, in chronic otitis media with effusion and in chronic rhinosinusitis. In 7 (35%) patients Haemophylus influenzae was isolated, in 6 (30%) Streptococcus pneumoniae, in 4 (20%) Moraxella catаrrhalis, in 2 (10%) patients Staphylococcus aureus and in 1 (5%) patient Streptococcus pyogenes - group A was isolated. One bacterium was isolated from all adenoid vegetations, except in one case when two bacteria (Haemophylus influenzae and Staphylococcus aureus) were concurrently isolated. Our results have shown that the key role in adenoid vegetations in chronic otitis media with effusion and chronic rhinosinusitis is not only the mechanism of rhinopharyngeal obstruction, but also the presence of bacterial strains with a large potential for formation of biofilms adhered to their surface, especially in cases with symptoms of chronic otitis media with effusion and chronic rhinosinusitis that were resistant to antibiotic therapy.

Antibacterial titanium nano-patterned arrays inspired by dragonfly wings.

Titanium and its alloys remain the most popular choice as a medical implant material because of its desirable properties. The successful osseointegration of titanium implants is, however, adversely affected by the presence of bacterial biofilms that can form on the surface, and hence methods for preventing the formation of surface biofilms have been the subject of intensive research over the past few years. In this study, we report the response of bacteria and primary human fibroblasts to the antibacterial nanoarrays fabricated on titanium surfaces using a simple hydrothermal etching process. These fabricated titanium surfaces were shown to possess selective bactericidal activity, eliminating almost 50% of Pseudomonas aeruginosa cells and about 20% of the Staphylococcus aureus cells coming into contact with the surface. These nano-patterned surfaces were also shown to enhance the aligned attachment behavior and proliferation of primary human fibroblasts over 10 days of growth. These antibacterial surfaces, which are capable of exhibiting differential responses to bacterial and eukaryotic cells, represent surfaces that have excellent prospects for biomedical applications.

Dental plaque as a biofilm - a risk in oral cavity and methods to prevent

Bacteria living constantly in the oral cavity are in the form of a biofilm. The biofilm formed on a solid base such as the enamel of the teeth, fillings, restorations, orthodontic appliances or obturators is dental plaque. Disturbance of homeostasis of biofilm, excessive growth or increase in the number of acid-forming bacteria leads to the development of the most common diseases of the oral cavity, i.e. dental caries and periodontal disease. The presence of bacterial biofilm on the walls of the root canal or at the top of the root on an outer wall leads to complications and failure in endodontic treatment. The aim of the study was to present the latest information on the occurrence, development and the role of biofilm in the etiopathogenesis of oral diseases and its control. Based on the literature analyzed, it can be concluded that the biofilm, due to its complex structure and numerous mechanisms of bacteria adaptation, is an effective barrier against the traditional agents with antibacterial properties. There are now great hopes for nanotechnology as an innovative method for obtaining new structures of nanometric size and different properties than source materials. The use of antibacterial properties of nano-silver used in dentistry significantly reduces the metabolic activity and the number of colony forming bacteria and lactic acid production in the biofilm.

Influence of strain Bacillus cereus bacterium on corrosion behaviour of carbon steel in natural sea water

This paper examines the corrosion behaviours of carbon steel immersed in sterile natural sea water with and without strain Bacillus cereus. Electrochemical studies, including Tafel plots and electrochemical impedance spectroscopy (EIS) were performed to evaluate the variation of the corrosion behaviour of carbon steel in medium containing B. cereus as compared to the sterile control samples. The results of Tafel plot measurements showed significant reduction in the corrosion rate in the presence of bacterial biofilm produced by strain B. cereus. The EIS data showed that the charge transfer resistance is greater in a medium containing B. cereus and increases with immersion time.

Relationship between biofilms and clinical features in patients with sinus fungal ball.

