Understanding urogenital biofilms and potential impact of probiotics

Effect of Lactobacillus challenge on Gardnerella vaginalis biofilms

Bacterial vaginosis (BV) is the most common infectious condition in women. It is caused primarily by anaerobic bacteria which rapidly form biofilms recalcitrant to antibiotic treatment, elevate vaginal pH, induce inflammatory processes and displace indigenous lactobacilli from the vault. Gardnerella vaginalis is commonly associated with these infections. Microscopy analysis showed that within 72 h, viable G. vaginalis covered a surface area of 567 microm(2), reached a depth of 16 microm and a density of approximately 104 microm(3). They maintained these levels for a further 3 days unless challenged with lactobacilli strains. Lactobacillus reuteri RC-14 produced the biggest displacement of Gardnerella. This was not due to pH, which remained between 4.7 and 5.1 for all experiments, nor by hydrogen peroxide which is produced in low amounts by strain L. reuteri RC-14, high amounts by L. crispatus 33820 and not at all by L. rhamnosus GR-1. Deconvolution microscopy showed changes in structure and viability of the biofilms, with loss of dense Gardnerella biofilm pods. For the first time, a strain of L. iners, the most commonly isolated vaginal Lactobacillus in healthy women, was tested for potential probiotic properties. It was found to disrupt Gardnerella biofilm surface area, density and depth, albeit to a lesser extent than L. reuteri RC-14. These studies help to provide insight into the clinical situation in which probiotic and indigenous vaginal lactobacilli can interfere with Gardnerella's presence and reduce the risk of bacterial vaginosis.

Is otitis media with effusion a biofilm infection?

Recent attention has focused on the possibility that otitis media with effusion (OME) may represent a chronic infective state such as those evidenced in conditions secondary to biofilms or small colony variants. This review discusses the evidence suggesting that this may indeed be the case and explains why this may prove to be important in the future management of this condition by discussing recent advances in understanding these bacterial phenotypic variants.