Macrolides and staphylococcal biofilms.

Medical device-associated infections represent a growing problem with limited or no therapeutic options beyond implant removal. Bacterial biofilm is the major and the final determinant of the poor prognosis of these difficult-to-treat infections. Due to the high antimicrobial resistance level of bacteria organized in biofilms, combination therapy is most often recommended, and macrolides may represent antibiotics of choice. Their anti-biofilm activity has been successfully used in-vitro and in-vivo against biofilm-associated infections caused by Pseudomonas aeruginosa and other Gram-negative bacilli. However there is only little data regarding their clinical interest against infections involving staphylococcal biofilms. Despite controversial reports, there is growing in-vitro and in-vivo evidences of anti-staphylococcal biofilm activity of macrolides that could represent a significant advance in the battle against implant-related infections.