The presence of bacterial biofilms (BBF) and fungal biofilms (FBF) is associated with greater disease severity in chronic rhinosinusitis. However, researches on biofilms in fungal rhinosinusitis are rare. This study investigated the relationship between biofilms and clinical features in patients with sinus fungal ball (SFB). Sixty-four SFB patients undergoing endoscopic sinus surgery and 21 controls were enrolled in this study. Mucosal samples from nasal sinuses were collected for biofilm detection under confocal scanning laser microscopy (CSLM). The general clinical data, Lund-Mackay computed tomography (CT) score, Lund-Kennedy endoscopy score, Global Osteitis Scoring Scale (GOSS) score, Sinonasal Outcome Test (SNOT)-22 score and visual analog scale (VAS) score were recorded. Associations between these parameters and biofilms were assessed. Under CSLM, the positive rates of BBF and FBF were 45.3 % (29/64) and 21.9 % (14/64), respectively in the SFB group but none in controls. When sub-classified according to biofilm status, the BBF-positive subgroup had significantly higher Lund-Mackay score and GOSS score than the BBF-negative one, but there were no differences in demographic characteristics, health-related quality-of-life and endoscopic inflammatory severity. BBF and FBF coexisted on the sinus mucosa of the patients with SFB. BBF was associated with more severe disease, but the distribution of FBF did not affect the severity of SFB.

Clinical characteristics of biofilms in patients with chronic rhinosinusitis: a prospective case-control study.

Recent studies have indicated that biofilms are involved in the pathogenesis of recurrent and recalcitrant chronic rhinosinusitis (CRS). The present study was performed to evaluate the presence of biofilms and to evaluate the relationships between the presence of biofilms and clinical features of CRS. A total of 33 patients were included in this study. Maxillary sinus mucosa from 26 CRS patients and the ethmoid mucosa from 7 patients undergoing septoplasty were collected. Biofilms were evaluated by scanning electron microscopy. Preoperative symptom scores, preoperative and intraoperative nasoendoscopic findings, and postoperative healing period were compared between the groups. Biofilms were detected in 14 (42.4%) of the 33 patients. Biofilms were present in 13 (50%) of the 26 patients in the CRS group, but in only one (14.3%) of the seven patients in the control group. There were no significant differences in preoperative symptom scores or preoperative nasal Lund-Kennedy endoscopic scores between the groups. However, the average Lund-Mackay and intraoperative sinus Lund-Kennedy endoscopic scores were significantly higher in biofilm-positive than biofilm-negative patients (P<0.05). In the follow-up period, the healing time was significantly longer in biofilm-positive than biofilm-negative patients (P<0.05). This study suggested that the presence of bacterial biofilms may contribute to the pathogenesis of CRS and the clinical characteristics of CRS patients after endoscopic sinus surgery.

Bacterial Biofilms and Increased Bacterial Counts Are Associated with Airway Stenosis

Objectives: The majority of airway stenoses are acquired secondary to the use of prolonged endotracheal intubation (ETT). Pressure exerted on the tracheal mucosa by the presence of ETT leads to irritation, ulceration, and granulation tissue formation and eventual fibrosis. An excess of granulation tissue promotes excess wound contracture. Antibiotics have been shown to decrease local inflammation and granulation tissue formation in the trachea. However, antibiotic therapy is not 100% effective in preventing or treating granulation tissue formation. Development of bacterial biofilms may explain this finding. This study was done to evaluate the difference between stenotic segment and normal trachea in terms of 1) presence of bacterial biofilms; 2) quantitative analysis of bacterial count; 3) inflammatory markers within tracheal tissue. Methods: Institutional review board approved case-control study, where cases were patients with airway stenosis and controls were patients without airway stenosis. We performed scanning electron microscopy (SEM) for biofilm, quantitative polymerase chain reaction (qPCR) for quantitative analysis of bacterial count, and immunohistochemistry (IHC) for inflammatory markers. Results: SEM showed presence of biofilm in cases compared to controls. The number of 16S rRNA gene copies using qPCR, a surrogate for the number of bacterial cells, was significantly higher in cases (mean=198) compared to controls (mean=30 ) ( P &lt; 0.05). Pediatric cases showed a significantly higher bacterial count than adult cases. IHC showed stronger staining for SMAD3 and transforming growth factor β (TGF-β). Conclusions: Biofilms are present in airway stenotic segments, and there exists a difference in tracheal microbiomes and inflammatory markers between patients with airway stenosis and normal controls.

