Biofilms and antimicrobial resistance
Biofilms and antimicrobial resistance
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DOI：
10.1097/01.blo.0000175714.68624.74
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发表时间：
2005-08-01
影响因子：
4.2
通讯作者：
Patel, R
中科院分区：
文献类型：
--
作者：
Patel, R
许多骨科感染的发病机制与生物膜中微生物的存在有关。我研究了生物膜相关的抗菌素耐药性机制的新认识。生物膜相关的抗微生物剂的耐药性开始于附着阶段，并随着生物膜的老化而增加。已经假设和研究了生物膜中微生物的抗微生物剂抗性增加的多种原因。虽然生物膜中的细菌被细胞外基质包围，可能会物理限制抗菌剂的扩散，但这似乎不是生物膜相关抗菌剂耐药性的主要机制。生物膜内的营养物和氧气消耗导致一些细菌进入非生长（即静止）状态，在这种状态下，它们对生长依赖性抗菌剂的杀伤作用不太敏感。细菌的亚群可能分化成表型耐药状态。(30)最后，生物膜中的一些生物体已被证明表达生物膜特异性抗微生物剂抗性基因，这些基因不是生物膜形成所必需的。总体而言，生物膜相关的抗菌素耐药性机制似乎是多因素的，并且可能因微生物而异。在研究和临床环境中适当定义骨科假体器械相关感染的抗菌方案之前，可能需要解决生物膜对抗菌剂敏感性试验的技术。最后，正在定义各种方法来克服生物膜相关的抗菌素耐药性。
The pathogenesis of many orthopaedic infections is related to the presence of microorganisms in biofilms. I examine the emerging understanding of the mechanisms of biofilm-associated antimicrobial resistance. Biofilm-associated resistance to antimicrobial agents begins at the attachment phase and increases as the biofilm ages. A variety of reasons for the increased antimicrobial resistance of microorganisms in biofilms have been postulated and investigated. Although bacteria in biofilms are surrounded by an extracellular matrix that might physically restrict the diffusion of antimicrobial agents, this does not seem to be a predominant mechanism of biofilm-associated antimicrobial resistance. Nutrient and oxygen depletion within the biofilm cause some bacteria to enter a nongrowing (ie, stationary) state, in which they are less susceptible to growth-dependent antimicrobial killing. A subpopulation of bacteria might differentiate into a phenotypically resistant state.(30) Finally, some organisms in biofilms have been shown to express biofilm-specific antimicrobial resistance genes that are not required for biofilm formation. Overall, the mechanism of biofilm-associated antimicrobial resistance seems to be multifactorial and may vary from organism to organism. Techniques that address biofilm susceptibility testing to antimicrobial agents may be necessary before antimicrobial regimens for orthopaedic prosthetic device-associated infections can be appropriately defined in research and clinical settings. Finally, a variety of approaches are being defined to overcome biofilm-associated antimicrobial resistance.