Biofilm elimination on intravascular catheters: important considerations for the infectious disease practitioner.

The presence of biofilms on intravascular catheters and their role in catheter-related bloodstream infections is well accepted. The tolerance of catheter-associated biofilm organisms toward systemic antimicrobial treatments and the potential for development of antimicrobial resistance in the health care environment underscores the importance of alternative treatment strategies. Biofilms are microbial communities that exhibit unique characteristics that must be considered when evaluating the potential of biofilm prevention or control strategies. Because biofilm-associated infections do not respond consistently to therapeutically achievable concentrations of many antimicrobial agents, treatments that are more effective against slowly growing biofilm cells or combination treatments that can penetrate the biofilm matrix may be more effective. Alternative strategies that do not incorporate antimicrobial drugs have also been investigated. These approaches have the potential to prevent or eradicate biofilms on indwelling intravascular catheters and prevent or resolve catheter-related infections.