The influence of bacterial biofilm on the clinical outcome of chronic rhinosinusitis: a prospective, double-blind, scanning electron microscopy study

The aim of this study was to assess the influence of bacterial biofilms in chronic rhinosinusitis (CRS) patients on the clinical outcomes following endoscopic sinus surgery (ESS). This was a prospective, double-blind study. Patients undergoing ESS, because of CRS, were recruited. Overall 80 patients were qualified. For each of these demographic, clinical and radiologic characteristics were recorded. During surgery each patient had at least 7 mucosal specimens taken to assess, using scanning electron microscopy, the possible presence of bacterial biofilms. Prior to mucosa specimen excision, swabs for bacteriological and fungal analyses were taken. Each patient underwent perioperative and follow-up assessment at 3 and 6 months post-ESS. Biofilms were found in 33 (41.3%) patients (study group). From among the 47 patients without the presence of biofilms, 33 (control group) were taken to match the study group in age, gender and clinical characteristics. The intensity of subjective and objective CRS symptoms, as well as patient quality-of-life, did not correlate with the Lund and Mackay score (p > 0.05). Analysis of variance showed that, in the control group or the group as a whole, the intensity of subjective and objective symptoms decreased (p < 0.05), and the quality-of-life increased with time (p < 0.05). In conclusion, biofilm-positive patients tend to have a greater severity of disease preoperatively and continue to have persistent and more severe symptoms post-ESS. This study supports the role of biofilms in maintaining the chronic and recalcitrant nature of CRS. The lack of planktonic bacteria in post-operative sinus swabs does not rule out the presence of bacterial biofilms.

An Effective Antibiofilm Agent Against Pseudomonas aeruginosa Biofilm from Traditional Thai Herbal Recipes Used for Wound Treatments

The presence of bacterial biofilm, particularly formed by Pseudomonas aeruginosa, has been considered an important factor responsible for wound chronicity. The objective of this study was to investigate the antibiofilm activity of water and ethanol extracts obtained from three traditional herbal recipes (THR-SK004, THR-SK010, and THR-SK011) on biofilm formation and on mature biofilm of a reference strain of P. aeruginosa. The effects of the extracts on the biofilm mass were evaluated by using crystal violet (CV) assay. The respiratory activity of preformed biofilm of P. aeruginosa after treatment with the extract was determined by MTT reduction assay. Scanning electron microscopy was used to furnish images of biofilm reduction after the recipe treatment. Tested ethanol extracts displayed antibiofilm activity, but the water extracts exhibited low biofilm inhibition activity at the tested concentrations. Remarkable reduction in biofilm formation of P. aeruginosa was found after treatment with the THR-SK010 ethanol extract (THR-SK010E). Treatments with this extract resulted in prevention of biofilm formation of P. aeruginosa on both polystyrene and glass surfaces. Almost 50% reduction in the bacterial metabolic activity in the preformed biofilm was seen after exposure to the extract-supplemented buffer for 12 hr. After a 24-hr treatment with THR-SK010E at 62.5 μg/ml, 97.3% of the preformed biofilms were destroyed. Promising antibiofilm activity was displayed by the THR-SK010 ethanol extract, suggesting further investigation to explore the possible utilization of the herbal recipe as an antibiofilm agent, especially for wound treatment.

