The Use of Probiotics to Fight Biofilms in Medical Devices: A Systematic Review and Meta-Analysis

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.

Candida biofilm formation on voice prostheses

Laryngopharyngeal malignancy is treated with radiotherapy and/or surgery. When total laryngectomy is required, major laryngeal functions (phonation, airway control, swallowing and coughing) are affected. The insertion of a silicone rubber voice prosthesis in a surgically created tracheoesophageal puncture is the most effective method for voice rehabilitation. Silicone, as is the case with other synthetic materials such as polymethylmethacrylate, polyurethane, polyvinyl chloride, polypropylene and polystyrene, has the propensity to become rapidly colonized by micro-organisms (mainly Candida albicans) forming a biofilm, which leads to the failure of the devices. Silicone is used within voice prosthetic devices because of its flexible properties, which are essential for valve function. Valve failure, as well as compromising speech, may result in aspiration pneumonia, and repeated valve replacement may lead to either tract stenosis or insufficiency. Prevention and control of biofilm formation are therefore crucial for the lifespan of the prosthesis and promotion of tracheoesophageal tissue and lung health. To date, the mechanisms of biofilm formation on voice prostheses are not fully understood. Further studies are therefore required to identify factors influencing Candida biofilm formation. This review describes the factors known to influence biofilm formation on voice prostheses and current strategies employed to prolong their life by interfering with microbial colonization.

Inhibition of microbial adhesion to silicone rubber treated with biosurfactant fromStreptococcus thermophilusA

Microbial adhesion of four bacterial and two yeast strains isolated from explanted voice prostheses to silicone rubber before and after conditioning with a biosurfactant obtained from the probiotic bacterium Streptococcus thermophilus A was investigated in a parallel plate flow chamber. The silicone rubber with and without an adsorbed biosurfactant layer was characterized using contact angle measurements. Water contact angles indicated that the silicone rubber surface with adsorbed biosurfactant was more hydrophilic (58 degrees) than bare silicone rubber (109 degrees). The results obtained showed that the biosurfactant was effective in decreasing the initial deposition rates, and the number of bacterial cells adhering after 4 h, for all microorganisms tested. A decrease in the initial deposition rate was observed for Rothia dentocariosa GBJ 52/2B and Staphylococcus aureus GB 2/1 from 1937+/-194 to 179+/-21 microorganisms cm(-2) s(-1) and from 1255+/-54 to 233+/-26 microorganisms cm(-2) s(-1), respectively, accounting for an 86% reduction of the initial deposition rate for both strains. The number of bacterial cells adhering to the silicone rubber with preadsorbed biosurfactant after 4 h was further reduced by 89% and 97% by the two strains, respectively. The two yeast strains tested showed less reduction in adhesion after 4 h, to values between 67% and 70%. Such a pretreatment with surface-active compounds may constitute a promising strategy to reduce the microbial colonization rate of silicone rubber voice prostheses.