Staphylococcal biofilms: quest for the magic bullet.

The biofilm phenotype has been recognized only relatively recently in medical history but it has rapidly become clear that the development of many, if not the majority of bacterial infections depends upon the formation of a biofilm. Medical device-related infections are one of the clearest examples of biofilm-dependent infections. Bacteria proficiently adhere to and establish biofilms on synthetic surfaces, and to date, no material has proven to completely preclude bacterial adherence. Any inserted device can be colonized but intravenous catheters, due to their widespread use, are the most commonly colonized devices. As many as half a million catheter-related infections occur each year in the United States and the staphylococci, in particular, Staphylococcus aureus and Staphylococcus epidermidis, are the leading cause. Biofilms exhibit tolerance to biocides, chemotherapeutic agents, and host-immune defenses and subsequently, biofilm-associated infections are extremely difficult to treat, frequently chronic, and often recurrent, making them a confounding clinical problem. Development of an effective strategy for preventing and/or treating these infections is of paramount importance and consequently, the search for novel approaches to target the biofilm phenotype has exploded in recent years. Because the biofilm phenotype is complex, targets for antibiofilm approaches are numerous and this line of research is significantly expanding our knowledge about the biofilm mode of growth and its role in disease. This review highlights a number of antibiofilm approaches that are currently under investigation as novel interventions for staphylococcal infections.