Polymerase chain reaction detection of potentially pathogenic free-living amoebae in dental units

Several genera of amoebae can be found in water from dental units and on the inner surface of waterlines. The presence of bacterial biofilms on these surfaces is thought to favor the proliferation of amoebae. Potentially pathogenic Acanthamoeba and Naegleria spp. may be an infection risk for patients through contact with open surgical sites or aerosolization. A polymerase chain reaction of DNA extracted from pelleted samples showed that Acanthamoeba spp. and Naegleria spp. were present in water from dental units, suction lines, and suction filters at the dental clinic of the Université de Montréal. Acanthamoeba spp. were detected in 24.2% of 66 samples and Naegleria spp. in 3.0%. We discuss the infection risk associated with these results.

A Porous Elastic Model for Bacterial Biofilms: Application to the Simulation of Deformation of Bacterial Biofilms Under Microfluidic Jet Impingement

The presence of bacterial biofilms is detrimental in a wide range of healthcare situations especially wound healing. Physical debridement of biofilms is a method widely used to remove them. This study evaluates the use of microfluidic jet impingement to debride biofilms. In this case, a biofilm is treated as a saturated porous medium also having linear elastic properties. A numerical modeling approach is used to calculate the von Mises stress distribution within a porous medium under fluid-structure interaction (FSI) loading to determine the initial rupture of the biofilm structure. The segregated model first simulates the flow field to obtain the FSI interface loading along the fluid-solid interface and body force loading within the porous medium. A stress-strain model is consequently used to calculate the von Mises stress distribution to obtain the biofilm deformation. Under a vertical jet, 60% of the deformation of the porous medium can be accounted for by treating the medium as if it was an impermeable solid. However, the maximum deformation in the porous medium corresponds to the point of maximum shear stress which is a different position in the porous medium than that of the maximum normal stress in an impermeable solid. The study shows that a jet nozzle of 500 μm internal diameter (ID) with flow of Reynolds number (Re) of 200 can remove the majority of biofilm species.

Laser irradiation effect on Staphylococcus aureus and Pseudomonas aeruginosa biofilms isolated from venous leg ulcer

Chronic wounds, including diabetic foot ulcers, pressure ulcers and venous leg ulcers, represent a significant cause of morbidity in developed countries, predominantly in older patients. The aetiology of these wounds is probably multifactorial, but the role of bacteria in their pathogenesis is still unclear. Moreover, the presence of bacterial biofilms has been considered an important factor responsible for wounds chronicity. We aimed to investigate the laser action as a possible biofilm eradicating strategy, in order to attempt an additional treatment to antibiotic therapy to improve wound healing. In this work, the effect of near-infrared (NIR) laser was evaluated on mono and polymicrobial biofilms produced by two pathogenic bacterial strains, Staphylococcus aureus PECHA10 and Pseudomonas aeruginosa PECHA9, both isolated from a chronic venous leg ulcer. Laser effect was assessed by biomass measurement, colony forming unit count and cell viability assay. It was shown that the laser treatment has not affected the biofilms biomass neither the cell viability, although a small disruptive action was observed in the structure of all biofilms tested. A reduction on cell growth was observed in S. aureus and in polymicrobial biofilms. This work represents an initial in vitro approach to study the influence of NIR laser treatment on bacterial biofilms in order to explain its potentially advantageous effects in the healing process of chronic infected wounds.

