Shedding light on biofilm in critical care: an underestimated compartment to struggle against invasive medical devices-associated healthcare infections?

Abstract

Biofilms are ubiquitous communities of often mixed micro-organisms embedded in an extracellular matrix. They are very likely to develop on biotic or abiotic surfaces such as invasive devices and are possibly associated with the occurrence of device-related infections. In critical care medicine, intravascular catheters and endotracheal tubes account for most of device-related infections. Although the existence of biofilm on invasive devices is now well documented, its potential role in the development of device-related infections remains unclear. Indeed, standardized methods for biofilm visualization and microbiological analysis are lacking, as well as specific guidelines for the diagnosis of biofilm-related infections. So far, the diagnosis of device-related infections relies upon clinical and microbiological factors that both highly vary from one group to another. For this reason, punctual recourse to histopathology as well as implementation of novel imaging modalities, may improve their global diagnosis and management, to be chosen between the extraction of the device – when feasible – and appropriate anti-infectious therapy.