Observation of bacterial biofilms in patients with chronic rhinosinusitis

To explore the presence of bacterial biofilms (BF) in patients with CRS and the effect of BF on clinical symptoms and postoperative outcomes. Seventy-two patients with chronic sinusitis were enrolled in this study. The control group included 15 patients with deviation of the nasal septum and 10 patients had a fracture of the nasal bone. Mucosa of the uncinate process or ethmoid near the ostium of the maxillary sinus was obtained during endoscopic sinus surgery. The specimens were subjected to scanning electron microscopy. Patients were followed for 1 year and observed by the Lund-Kennedy endoscopy, and the Haikou standard classification (ESS-1997). Statistical analysis was performed by t-test or chi-square test. Three patients were lost to follow-up. The scanning electron microscopy analysis showed bacterial biofilms in 49 of the 69 patients with chronic sinusitis. A marked destruction of the epithelium and cilia was observed in samples positive for bacterial biofilms. No bacterial biofilms were detected in the control group, and scanning electron microscopy showed normal epithelium and cilia in those specimens. There was no significant difference in gender, classification or duration of disease between the BF(-) and BF(+) groups. At six months and one year postoperative, the Lund-Kennedy endoscopy scores for CRS patients with BF (4.78 +/- 1.67; 4.55 +/- 1.61) were significantly higher than those without BF (3.65 +/- 1.39; 3.65 +/- 1.18) (t = -2.654, P < 0.01; t = -2.264, P < 0.05). Based on the Haikou standard classification, there was a significantly difference between patients with BF and those without BF (chi2 = 18.014, 22.063, P < 0.001, respectively). Different life stages of bacterial biofilms were demonstrated to be present in CRS. Gender, classification or duration of disease did not affect the presence of bacterial biofilms in patients with CRS. There is a correlation between bacterial biofilms and an unfavorable outcome in patients with CRS after ESS.

Quantitative analysis of the cellular inflammatory response against biofilm bacteria in chronic wounds

Chronic wounds are an important problem worldwide. These wounds are characterized by a persistent inflammatory stage associated with excessive accumulation and elevated cell activity of neutrophils, suggesting that there must be a persistent stimulus that attracts and recruits neutrophils to the wound. One such stimulus might be the presence of bacterial biofilms in chronic wounds. In the present study, biopsy specimens from chronic venous leg ulcers were investigated for the detection of bacteria using peptide nucleic acid-based fluorescence in situ hybridization (PNA-FISH) and confocal laser scanning microscopy. The bacteria in the wounds were often situated in large aggregates. To obtain a measure of the cellular inflammatory response against the bacteria in the chronic wounds, the amount of neutrophils accumulated at the site of infection was evaluated through differential neutrophil counting on the tissue sections from wounds containing either Pseudomonas aeruginosa or Staphylococcus aureus. The P. aeruginosa-containing wounds had significantly higher numbers of neutrophils accumulated compared with the S. aureus-containing wounds. These results are discussed in relation to the hypothesis that the presence of P. aeruginosa biofilms in chronic wounds may be one of the main factors leading to a persistent inflammatory response and impaired wound healing.

Biofilm and persistent inflammation in endoscopic sinus surgery

Bacterial biofilms have been observed in many patients with chronic rhinosinusitis, but their importance is still being investigated. This study examines the association between biofilms and other clinical findings in chronic rhinosinusitis patients.Twenty-four patients with chronic rhinosinusitis who failed medical management underwent endoscopic sinus surgery (ESS). Tissue was collected from the ethmoid sinus and analyzed for the presence of biofilm by hematoxylin and eosin staining, fluorescent in situ hybridization, and confocal scanning laser microscopy. Biofilms were classified as extensive (> 50% of mucosal surface in sample) or present (< 50% of surface). The surgeon remained blinded to the biofilm status of patients until postoperative follow-up was complete.The presence of bacterial biofilm was strongly associated with persistent mucosal inflammation after ESS (53% of biofilm-positive patients vs 0% of biofilm-negative patients, P = 0.009). The amount of biofilm was not important as there was no significant difference between the extensive and present biofilm classifications with respect to inflammation. The presence of biofilm was not associated with prior ESS, allergies, eosinophils, polyps, or presence of fungal elements.

Relationship between bacterial biofilms and chronic rhinosinusitis by scanning electron microscopic study

To determine the presence and the morphological features of bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis (CRS) compared with control patients without CRS by scanning electron microscopy (SEM), and to evaluate the role of biofilm on the pathogenesis of CRS. Fifteen patients with CRS undergoing endoscopic sinus surgery and 11 control patients with fracture of nasal bone were enrolled in this study. Clinical information was recorded from each patient. All patients underwent a thorough otolaryngological examination, preoperative paranasal sinus computerized tomography (CT) scanning which were evaluated according to the Lund-Mckay CT scoring system. All the samples including uncinate process, ethmoid mucosa from CRS group and uncinate process, ethmoid bulla from control group were prepared using standard methods for SEM. The presence of bacterial biofilms on the samples of two groups was observed by SEM. Statistical analysis was performed using SPSS 13.0. Continuous data was analyzed by Student t test and dichotomous data was analyzed by chi² or Fisher exact test. P was considered to be significant at a level of 0.05. Nine (60.0%) of the 15 patients were found to have evidence of biofilms. In control group, only 1 (9.1%) of 11 patients had biofilm. The difference was statistical significant (chi² = 6.949, P < 0.01). All controls except one had healthy appearing cilia and goblet cells without biofilms. All the 16 CRS patients showed aberrant findings of the mucosal surface with variation in degrees of severity from disarrayed cilia to complete absence of cilia and goblet cells. Among them the typical morphologic feature such as water channels, 3-D structure, and matrix-embedding spherical or elliptical bodies were noted in 9 cases. Five samples including one case from control showed cilia aggregation. The preoperative CT scores of the CRS patients with biofilms (n = 9) were significantly higher than those without biofilms (n = 6, t = 2.14, P < 0.05). The typical morphologic feature of BF such as water channels, 3-D structure, and matrix-embedding spherical or elliptical bodies were noted in sinus mucosa of patients with CRS by the SEM. The positive rate of bacterial biofilms in CRS group was significantly higher compared to control group, which indicated bacterial biofilms might play an important role in the pathogenesis of CRS. Besides the typical bacterial biofilm features, cilia aggregation was found in five cases of CRS patients. We consider cilia aggregation can be regarded as one morphologic feature of bacterial biofilm in nasal mucosa, which needs further study. The presence of bacterial biofilms in CRS patients is associated with paranasal CT scores, which indicates that bacterial biofilm is correlated with the severity of CRS.

The Demonstration of Bacterial Biofilm and It's Impact on Postoperative Course in Patients with Chronic Rhinosinusitis

Background and ObjectivesZZBacterial biofilm is thought to contribute to the progression and persistence of chronic rhinosinusitis. There are many studies which demonstrate these structures on chronic rhinosinusitis (CRS), but the majority of the studies just focus on the documentation of their presence and the method for identification. There are also a few researches that show the impact of biofilm on postoperative surgical outcomes. In this study, we demonstrated bacterial biofilm in CRS patients and determined whether they affect clinical courses and outcomes after surgery. Subjects and MethodZZThe mucosa of ethmoid bulla was obtained during endoscopic sinus surgery from 21 CRS patients. Fluorescent microscope and scanning electron microscopy (SEM) were used for the determination of biofilm. The outcomes of the surgery were evaluated by endoscope every two weeks for 6 months. Preoperative symptom scores, CT scores, and the post operative results were compared between patients with biofilm and patients without biofilm. ResultsZZBacterial biofilm were seen in 13 (62%) of the 21 CRS patients. A statistical association existed between the presence of biofilm and the worsened preoperative symptom scores, but the preoperative CT scores were not related to the presence of biofilm. Patients with biofilm had long-lasting postoperative mucosal inflammation and a prolonged healing time, and these differences have statistical significance. ConclusionZZThis study showed that the presence of bacterial biofilm were significantly correlated with worsening preoperative symptom scores and the prolonged postoperative recovery time. Therefore, bacterial biofilm may play an important role in the recalcitrant and resistant nature of CRS. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:349-53 Key WordsZZChronic rhinosinusitis·Biofilm.